Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$168.34

Service Code	NDC 49884-321-55
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$106.05
Max. Negotiated Rate	$151.51
Rate for Payer: Aetna Commercial	$143.09
Rate for Payer: Aetna New Business (MI Preferred)	$109.42
Rate for Payer: Cash Price	$134.67
Rate for Payer: Cofinity Commercial	$117.84
Rate for Payer: Cofinity Commercial	$144.77
Rate for Payer: Healthscope Commercial	$151.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$143.09
Rate for Payer: PHP Commercial	$143.09
Rate for Payer: Priority Health Cigna Priority Health	$117.84
Rate for Payer: Priority Health SBD	$106.05

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$117.14

Service Code	NDC 33342-084-07
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$105.43
Rate for Payer: Aetna Commercial	$99.57
Rate for Payer: Aetna New Business (MI Preferred)	$76.14
Rate for Payer: Cash Price	$93.71
Rate for Payer: Cofinity Commercial	$100.74
Rate for Payer: Cofinity Commercial	$82.00
Rate for Payer: Healthscope Commercial	$105.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.57
Rate for Payer: PHP Commercial	$99.57
Rate for Payer: Priority Health Cigna Priority Health	$82.00
Rate for Payer: Priority Health SBD	$73.80

OLANZAPINE 10 MG DISINTEGRATING TABLET

Facility

$5.62

Service Code	NDC 49884-321-52
Hospital Charge Code	28160
Hospital Revenue Code	637
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$5.06
Rate for Payer: Aetna Commercial	$4.78
Rate for Payer: Aetna New Business (MI Preferred)	$3.65
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.93
Rate for Payer: Cofinity Commercial	$4.83
Rate for Payer: Healthscope Commercial	$5.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.78
Rate for Payer: PHP Commercial	$4.78
Rate for Payer: Priority Health Cigna Priority Health	$3.93
Rate for Payer: Priority Health SBD	$3.54

OLANZAPINE 10 MG INTRAMUSCULAR SOLUTION

Facility

$77.08

Service Code	HCPCS J2359
Hospital Charge Code	38263
Hospital Revenue Code	636
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$69.37
Rate for Payer: Aetna Commercial	$65.52
Rate for Payer: Aetna New Business (MI Preferred)	$50.10
Rate for Payer: Cash Price	$61.66
Rate for Payer: Cofinity Commercial	$53.96
Rate for Payer: Cofinity Commercial	$66.29
Rate for Payer: Healthscope Commercial	$69.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.52
Rate for Payer: PHP Commercial	$65.52
Rate for Payer: Priority Health Cigna Priority Health	$53.96
Rate for Payer: Priority Health SBD	$48.56

OLANZAPINE 10 MG TABLET

Facility

$385.40

Service Code	NDC 0904-6376-61
Hospital Charge Code	17937
Hospital Revenue Code	637
Min. Negotiated Rate	$242.80
Max. Negotiated Rate	$346.86
Rate for Payer: Aetna Commercial	$327.59
Rate for Payer: Aetna New Business (MI Preferred)	$250.51
Rate for Payer: Cash Price	$308.32
Rate for Payer: Cofinity Commercial	$269.78
Rate for Payer: Cofinity Commercial	$331.44
Rate for Payer: Healthscope Commercial	$346.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$327.59
Rate for Payer: PHP Commercial	$327.59
Rate for Payer: Priority Health Cigna Priority Health	$269.78
Rate for Payer: Priority Health SBD	$242.80

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$6.95

Service Code	NDC 55111-262-79
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$6.26
Rate for Payer: Aetna Commercial	$5.91
Rate for Payer: Aetna New Business (MI Preferred)	$4.52
Rate for Payer: Cash Price	$5.56
Rate for Payer: Cofinity Commercial	$4.86
Rate for Payer: Cofinity Commercial	$5.98
Rate for Payer: Healthscope Commercial	$6.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.91
Rate for Payer: PHP Commercial	$5.91
Rate for Payer: Priority Health Cigna Priority Health	$4.86
Rate for Payer: Priority Health SBD	$4.38

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$115.20

Service Code	NDC 59746-306-32
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$72.58
Max. Negotiated Rate	$103.68
Rate for Payer: Aetna Commercial	$97.92
Rate for Payer: Aetna New Business (MI Preferred)	$74.88
Rate for Payer: Cash Price	$92.16
Rate for Payer: Cofinity Commercial	$80.64
Rate for Payer: Cofinity Commercial	$99.07
Rate for Payer: Healthscope Commercial	$103.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$97.92
Rate for Payer: PHP Commercial	$97.92
Rate for Payer: Priority Health Cigna Priority Health	$80.64
Rate for Payer: Priority Health SBD	$72.58

