Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

$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 75 MCG TABLET

Facility

$2.63

Service Code	NDC 51079-441-01
Hospital Charge Code	4422
Hospital Revenue Code	637
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$2.37
Rate for Payer: Aetna Commercial	$2.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.71
Rate for Payer: Cash Price	$2.10
Rate for Payer: Cofinity Commercial	$2.26
Rate for Payer: Cofinity Commercial	$1.84
Rate for Payer: Healthscope Commercial	$2.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.24
Rate for Payer: PHP Commercial	$2.24
Rate for Payer: Priority Health Cigna Priority Health	$1.84
Rate for Payer: Priority Health SBD	$1.66

LEVOTHYROXINE 75 MCG TABLET

Facility

$633.75

Service Code	NDC 0074-5182-90
Hospital Charge Code	4422
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 75 MCG TABLET

Facility

$363.38

Service Code	NDC 0378-1805-77
Hospital Charge Code	4422
Hospital Revenue Code	637
Min. Negotiated Rate	$228.93
Max. Negotiated Rate	$327.04
Rate for Payer: Aetna Commercial	$308.87
Rate for Payer: Aetna New Business (MI Preferred)	$236.20
Rate for Payer: Cash Price	$290.70
Rate for Payer: Cofinity Commercial	$254.37
Rate for Payer: Cofinity Commercial	$312.51
Rate for Payer: Healthscope Commercial	$327.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$308.87
Rate for Payer: PHP Commercial	$308.87
Rate for Payer: Priority Health Cigna Priority Health	$254.37
Rate for Payer: Priority Health SBD	$228.93

LEVOTHYROXINE 75 MCG TABLET

Facility

$262.56

Service Code	NDC 51079-441-20
Hospital Charge Code	4422
Hospital Revenue Code	637
Min. Negotiated Rate	$165.41
Max. Negotiated Rate	$236.30
Rate for Payer: Aetna Commercial	$223.18
Rate for Payer: Aetna New Business (MI Preferred)	$170.66
Rate for Payer: Cash Price	$210.05
Rate for Payer: Cofinity Commercial	$183.79
Rate for Payer: Cofinity Commercial	$225.80
Rate for Payer: Healthscope Commercial	$236.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$223.18
Rate for Payer: PHP Commercial	$223.18
Rate for Payer: Priority Health Cigna Priority Health	$183.79
Rate for Payer: Priority Health SBD	$165.41

LEVOTHYROXINE 88 MCG TABLET

Facility

$633.75

Service Code	NDC 0074-6594-90
Hospital Charge Code	10403
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 88 MCG TABLET

Facility

$412.30

Service Code	NDC 0527-1344-01
Hospital Charge Code	10403
Hospital Revenue Code	637
Min. Negotiated Rate	$259.75
Max. Negotiated Rate	$371.07
Rate for Payer: Aetna Commercial	$350.46
Rate for Payer: Aetna New Business (MI Preferred)	$268.00
Rate for Payer: Cash Price	$329.84
Rate for Payer: Cofinity Commercial	$288.61
Rate for Payer: Cofinity Commercial	$354.58
Rate for Payer: Healthscope Commercial	$371.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.46
Rate for Payer: PHP Commercial	$350.46
Rate for Payer: Priority Health Cigna Priority Health	$288.61
Rate for Payer: Priority Health SBD	$259.75

LEVOTHYROXINE 88 MCG TABLET

Facility

$241.44

Service Code	NDC 42292-038-20
Hospital Charge Code	10403
Hospital Revenue Code	637
Min. Negotiated Rate	$152.11
Max. Negotiated Rate	$217.30
Rate for Payer: Aetna Commercial	$205.22
Rate for Payer: Aetna New Business (MI Preferred)	$156.94
Rate for Payer: Cash Price	$193.15
Rate for Payer: Cofinity Commercial	$169.01
Rate for Payer: Cofinity Commercial	$207.64
Rate for Payer: Healthscope Commercial	$217.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$205.22
Rate for Payer: PHP Commercial	$205.22
Rate for Payer: Priority Health Cigna Priority Health	$169.01
Rate for Payer: Priority Health SBD	$152.11

LEVOTHYROXINE 88 MCG TABLET

Facility

$2.42

Service Code	NDC 42292-038-01
Hospital Charge Code	10403
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.69
Rate for Payer: Priority Health SBD	$1.52

LEVOTHYROXINE 88 MCG TABLET

Facility

$369.36

Service Code	NDC 0378-1807-77
Hospital Charge Code	10403
Hospital Revenue Code	637
Min. Negotiated Rate	$232.70
Max. Negotiated Rate	$332.42
Rate for Payer: Aetna Commercial	$313.96
Rate for Payer: Aetna New Business (MI Preferred)	$240.08
Rate for Payer: Cash Price	$295.49
Rate for Payer: Cofinity Commercial	$258.55
Rate for Payer: Cofinity Commercial	$317.65
Rate for Payer: Healthscope Commercial	$332.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$313.96
Rate for Payer: PHP Commercial	$313.96
Rate for Payer: Priority Health Cigna Priority Health	$258.55
Rate for Payer: Priority Health SBD	$232.70

LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$17.40

Service Code	NDC 0409-3178-01
Hospital Charge Code	10427
Hospital Revenue Code	250
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$15.66
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: Aetna New Business (MI Preferred)	$11.31
Rate for Payer: Cash Price	$13.92
Rate for Payer: Cofinity Commercial	$12.18
Rate for Payer: Cofinity Commercial	$14.96
Rate for Payer: Healthscope Commercial	$15.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.79
Rate for Payer: PHP Commercial	$14.79
Rate for Payer: Priority Health Cigna Priority Health	$12.18
Rate for Payer: Priority Health SBD	$10.96

LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$29.46

Service Code	NDC 63323-482-27
Hospital Charge Code	10427
Hospital Revenue Code	250
Min. Negotiated Rate	$18.56
Max. Negotiated Rate	$26.51
Rate for Payer: Aetna Commercial	$25.04
Rate for Payer: Aetna New Business (MI Preferred)	$19.15
Rate for Payer: Cash Price	$23.57
Rate for Payer: Cofinity Commercial	$20.62
Rate for Payer: Cofinity Commercial	$25.34
Rate for Payer: Healthscope Commercial	$26.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.04
Rate for Payer: PHP Commercial	$25.04
Rate for Payer: Priority Health Cigna Priority Health	$20.62
Rate for Payer: Priority Health SBD	$18.56

LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$15.54

Service Code	NDC 0409-3178-03
Hospital Charge Code	10427
Hospital Revenue Code	250
Min. Negotiated Rate	$9.79
Max. Negotiated Rate	$13.99
Rate for Payer: Aetna Commercial	$13.21
Rate for Payer: Aetna New Business (MI Preferred)	$10.10
Rate for Payer: Cash Price	$12.43
Rate for Payer: Cofinity Commercial	$10.88
Rate for Payer: Cofinity Commercial	$13.36
Rate for Payer: Healthscope Commercial	$13.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.21
Rate for Payer: PHP Commercial	$13.21
Rate for Payer: Priority Health Cigna Priority Health	$10.88
Rate for Payer: Priority Health SBD	$9.79

LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$22.62

Service Code	NDC 0409-3182-01
Hospital Charge Code	10430
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$20.36
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.70
Rate for Payer: Cash Price	$18.10
Rate for Payer: Cofinity Commercial	$15.83
Rate for Payer: Cofinity Commercial	$19.45
Rate for Payer: Healthscope Commercial	$20.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.23
Rate for Payer: PHP Commercial	$19.23
Rate for Payer: Priority Health Cigna Priority Health	$15.83
Rate for Payer: Priority Health SBD	$14.25

LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$21.83

Service Code	NDC 0409-3182-31
Hospital Charge Code	10430
Hospital Revenue Code	250
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$19.65
Rate for Payer: Aetna Commercial	$18.56
Rate for Payer: Aetna New Business (MI Preferred)	$14.19
Rate for Payer: Cash Price	$17.46
Rate for Payer: Cofinity Commercial	$15.28
Rate for Payer: Cofinity Commercial	$18.77
Rate for Payer: Healthscope Commercial	$19.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.56
Rate for Payer: PHP Commercial	$18.56
Rate for Payer: Priority Health Cigna Priority Health	$15.28
Rate for Payer: Priority Health SBD	$13.75

LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$17.98

Service Code	NDC 63323-483-03
Hospital Charge Code	10430
Hospital Revenue Code	250
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$11.69
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cofinity Commercial	$12.59
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Healthscope Commercial	$16.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.28
Rate for Payer: PHP Commercial	$15.28
Rate for Payer: Priority Health Cigna Priority Health	$12.59
Rate for Payer: Priority Health SBD	$11.33

LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$21.83

Service Code	NDC 0409-3182-03
Hospital Charge Code	10430
Hospital Revenue Code	250
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$19.65
Rate for Payer: Aetna Commercial	$18.56
Rate for Payer: Aetna New Business (MI Preferred)	$14.19
Rate for Payer: Cash Price	$17.46
Rate for Payer: Cofinity Commercial	$15.28
Rate for Payer: Cofinity Commercial	$18.77
Rate for Payer: Healthscope Commercial	$19.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.56
Rate for Payer: PHP Commercial	$18.56
Rate for Payer: Priority Health Cigna Priority Health	$15.28
Rate for Payer: Priority Health SBD	$13.75

LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION

Facility

$17.98

Service Code	NDC 63323-483-27
Hospital Charge Code	10430
Hospital Revenue Code	250
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$16.18
Rate for Payer: Aetna Commercial	$15.28
Rate for Payer: Aetna New Business (MI Preferred)	$11.69
Rate for Payer: Cash Price	$14.38
Rate for Payer: Cofinity Commercial	$12.59
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Healthscope Commercial	$16.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.28
Rate for Payer: PHP Commercial	$15.28
Rate for Payer: Priority Health Cigna Priority Health	$12.59
Rate for Payer: Priority Health SBD	$11.33

LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR

Facility

$15.21

Service Code	NDC 25021-673-76
Hospital Charge Code	118460
Hospital Revenue Code	637
Min. Negotiated Rate	$6.08
Max. Negotiated Rate	$13.69
Rate for Payer: Aetna Commercial	$12.93
Rate for Payer: Aetna New Business (MI Preferred)	$9.89
Rate for Payer: BCBS Complete	$6.08
Rate for Payer: Cash Price	$12.17
Rate for Payer: Cofinity Commercial	$10.65
Rate for Payer: Cofinity Commercial	$13.08
Rate for Payer: Healthscope Commercial	$13.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.93
Rate for Payer: PHP Commercial	$12.93
Rate for Payer: Priority Health Cigna Priority Health	$10.65
Rate for Payer: Priority Health SBD	$9.58

LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR

Facility

$15.21

Service Code	NDC 25021-673-76
Hospital Charge Code	118460
Hospital Revenue Code	637
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$13.69
Rate for Payer: Aetna Commercial	$12.93
Rate for Payer: Aetna New Business (MI Preferred)	$9.89
Rate for Payer: Cash Price	$12.17
Rate for Payer: Cofinity Commercial	$10.65
Rate for Payer: Cofinity Commercial	$13.08
Rate for Payer: Healthscope Commercial	$13.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.93
Rate for Payer: PHP Commercial	$12.93
Rate for Payer: Priority Health Cigna Priority Health	$10.65
Rate for Payer: Priority Health SBD	$9.58

LIDOCAINE 2 %-VITAMIN E-ALOE VERA-COLLAGEN TOPICAL GEL

Facility

$16.95

Service Code	NDC 6697710005
Hospital Charge Code	77011
Hospital Revenue Code	637
Min. Negotiated Rate	$10.68
Max. Negotiated Rate	$15.26
Rate for Payer: Aetna Commercial	$14.41
Rate for Payer: Aetna New Business (MI Preferred)	$11.02
Rate for Payer: Cash Price	$13.56
Rate for Payer: Cofinity Commercial	$11.86
Rate for Payer: Cofinity Commercial	$14.58
Rate for Payer: Healthscope Commercial	$15.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.41
Rate for Payer: PHP Commercial	$14.41
Rate for Payer: Priority Health Cigna Priority Health	$11.86
Rate for Payer: Priority Health SBD	$10.68

LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL

Facility

$29.93

Service Code	NDC 71266-6290-1
Hospital Charge Code	196007
Hospital Revenue Code	637
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$26.94
Rate for Payer: Aetna Commercial	$25.44
Rate for Payer: Aetna New Business (MI Preferred)	$19.45
Rate for Payer: Cash Price	$23.94
Rate for Payer: Cofinity Commercial	$20.95
Rate for Payer: Cofinity Commercial	$25.74
Rate for Payer: Healthscope Commercial	$26.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.44
Rate for Payer: PHP Commercial	$25.44
Rate for Payer: Priority Health Cigna Priority Health	$20.95
Rate for Payer: Priority Health SBD	$18.86

LIDOCAINE 4 % TOPICAL PATCH

Facility

$18.72

Service Code	NDC 70000-0366-1
Hospital Charge Code	108212
Hospital Revenue Code	637
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$13.10
Rate for Payer: Priority Health SBD	$11.79

LIDOCAINE 4 % TOPICAL PATCH

Facility

$48.73

Service Code	NDC 4561100938
Hospital Charge Code	108212
Hospital Revenue Code	637
Min. Negotiated Rate	$30.70
Max. Negotiated Rate	$43.86
Rate for Payer: Aetna Commercial	$41.42
Rate for Payer: Aetna New Business (MI Preferred)	$31.67
Rate for Payer: Cash Price	$38.98
Rate for Payer: Cofinity Commercial	$34.11
Rate for Payer: Cofinity Commercial	$41.91
Rate for Payer: Healthscope Commercial	$43.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.42
Rate for Payer: PHP Commercial	$41.42
Rate for Payer: Priority Health Cigna Priority Health	$34.11
Rate for Payer: Priority Health SBD	$30.70

Know your out-of-pocket cost for care.

All Charges