Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NICOTINE 7 MG/24 HR DAILY TRANSDERMAL PATCH

Facility

$62.30

Service Code	NDC 43598-446-70
Hospital Charge Code	27860
Hospital Revenue Code	637
Min. Negotiated Rate	$39.25
Max. Negotiated Rate	$56.07
Rate for Payer: Aetna Commercial	$52.96
Rate for Payer: Aetna New Business (MI Preferred)	$40.50
Rate for Payer: Cash Price	$49.84
Rate for Payer: Cofinity Commercial	$43.61
Rate for Payer: Cofinity Commercial	$53.58
Rate for Payer: Healthscope Commercial	$56.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.96
Rate for Payer: PHP Commercial	$52.96
Rate for Payer: Priority Health Cigna Priority Health	$43.61
Rate for Payer: Priority Health SBD	$39.25

NICOTINE (POLACRILEX) 2 MG BUCCAL LOZENGE

Facility

$250.35

Service Code	NDC 45802-344-05
Hospital Charge Code	34769
Hospital Revenue Code	637
Min. Negotiated Rate	$157.72
Max. Negotiated Rate	$225.32
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna New Business (MI Preferred)	$162.73
Rate for Payer: Cash Price	$200.28
Rate for Payer: Cofinity Commercial	$175.24
Rate for Payer: Cofinity Commercial	$215.30
Rate for Payer: Healthscope Commercial	$225.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.80
Rate for Payer: PHP Commercial	$212.80
Rate for Payer: Priority Health Cigna Priority Health	$175.24
Rate for Payer: Priority Health SBD	$157.72

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$89.01

Service Code	NDC 45802-089-01
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$56.08
Max. Negotiated Rate	$80.11
Rate for Payer: Aetna Commercial	$75.66
Rate for Payer: Aetna New Business (MI Preferred)	$57.86
Rate for Payer: Cash Price	$71.21
Rate for Payer: Cofinity Commercial	$62.31
Rate for Payer: Cofinity Commercial	$76.55
Rate for Payer: Healthscope Commercial	$80.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$75.66
Rate for Payer: PHP Commercial	$75.66
Rate for Payer: Priority Health Cigna Priority Health	$62.31
Rate for Payer: Priority Health SBD	$56.08

NICOTINE (POLACRILEX) 2 MG BUCCAL MINI LOZENGE

Facility

$267.02

Service Code	NDC 45802-089-02
Hospital Charge Code	182298
Hospital Revenue Code	637
Min. Negotiated Rate	$168.22
Max. Negotiated Rate	$240.32
Rate for Payer: Aetna Commercial	$226.97
Rate for Payer: Aetna New Business (MI Preferred)	$173.56
Rate for Payer: Cash Price	$213.62
Rate for Payer: Cofinity Commercial	$186.91
Rate for Payer: Cofinity Commercial	$229.64
Rate for Payer: Healthscope Commercial	$240.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$226.97
Rate for Payer: PHP Commercial	$226.97
Rate for Payer: Priority Health Cigna Priority Health	$186.91
Rate for Payer: Priority Health SBD	$168.22

NIFEDIPINE 10 MG CAPSULE

Facility

$321.60

Service Code	NDC 43386-440-24
Hospital Charge Code	5558
Hospital Revenue Code	637
Min. Negotiated Rate	$202.61
Max. Negotiated Rate	$289.44
Rate for Payer: Aetna Commercial	$273.36
Rate for Payer: Aetna New Business (MI Preferred)	$209.04
Rate for Payer: Cash Price	$257.28
Rate for Payer: Cofinity Commercial	$225.12
Rate for Payer: Cofinity Commercial	$276.58
Rate for Payer: Healthscope Commercial	$289.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.36
Rate for Payer: PHP Commercial	$273.36
Rate for Payer: Priority Health Cigna Priority Health	$225.12
Rate for Payer: Priority Health SBD	$202.61