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$3.84

Service Code	NDC 59746-306-12
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$2.42
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$3.26
Rate for Payer: Aetna New Business (MI Preferred)	$2.50
Rate for Payer: Cash Price	$3.07
Rate for Payer: Cofinity Commercial	$2.69
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Healthscope Commercial	$3.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.26
Rate for Payer: PHP Commercial	$3.26
Rate for Payer: Priority Health Cigna Priority Health	$2.69
Rate for Payer: Priority Health SBD	$2.42

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$814.08

Service Code	NDC 60505-3275-0
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$512.87
Max. Negotiated Rate	$732.67
Rate for Payer: Aetna Commercial	$691.97
Rate for Payer: Aetna New Business (MI Preferred)	$529.15
Rate for Payer: Cash Price	$651.26
Rate for Payer: Cofinity Commercial	$569.86
Rate for Payer: Cofinity Commercial	$700.11
Rate for Payer: Healthscope Commercial	$732.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$691.97
Rate for Payer: PHP Commercial	$691.97
Rate for Payer: Priority Health Cigna Priority Health	$569.86
Rate for Payer: Priority Health SBD	$512.87

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$208.37

Service Code	NDC 55111-262-81
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$131.27
Max. Negotiated Rate	$187.53
Rate for Payer: Aetna Commercial	$177.11
Rate for Payer: Aetna New Business (MI Preferred)	$135.44
Rate for Payer: Cash Price	$166.70
Rate for Payer: Cofinity Commercial	$145.86
Rate for Payer: Cofinity Commercial	$179.20
Rate for Payer: Healthscope Commercial	$187.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.11
Rate for Payer: PHP Commercial	$177.11
Rate for Payer: Priority Health Cigna Priority Health	$145.86
Rate for Payer: Priority Health SBD	$131.27

OLANZAPINE 5 MG DISINTEGRATING TABLET

Facility

$57.57

Service Code	NDC 33342-083-07
Hospital Charge Code	28159
Hospital Revenue Code	637
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$51.81
Rate for Payer: Aetna Commercial	$48.93
Rate for Payer: Aetna New Business (MI Preferred)	$37.42
Rate for Payer: Cash Price	$46.06
Rate for Payer: Cofinity Commercial	$40.30
Rate for Payer: Cofinity Commercial	$49.51
Rate for Payer: Healthscope Commercial	$51.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.93
Rate for Payer: PHP Commercial	$48.93
Rate for Payer: Priority Health Cigna Priority Health	$40.30
Rate for Payer: Priority Health SBD	$36.27

OLANZAPINE 5 MG TABLET

Facility

$3.18

Service Code	NDC 68084-723-11
Hospital Charge Code	17936
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.07
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.23
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Healthscope Commercial	$2.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.70
Rate for Payer: PHP Commercial	$2.70
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health SBD	$2.00

OLANZAPINE 5 MG TABLET

Facility

$263.20

Service Code	NDC 0904-6377-61
Hospital Charge Code	17936
Hospital Revenue Code	637
Min. Negotiated Rate	$165.82
Max. Negotiated Rate	$236.88
Rate for Payer: Aetna Commercial	$223.72
Rate for Payer: Aetna New Business (MI Preferred)	$171.08
Rate for Payer: Cash Price	$210.56
Rate for Payer: Cofinity Commercial	$184.24
Rate for Payer: Cofinity Commercial	$226.35
Rate for Payer: Healthscope Commercial	$236.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$223.72
Rate for Payer: PHP Commercial	$223.72
Rate for Payer: Priority Health Cigna Priority Health	$184.24
Rate for Payer: Priority Health SBD	$165.82

OLOPATADINE 0.1 % EYE DROPS

Facility

$47.64

Service Code	NDC 0536-1308-40
Hospital Charge Code	19452
Hospital Revenue Code	637
Min. Negotiated Rate	$30.01
Max. Negotiated Rate	$42.88
Rate for Payer: Aetna Commercial	$40.49
Rate for Payer: Aetna New Business (MI Preferred)	$30.97
Rate for Payer: Cash Price	$38.11
Rate for Payer: Cofinity Commercial	$33.35
Rate for Payer: Cofinity Commercial	$40.97
Rate for Payer: Healthscope Commercial	$42.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.49
Rate for Payer: PHP Commercial	$40.49
Rate for Payer: Priority Health Cigna Priority Health	$33.35
Rate for Payer: Priority Health SBD	$30.01

