Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MODAFINIL 200 MG TABLET

Facility

$272.60

Service Code	NDC 62332-386-90
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$171.74
Max. Negotiated Rate	$245.34
Rate for Payer: Aetna Commercial	$231.71
Rate for Payer: Aetna New Business (MI Preferred)	$177.19
Rate for Payer: Cash Price	$218.08
Rate for Payer: Cofinity Commercial	$190.82
Rate for Payer: Cofinity Commercial	$234.44
Rate for Payer: Healthscope Commercial	$245.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.71
Rate for Payer: PHP Commercial	$231.71
Rate for Payer: Priority Health Cigna Priority Health	$190.82
Rate for Payer: Priority Health SBD	$171.74

MOMETASONE 0.1 % TOPICAL OINTMENT

Facility

$18.16

Service Code	NDC 68462-225-17
Hospital Charge Code	10648
Hospital Revenue Code	637
Min. Negotiated Rate	$11.44
Max. Negotiated Rate	$16.34
Rate for Payer: Aetna Commercial	$15.44
Rate for Payer: Aetna New Business (MI Preferred)	$11.80
Rate for Payer: Cash Price	$14.53
Rate for Payer: Cofinity Commercial	$12.71
Rate for Payer: Cofinity Commercial	$15.62
Rate for Payer: Healthscope Commercial	$16.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.44
Rate for Payer: PHP Commercial	$15.44
Rate for Payer: Priority Health Cigna Priority Health	$12.71
Rate for Payer: Priority Health SBD	$11.44

MOMETASONE 0.1 % TOPICAL OINTMENT

Facility

$21.20

Service Code	NDC 45802-119-37
Hospital Charge Code	10648
Hospital Revenue Code	637
Min. Negotiated Rate	$13.36
Max. Negotiated Rate	$19.08
Rate for Payer: Aetna Commercial	$18.02
Rate for Payer: Aetna New Business (MI Preferred)	$13.78
Rate for Payer: Cash Price	$16.96
Rate for Payer: Cofinity Commercial	$14.84
Rate for Payer: Cofinity Commercial	$18.23
Rate for Payer: Healthscope Commercial	$19.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.02
Rate for Payer: PHP Commercial	$18.02
Rate for Payer: Priority Health Cigna Priority Health	$14.84
Rate for Payer: Priority Health SBD	$13.36

MONALISA TOUCH, SERIES, UP TO 3 VISITS

Professional

Both

$1,800.00

Service Code	HCPCS 00561
Hospital Revenue Code	990
Min. Negotiated Rate	$720.00
Max. Negotiated Rate	$1,260.00
Rate for Payer: BCBS Complete	$720.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Priority Health Cigna Priority Health	$1,260.00

MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES

Professional

Both

$600.00

Service Code	HCPCS 00562
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

MONTELUKAST 10 MG TABLET

Facility

$3.68

Service Code	NDC 50268-575-11
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Healthscope Commercial	$3.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.13
Rate for Payer: PHP Commercial	$3.13
Rate for Payer: Priority Health Cigna Priority Health	$2.58
Rate for Payer: Priority Health SBD	$2.32

MONTELUKAST 10 MG TABLET

Facility

$236.55

Service Code	NDC 0904-6808-61
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$149.03
Max. Negotiated Rate	$212.90
Rate for Payer: Aetna Commercial	$201.07
Rate for Payer: Aetna New Business (MI Preferred)	$153.76
Rate for Payer: Cash Price	$189.24
Rate for Payer: Cofinity Commercial	$165.58
Rate for Payer: Cofinity Commercial	$203.43
Rate for Payer: Healthscope Commercial	$212.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$201.07
Rate for Payer: PHP Commercial	$201.07
Rate for Payer: Priority Health Cigna Priority Health	$165.58
Rate for Payer: Priority Health SBD	$149.03

MONTELUKAST 10 MG TABLET

Facility

$183.83

Service Code	NDC 50268-575-15
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$115.81
Max. Negotiated Rate	$165.45
Rate for Payer: Aetna Commercial	$156.26
Rate for Payer: Aetna New Business (MI Preferred)	$119.49
Rate for Payer: Cash Price	$147.06
Rate for Payer: Cofinity Commercial	$128.68
Rate for Payer: Cofinity Commercial	$158.09
Rate for Payer: Healthscope Commercial	$165.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$156.26
Rate for Payer: PHP Commercial	$156.26
Rate for Payer: Priority Health Cigna Priority Health	$128.68
Rate for Payer: Priority Health SBD	$115.81

MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION

Facility

$0.59

Service Code	NDC 9900-0007-20
Hospital Charge Code	165001
Hospital Revenue Code	637
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: Aetna New Business (MI Preferred)	$0.38
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cofinity Commercial	$0.41
Rate for Payer: Cofinity Commercial	$0.51
Rate for Payer: Healthscope Commercial	$0.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.50
Rate for Payer: PHP Commercial	$0.50
Rate for Payer: Priority Health Cigna Priority Health	$0.41
Rate for Payer: Priority Health SBD	$0.37