NIFEDIPINE 10 MG CAPSULE

Facility

$272.65

Service Code	NDC 23155-194-01
Hospital Charge Code	5558
Hospital Revenue Code	637
Min. Negotiated Rate	$171.77
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.75
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: Cash Price	$218.12
Rate for Payer: Cofinity Commercial	$190.86
Rate for Payer: Cofinity Commercial	$234.48
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$231.75
Rate for Payer: PHP Commercial	$231.75
Rate for Payer: Priority Health Cigna Priority Health	$190.86
Rate for Payer: Priority Health SBD	$171.77

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$377.28

Service Code	NDC 68084-597-01
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$237.69
Max. Negotiated Rate	$339.55
Rate for Payer: Aetna Commercial	$320.69
Rate for Payer: Aetna New Business (MI Preferred)	$245.23
Rate for Payer: Cash Price	$301.82
Rate for Payer: Cofinity Commercial	$264.10
Rate for Payer: Cofinity Commercial	$324.46
Rate for Payer: Healthscope Commercial	$339.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$320.69
Rate for Payer: PHP Commercial	$320.69
Rate for Payer: Priority Health Cigna Priority Health	$264.10
Rate for Payer: Priority Health SBD	$237.69

NIFEDIPINE ER 30 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3.78

Service Code	NDC 68084-597-11
Hospital Charge Code	27333
Hospital Revenue Code	637
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$3.40
Rate for Payer: Aetna Commercial	$3.21
Rate for Payer: Aetna New Business (MI Preferred)	$2.46
Rate for Payer: Cash Price	$3.02
Rate for Payer: Cofinity Commercial	$2.65
Rate for Payer: Cofinity Commercial	$3.25
Rate for Payer: Healthscope Commercial	$3.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.21
Rate for Payer: PHP Commercial	$3.21
Rate for Payer: Priority Health Cigna Priority Health	$2.65
Rate for Payer: Priority Health SBD	$2.38

NIMODIPINE 30 MG CAPSULE

Facility

$9.29

Service Code	NDC 68084-912-33
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$8.36
Rate for Payer: Aetna Commercial	$7.90
Rate for Payer: Aetna New Business (MI Preferred)	$6.04
Rate for Payer: Cash Price	$7.43
Rate for Payer: Cofinity Commercial	$6.50
Rate for Payer: Cofinity Commercial	$7.99
Rate for Payer: Healthscope Commercial	$8.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.90
Rate for Payer: PHP Commercial	$7.90
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: Priority Health SBD	$5.85

NIMODIPINE 30 MG CAPSULE

Facility

$185.67

Service Code	NDC 68084-912-32
Hospital Charge Code	10722
Hospital Revenue Code	637
Min. Negotiated Rate	$116.97
Max. Negotiated Rate	$167.10
Rate for Payer: Aetna Commercial	$157.82
Rate for Payer: Aetna New Business (MI Preferred)	$120.69
Rate for Payer: Cash Price	$148.54
Rate for Payer: Cofinity Commercial	$129.97
Rate for Payer: Cofinity Commercial	$159.68
Rate for Payer: Healthscope Commercial	$167.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$157.82
Rate for Payer: PHP Commercial	$157.82
Rate for Payer: Priority Health Cigna Priority Health	$129.97
Rate for Payer: Priority Health SBD	$116.97

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084-446-01
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$555.24
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$749.14
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$616.94
Rate for Payer: Priority Health SBD	$555.24

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$698.40

Service Code	NDC 47781-303-01
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$439.99
Max. Negotiated Rate	$628.56
Rate for Payer: Aetna Commercial	$593.64
Rate for Payer: Aetna New Business (MI Preferred)	$453.96
Rate for Payer: Cash Price	$558.72
Rate for Payer: Cofinity Commercial	$488.88
Rate for Payer: Cofinity Commercial	$600.62
Rate for Payer: Healthscope Commercial	$628.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$593.64
Rate for Payer: PHP Commercial	$593.64
Rate for Payer: Priority Health Cigna Priority Health	$488.88
Rate for Payer: Priority Health SBD	$439.99

