Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NORTRIPTYLINE 10 MG CAPSULE

Facility

$227.95

Service Code	NDC 51672-4001-1
Hospital Charge Code	5674
Hospital Revenue Code	637
Min. Negotiated Rate	$143.61
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Commercial	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$193.76
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health Cigna Priority Health	$159.56
Rate for Payer: Priority Health SBD	$143.61

NORTRIPTYLINE 10 MG CAPSULE

Facility

$132.05

Service Code	NDC 50268-603-15
Hospital Charge Code	5674
Hospital Revenue Code	637
Min. Negotiated Rate	$83.19
Max. Negotiated Rate	$118.84
Rate for Payer: Aetna Commercial	$112.24
Rate for Payer: Aetna New Business (MI Preferred)	$85.83
Rate for Payer: Cash Price	$105.64
Rate for Payer: Cofinity Commercial	$113.56
Rate for Payer: Cofinity Commercial	$92.44
Rate for Payer: Healthscope Commercial	$118.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$112.24
Rate for Payer: PHP Commercial	$112.24
Rate for Payer: Priority Health Cigna Priority Health	$92.44
Rate for Payer: Priority Health SBD	$83.19

NORTRIPTYLINE 25 MG CAPSULE

Facility

$354.35

Service Code	NDC 60687-293-01
Hospital Charge Code	5675
Hospital Revenue Code	637
Min. Negotiated Rate	$223.24
Max. Negotiated Rate	$318.92
Rate for Payer: Aetna Commercial	$301.20
Rate for Payer: Aetna New Business (MI Preferred)	$230.33
Rate for Payer: Cash Price	$283.48
Rate for Payer: Cofinity Commercial	$248.04
Rate for Payer: Cofinity Commercial	$304.74
Rate for Payer: Healthscope Commercial	$318.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$301.20
Rate for Payer: PHP Commercial	$301.20
Rate for Payer: Priority Health Cigna Priority Health	$248.04
Rate for Payer: Priority Health SBD	$223.24

NORTRIPTYLINE 25 MG CAPSULE

Facility

$3.55

Service Code	NDC 60687-293-11
Hospital Charge Code	5675
Hospital Revenue Code	637
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$3.20
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Healthscope Commercial	$3.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.02
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health Cigna Priority Health	$2.48
Rate for Payer: Priority Health SBD	$2.24

NORTRIPTYLINE 25 MG CAPSULE

Facility

$202.10

Service Code	NDC 51672-4002-1
Hospital Charge Code	5675
Hospital Revenue Code	637
Min. Negotiated Rate	$127.32
Max. Negotiated Rate	$181.89
Rate for Payer: Aetna Commercial	$171.78
Rate for Payer: Aetna New Business (MI Preferred)	$131.36
Rate for Payer: Cash Price	$161.68
Rate for Payer: Cofinity Commercial	$141.47
Rate for Payer: Cofinity Commercial	$173.81
Rate for Payer: Healthscope Commercial	$181.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$171.78
Rate for Payer: PHP Commercial	$171.78
Rate for Payer: Priority Health Cigna Priority Health	$141.47
Rate for Payer: Priority Health SBD	$127.32

NOVASOURCE RENAL BOLUS FEED

Facility

$22.20

Service Code	NDC 4390035180
Hospital Charge Code	150853
Hospital Revenue Code	637
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$15.54
Rate for Payer: Priority Health SBD	$13.99

NOVASOURCE RENAL CONTINUOUS FEED

Facility

$22.20

Service Code	NDC 4390035180
Hospital Charge Code	168945
Hospital Revenue Code	637
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$15.54
Rate for Payer: Priority Health SBD	$13.99

NOVASOURCE RENAL CYCLIC FEED

Facility

$22.20

Service Code	NDC 4390035180
Hospital Charge Code	200087
Hospital Revenue Code	637
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$15.54
Rate for Payer: Priority Health SBD	$13.99

NOVASOURCE RENAL INTERMITTENT FEED

Facility

$22.20

Service Code	NDC 4390035180
Hospital Charge Code	200086
Hospital Revenue Code	637
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$15.54
Rate for Payer: Priority Health SBD	$13.99

NURSING CASE MANAGEMENT

Professional

Both

$25.00

Service Code	HCPCS RN001
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$17.50
Rate for Payer: BCBS Complete	$10.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Priority Health Cigna Priority Health	$17.50

NUTREN 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 9871616354
Hospital Charge Code	180645
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 9871616354
Hospital Charge Code	181405
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 9871616354
Hospital Charge Code	200083
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 9871616354
Hospital Charge Code	200082
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