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	190319
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$159.24
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION (BBC)

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	301224
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$159.24
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	150918
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$159.24
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 10 MG/ML INJECTION SOLUTION

Facility

$33.73

Service Code	HCPCS J2272
Hospital Charge Code	5168
Hospital Revenue Code	636
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$30.36
Rate for Payer: Aetna Commercial	$28.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.92
Rate for Payer: Cash Price	$26.98
Rate for Payer: Cofinity Commercial	$23.61
Rate for Payer: Cofinity Commercial	$29.01
Rate for Payer: Healthscope Commercial	$30.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.67
Rate for Payer: PHP Commercial	$28.67
Rate for Payer: Priority Health Cigna Priority Health	$23.61
Rate for Payer: Priority Health SBD	$21.25

MORPHINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.19

Service Code	HCPCS J2270
Hospital Charge Code	27390
Hospital Revenue Code	636
Min. Negotiated Rate	$10.83
Max. Negotiated Rate	$15.47
Rate for Payer: Aetna Commercial	$14.61
Rate for Payer: Aetna New Business (MI Preferred)	$11.17
Rate for Payer: Cash Price	$13.75
Rate for Payer: Cofinity Commercial	$12.03
Rate for Payer: Cofinity Commercial	$14.78
Rate for Payer: Healthscope Commercial	$15.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.61
Rate for Payer: PHP Commercial	$14.61
Rate for Payer: Priority Health Cigna Priority Health	$12.03
Rate for Payer: Priority Health SBD	$10.83

MORPHINE 10 MG/ML INTRAVENOUS SYRINGE

Facility

$26.50

Service Code	HCPCS J2270
Hospital Charge Code	172788
Hospital Revenue Code	636
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$23.85
Rate for Payer: Aetna Commercial	$22.52
Rate for Payer: Aetna New Business (MI Preferred)	$17.22
Rate for Payer: Cash Price	$21.20
Rate for Payer: Cofinity Commercial	$18.55
Rate for Payer: Cofinity Commercial	$22.79
Rate for Payer: Healthscope Commercial	$23.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.52
Rate for Payer: PHP Commercial	$22.52
Rate for Payer: Priority Health Cigna Priority Health	$18.55
Rate for Payer: Priority Health SBD	$16.70

MORPHINE 15 MG IMMEDIATE RELEASE TABLET

Facility

$444.50

Service Code	NDC 0054-0235-25
Hospital Charge Code	5178
Hospital Revenue Code	637
Min. Negotiated Rate	$280.04
Max. Negotiated Rate	$400.05
Rate for Payer: Aetna Commercial	$377.82
Rate for Payer: Aetna New Business (MI Preferred)	$288.92
Rate for Payer: Cash Price	$355.60
Rate for Payer: Cofinity Commercial	$311.15
Rate for Payer: Cofinity Commercial	$382.27
Rate for Payer: Healthscope Commercial	$400.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$377.82
Rate for Payer: PHP Commercial	$377.82
Rate for Payer: Priority Health Cigna Priority Health	$311.15
Rate for Payer: Priority Health SBD	$280.04

MORPHINE 15 MG IMMEDIATE RELEASE TABLET

Facility

$123.38

Service Code	NDC 0054-0235-24
Hospital Charge Code	5178
Hospital Revenue Code	637
Min. Negotiated Rate	$77.73
Max. Negotiated Rate	$111.04
Rate for Payer: Aetna Commercial	$104.87
Rate for Payer: Aetna New Business (MI Preferred)	$80.20
Rate for Payer: Cash Price	$98.70
Rate for Payer: Cofinity Commercial	$106.11
Rate for Payer: Cofinity Commercial	$86.37
Rate for Payer: Healthscope Commercial	$111.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$104.87
Rate for Payer: PHP Commercial	$104.87
Rate for Payer: Priority Health Cigna Priority Health	$86.37
Rate for Payer: Priority Health SBD	$77.73

MORPHINE 15 MG IMMEDIATE RELEASE TABLET

Facility

$511.00

Service Code	NDC 60687-617-01
Hospital Charge Code	5178
Hospital Revenue Code	637
Min. Negotiated Rate	$321.93
Max. Negotiated Rate	$459.90
Rate for Payer: Aetna Commercial	$434.35
Rate for Payer: Aetna New Business (MI Preferred)	$332.15
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cofinity Commercial	$357.70
Rate for Payer: Cofinity Commercial	$439.46
Rate for Payer: Healthscope Commercial	$459.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$434.35
Rate for Payer: PHP Commercial	$434.35
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health SBD	$321.93

MORPHINE 15 MG IMMEDIATE RELEASE TABLET

Facility

$5.11

Service Code	NDC 60687-617-11
Hospital Charge Code	5178
Hospital Revenue Code	637
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$4.60
Rate for Payer: Aetna Commercial	$4.34
Rate for Payer: Aetna New Business (MI Preferred)	$3.32
Rate for Payer: Cash Price	$4.09
Rate for Payer: Cofinity Commercial	$3.58
Rate for Payer: Cofinity Commercial	$4.39
Rate for Payer: Healthscope Commercial	$4.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.34
Rate for Payer: PHP Commercial	$4.34
Rate for Payer: Priority Health Cigna Priority Health	$3.58
Rate for Payer: Priority Health SBD	$3.22