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$881.34

Service Code	NDC 68084-446-11
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$555.24
Max. Negotiated Rate	$793.21
Rate for Payer: Aetna Commercial	$749.14
Rate for Payer: Aetna New Business (MI Preferred)	$572.87
Rate for Payer: Cash Price	$705.07
Rate for Payer: Cofinity Commercial	$616.94
Rate for Payer: Cofinity Commercial	$757.95
Rate for Payer: Healthscope Commercial	$793.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$749.14
Rate for Payer: PHP Commercial	$749.14
Rate for Payer: Priority Health Cigna Priority Health	$616.94
Rate for Payer: Priority Health SBD	$555.24

NITROFURANTOIN MONOHYDRATE/MACROCRYSTALS 100 MG CAPSULE

Facility

$879.12

Service Code	NDC 0378-3422-01
Hospital Charge Code	10724
Hospital Revenue Code	637
Min. Negotiated Rate	$553.85
Max. Negotiated Rate	$791.21
Rate for Payer: Aetna Commercial	$747.25
Rate for Payer: Aetna New Business (MI Preferred)	$571.43
Rate for Payer: Cash Price	$703.30
Rate for Payer: Cofinity Commercial	$615.38
Rate for Payer: Cofinity Commercial	$756.04
Rate for Payer: Healthscope Commercial	$791.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$747.25
Rate for Payer: PHP Commercial	$747.25
Rate for Payer: Priority Health Cigna Priority Health	$615.38
Rate for Payer: Priority Health SBD	$553.85

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$4.67

Service Code	NDC 0378-9102-16
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.20
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Healthscope Commercial	$4.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.97
Rate for Payer: PHP Commercial	$3.97
Rate for Payer: Priority Health Cigna Priority Health	$3.27
Rate for Payer: Priority Health SBD	$2.94

NITROGLYCERIN 0.1 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$139.94

Service Code	NDC 0378-9102-93
Hospital Charge Code	27471
Hospital Revenue Code	637
Min. Negotiated Rate	$88.16
Max. Negotiated Rate	$125.95
Rate for Payer: Aetna Commercial	$118.95
Rate for Payer: Aetna New Business (MI Preferred)	$90.96
Rate for Payer: Cash Price	$111.95
Rate for Payer: Cofinity Commercial	$120.35
Rate for Payer: Cofinity Commercial	$97.96
Rate for Payer: Healthscope Commercial	$125.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$118.95
Rate for Payer: PHP Commercial	$118.95
Rate for Payer: Priority Health Cigna Priority Health	$97.96
Rate for Payer: Priority Health SBD	$88.16

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$94.61

Service Code	NDC 68382-309-30
Hospital Charge Code	27472
Hospital Revenue Code	637
Min. Negotiated Rate	$59.60
Max. Negotiated Rate	$85.15
Rate for Payer: Aetna Commercial	$80.42
Rate for Payer: Aetna New Business (MI Preferred)	$61.50
Rate for Payer: Cash Price	$75.69
Rate for Payer: Cofinity Commercial	$66.23
Rate for Payer: Cofinity Commercial	$81.36
Rate for Payer: Healthscope Commercial	$85.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.42
Rate for Payer: PHP Commercial	$80.42
Rate for Payer: Priority Health Cigna Priority Health	$66.23
Rate for Payer: Priority Health SBD	$59.60

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.16

Service Code	NDC 68382-309-01
Hospital Charge Code	27472
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

NITROGLYCERIN 0.2 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$107.45

Service Code	NDC 49730-111-30
Hospital Charge Code	27472
Hospital Revenue Code	637
Min. Negotiated Rate	$67.69
Max. Negotiated Rate	$96.70
Rate for Payer: Aetna Commercial	$91.33
Rate for Payer: Aetna New Business (MI Preferred)	$69.84
Rate for Payer: Cash Price	$85.96
Rate for Payer: Cofinity Commercial	$75.22
Rate for Payer: Cofinity Commercial	$92.41
Rate for Payer: Healthscope Commercial	$96.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.33
Rate for Payer: PHP Commercial	$91.33
Rate for Payer: Priority Health Cigna Priority Health	$75.22
Rate for Payer: Priority Health SBD	$67.69