NUTREN 2.0 BOLUS FEED

Facility

$4.75

Service Code	NDC 9871606230
Hospital Charge Code	150720
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.32
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CONTINUOUS FEED

Facility

$4.75

Service Code	NDC 9871606230
Hospital Charge Code	168944
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.32
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CYCLIC FEED

Facility

$4.75

Service Code	NDC 9871606230
Hospital Charge Code	200085
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.32
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 INTERMITTENT FEED

Facility

$4.75

Service Code	NDC 9871606230
Hospital Charge Code	200084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.32
Rate for Payer: Priority Health SBD	$2.99

NUTRITIONAL SUPPLEMENTS 0.06 GRAM-1.2 KCAL/ML ORAL LIQUID

Facility

$47.00

Service Code	NDC 7007462698
Hospital Charge Code	181335
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.95
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health Cigna Priority Health	$32.90
Rate for Payer: Priority Health SBD	$29.61

NUT.TX. COMPROMISED IMMUNE SYSTEM,REG 0.06 GRAM-1 KCAL/ML ORAL LIQUID

Facility

$55.50

Service Code	NDC 0212-3581-14
Hospital Charge Code	118217
Hospital Revenue Code	637
Min. Negotiated Rate	$34.96
Max. Negotiated Rate	$49.95
Rate for Payer: Aetna Commercial	$47.18
Rate for Payer: Aetna New Business (MI Preferred)	$36.08
Rate for Payer: Cash Price	$44.40
Rate for Payer: Cofinity Commercial	$38.85
Rate for Payer: Cofinity Commercial	$47.73
Rate for Payer: Healthscope Commercial	$49.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.18
Rate for Payer: PHP Commercial	$47.18
Rate for Payer: Priority Health Cigna Priority Health	$38.85
Rate for Payer: Priority Health SBD	$34.96

NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM

Facility

$17.82

Service Code	NDC 45802-059-35
Hospital Charge Code	5749
Hospital Revenue Code	637
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$16.04
Rate for Payer: Aetna Commercial	$15.15
Rate for Payer: Aetna New Business (MI Preferred)	$11.58
Rate for Payer: Cash Price	$14.26
Rate for Payer: Cofinity Commercial	$12.47
Rate for Payer: Cofinity Commercial	$15.33
Rate for Payer: Healthscope Commercial	$16.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.15
Rate for Payer: PHP Commercial	$15.15
Rate for Payer: Priority Health Cigna Priority Health	$12.47
Rate for Payer: Priority Health SBD	$11.23

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$4.68

Service Code	NDC 0121-0868-40
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.98
Rate for Payer: PHP Commercial	$3.98
Rate for Payer: Priority Health Cigna Priority Health	$3.28
Rate for Payer: Priority Health SBD	$2.95

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$289.72

Service Code	NDC 60432-537-16
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$182.52
Max. Negotiated Rate	$260.75
Rate for Payer: Aetna Commercial	$246.26
Rate for Payer: Aetna New Business (MI Preferred)	$188.32
Rate for Payer: Cash Price	$231.78
Rate for Payer: Cofinity Commercial	$202.80
Rate for Payer: Cofinity Commercial	$249.16
Rate for Payer: Healthscope Commercial	$260.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$246.26
Rate for Payer: PHP Commercial	$246.26
Rate for Payer: Priority Health Cigna Priority Health	$202.80
Rate for Payer: Priority Health SBD	$182.52

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.46

Service Code	NDC 68094-599-61
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$4.91
Rate for Payer: Aetna Commercial	$4.64
Rate for Payer: Aetna New Business (MI Preferred)	$3.55
Rate for Payer: Cash Price	$4.37
Rate for Payer: Cofinity Commercial	$3.82
Rate for Payer: Cofinity Commercial	$4.70
Rate for Payer: Healthscope Commercial	$4.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.64
Rate for Payer: PHP Commercial	$4.64
Rate for Payer: Priority Health Cigna Priority Health	$3.82
Rate for Payer: Priority Health SBD	$3.44

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$5.10

Service Code	NDC 0121-4785-05
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$4.59
Rate for Payer: Aetna Commercial	$4.34
Rate for Payer: Aetna New Business (MI Preferred)	$3.32
Rate for Payer: Cash Price	$4.08
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Commercial	$4.39
Rate for Payer: Healthscope Commercial	$4.59
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	$3.57
Rate for Payer: Priority Health SBD	$3.21

Know your out-of-pocket cost for care.

All Charges