MORPHINE 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS

Facility

$227.49

Service Code	HCPCS J2270
Hospital Charge Code	30604
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$159.24
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 2 MG/ML INJECTION SYRINGE

Facility

$29.77

Service Code	HCPCS J2272
Hospital Charge Code	5170
Hospital Revenue Code	636
Min. Negotiated Rate	$18.76
Max. Negotiated Rate	$26.79
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna New Business (MI Preferred)	$19.35
Rate for Payer: Cash Price	$23.82
Rate for Payer: Cofinity Commercial	$20.84
Rate for Payer: Cofinity Commercial	$25.60
Rate for Payer: Healthscope Commercial	$26.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.30
Rate for Payer: PHP Commercial	$25.30
Rate for Payer: Priority Health Cigna Priority Health	$20.84
Rate for Payer: Priority Health SBD	$18.76

MORPHINE 2 MG/ML INJECTION SYRINGE

Facility

$17.06

Service Code	HCPCS J2270
Hospital Charge Code	5170
Hospital Revenue Code	636
Min. Negotiated Rate	$10.75
Max. Negotiated Rate	$15.35
Rate for Payer: Aetna Commercial	$14.50
Rate for Payer: Aetna Commercial	$21.06
Rate for Payer: Aetna New Business (MI Preferred)	$11.09
Rate for Payer: Aetna New Business (MI Preferred)	$16.11
Rate for Payer: Cash Price	$13.65
Rate for Payer: Cash Price	$19.82
Rate for Payer: Cofinity Commercial	$11.94
Rate for Payer: Cofinity Commercial	$14.67
Rate for Payer: Cofinity Commercial	$21.31
Rate for Payer: Cofinity Commercial	$17.35
Rate for Payer: Healthscope Commercial	$22.30
Rate for Payer: Healthscope Commercial	$15.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.06
Rate for Payer: PHP Commercial	$14.50
Rate for Payer: PHP Commercial	$21.06
Rate for Payer: Priority Health Cigna Priority Health	$17.35
Rate for Payer: Priority Health Cigna Priority Health	$11.94
Rate for Payer: Priority Health SBD	$10.75
Rate for Payer: Priority Health SBD	$15.61

MORPHINE 30 MG IMMEDIATE RELEASE TABLET

Facility

$540.75

Service Code	NDC 0054-0236-25
Hospital Charge Code	5179
Hospital Revenue Code	637
Min. Negotiated Rate	$340.67
Max. Negotiated Rate	$486.68
Rate for Payer: Aetna Commercial	$459.64
Rate for Payer: Aetna New Business (MI Preferred)	$351.49
Rate for Payer: Cash Price	$432.60
Rate for Payer: Cofinity Commercial	$378.52
Rate for Payer: Cofinity Commercial	$465.04
Rate for Payer: Healthscope Commercial	$486.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$459.64
Rate for Payer: PHP Commercial	$459.64
Rate for Payer: Priority Health Cigna Priority Health	$378.52
Rate for Payer: Priority Health SBD	$340.67

MORPHINE 30 MG IMMEDIATE RELEASE TABLET

Facility

$837.90

Service Code	NDC 0054-0236-24
Hospital Charge Code	5179
Hospital Revenue Code	637
Min. Negotiated Rate	$527.88
Max. Negotiated Rate	$754.11
Rate for Payer: Aetna Commercial	$712.22
Rate for Payer: Aetna New Business (MI Preferred)	$544.64
Rate for Payer: Cash Price	$670.32
Rate for Payer: Cofinity Commercial	$586.53
Rate for Payer: Cofinity Commercial	$720.59
Rate for Payer: Healthscope Commercial	$754.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$712.22
Rate for Payer: PHP Commercial	$712.22
Rate for Payer: Priority Health Cigna Priority Health	$586.53
Rate for Payer: Priority Health SBD	$527.88

MORPHINE 4 MG/ML INJECTION SOLUTION

Facility

$30.64

Service Code	HCPCS J2272
Hospital Charge Code	186563
Hospital Revenue Code	636
Min. Negotiated Rate	$19.30
Max. Negotiated Rate	$27.58
Rate for Payer: Aetna Commercial	$26.04
Rate for Payer: Aetna New Business (MI Preferred)	$19.92
Rate for Payer: Cash Price	$24.51
Rate for Payer: Cofinity Commercial	$21.45
Rate for Payer: Cofinity Commercial	$26.35
Rate for Payer: Healthscope Commercial	$27.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.04
Rate for Payer: PHP Commercial	$26.04
Rate for Payer: Priority Health Cigna Priority Health	$21.45
Rate for Payer: Priority Health SBD	$19.30

Know your out-of-pocket cost for care.

All Charges