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$110.02

Service Code	NDC 68382-310-30
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$69.31
Max. Negotiated Rate	$99.02
Rate for Payer: Aetna Commercial	$93.52
Rate for Payer: Aetna New Business (MI Preferred)	$71.51
Rate for Payer: Cash Price	$88.02
Rate for Payer: Cofinity Commercial	$77.01
Rate for Payer: Cofinity Commercial	$94.62
Rate for Payer: Healthscope Commercial	$99.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.52
Rate for Payer: PHP Commercial	$93.52
Rate for Payer: Priority Health Cigna Priority Health	$77.01
Rate for Payer: Priority Health SBD	$69.31

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$108.59

Service Code	NDC 49730-112-30
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$68.41
Max. Negotiated Rate	$97.73
Rate for Payer: Aetna Commercial	$92.30
Rate for Payer: Aetna New Business (MI Preferred)	$70.58
Rate for Payer: Cash Price	$86.87
Rate for Payer: Cofinity Commercial	$76.01
Rate for Payer: Cofinity Commercial	$93.39
Rate for Payer: Healthscope Commercial	$97.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$92.30
Rate for Payer: PHP Commercial	$92.30
Rate for Payer: Priority Health Cigna Priority Health	$76.01
Rate for Payer: Priority Health SBD	$68.41

NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.67

Service Code	NDC 68382-310-01
Hospital Charge Code	27474
Hospital Revenue Code	637
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.30
Rate for Payer: Aetna Commercial	$3.12
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Healthscope Commercial	$3.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.12
Rate for Payer: PHP Commercial	$3.12
Rate for Payer: Priority Health Cigna Priority Health	$2.57
Rate for Payer: Priority Health SBD	$2.31

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$132.46

Service Code	NDC 0071-0418-13
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$52.98
Max. Negotiated Rate	$119.21
Rate for Payer: Aetna Commercial	$112.59
Rate for Payer: Aetna New Business (MI Preferred)	$86.10
Rate for Payer: BCBS Complete	$52.98
Rate for Payer: Cash Price	$105.97
Rate for Payer: Cofinity Commercial	$113.92
Rate for Payer: Cofinity Commercial	$92.72
Rate for Payer: Healthscope Commercial	$119.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.59
Rate for Payer: PHP Commercial	$112.59
Rate for Payer: Priority Health Cigna Priority Health	$92.72
Rate for Payer: Priority Health SBD	$83.45

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$132.46

Service Code	NDC 0071-0418-13
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$83.45
Max. Negotiated Rate	$119.21
Rate for Payer: Aetna Commercial	$112.59
Rate for Payer: Aetna New Business (MI Preferred)	$86.10
Rate for Payer: Cash Price	$105.97
Rate for Payer: Cofinity Commercial	$113.92
Rate for Payer: Cofinity Commercial	$92.72
Rate for Payer: Healthscope Commercial	$119.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.59
Rate for Payer: PHP Commercial	$112.59
Rate for Payer: Priority Health Cigna Priority Health	$92.72
Rate for Payer: Priority Health SBD	$83.45

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$74.37

Service Code	NDC 43598-436-11
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$66.93
Rate for Payer: Aetna Commercial	$63.21
Rate for Payer: Aetna New Business (MI Preferred)	$48.34
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: Cash Price	$59.50
Rate for Payer: Cofinity Commercial	$52.06
Rate for Payer: Cofinity Commercial	$63.96
Rate for Payer: Healthscope Commercial	$66.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.21
Rate for Payer: PHP Commercial	$63.21
Rate for Payer: Priority Health Cigna Priority Health	$52.06
Rate for Payer: Priority Health SBD	$46.85

Know your out-of-pocket cost for care.

All Charges