OMALIZUMAB 150 MG/ML SUBCUTANEOUS SYRINGE

Facility

$4,431.88

Service Code	HCPCS J2357
Hospital Charge Code	188928
Hospital Revenue Code	636
Min. Negotiated Rate	$2,792.08
Max. Negotiated Rate	$3,988.69
Rate for Payer: Aetna Commercial	$3,767.10
Rate for Payer: Aetna New Business (MI Preferred)	$2,880.72
Rate for Payer: Cash Price	$3,545.50
Rate for Payer: Cofinity Commercial	$3,102.32
Rate for Payer: Cofinity Commercial	$3,811.42
Rate for Payer: Healthscope Commercial	$3,988.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,767.10
Rate for Payer: PHP Commercial	$3,767.10
Rate for Payer: Priority Health Cigna Priority Health	$3,102.32
Rate for Payer: Priority Health SBD	$2,792.08

OMALIZUMAB 75 MG/0.5 ML SUBCUTANEOUS SYRINGE

Facility

$2,215.94

Service Code	HCPCS J2357
Hospital Charge Code	188926
Hospital Revenue Code	636
Min. Negotiated Rate	$1,396.04
Max. Negotiated Rate	$1,994.35
Rate for Payer: Aetna Commercial	$1,883.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,440.36
Rate for Payer: Cash Price	$1,772.75
Rate for Payer: Cofinity Commercial	$1,551.16
Rate for Payer: Cofinity Commercial	$1,905.71
Rate for Payer: Healthscope Commercial	$1,994.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,883.55
Rate for Payer: PHP Commercial	$1,883.55
Rate for Payer: Priority Health Cigna Priority Health	$1,551.16
Rate for Payer: Priority Health SBD	$1,396.04

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$238.26

Service Code	NDC 64380-761-11
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$150.10
Max. Negotiated Rate	$214.43
Rate for Payer: Aetna Commercial	$202.52
Rate for Payer: Aetna New Business (MI Preferred)	$154.87
Rate for Payer: Cash Price	$190.61
Rate for Payer: Cofinity Commercial	$166.78
Rate for Payer: Cofinity Commercial	$204.90
Rate for Payer: Healthscope Commercial	$214.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$202.52
Rate for Payer: PHP Commercial	$202.52
Rate for Payer: Priority Health Cigna Priority Health	$166.78
Rate for Payer: Priority Health SBD	$150.10

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$1,015.88

Service Code	NDC 0173-0884-08
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$640.00
Max. Negotiated Rate	$914.29
Rate for Payer: Aetna Commercial	$863.50
Rate for Payer: Aetna New Business (MI Preferred)	$660.32
Rate for Payer: Cash Price	$812.70
Rate for Payer: Cofinity Commercial	$711.12
Rate for Payer: Cofinity Commercial	$873.66
Rate for Payer: Healthscope Commercial	$914.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$863.50
Rate for Payer: PHP Commercial	$863.50
Rate for Payer: Priority Health Cigna Priority Health	$711.12
Rate for Payer: Priority Health SBD	$640.00

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$493.50

Service Code	NDC 60505-3170-7
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$310.90
Max. Negotiated Rate	$444.15
Rate for Payer: Aetna Commercial	$419.48
Rate for Payer: Aetna New Business (MI Preferred)	$320.78
Rate for Payer: Cash Price	$394.80
Rate for Payer: Cofinity Commercial	$345.45
Rate for Payer: Cofinity Commercial	$424.41
Rate for Payer: Healthscope Commercial	$444.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$419.48
Rate for Payer: PHP Commercial	$419.48
Rate for Payer: Priority Health Cigna Priority Health	$345.45
Rate for Payer: Priority Health SBD	$310.90

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$438.45

Service Code	NDC 0904-6706-06
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$276.22
Max. Negotiated Rate	$394.60
Rate for Payer: Aetna Commercial	$372.68
Rate for Payer: Aetna New Business (MI Preferred)	$284.99
Rate for Payer: Cash Price	$350.76
Rate for Payer: Cofinity Commercial	$306.92
Rate for Payer: Cofinity Commercial	$377.07
Rate for Payer: Healthscope Commercial	$394.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$372.68
Rate for Payer: PHP Commercial	$372.68
Rate for Payer: Priority Health Cigna Priority Health	$306.92
Rate for Payer: Priority Health SBD	$276.22

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$8.80

Service Code	NDC 60687-127-11
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$3.52
Max. Negotiated Rate	$7.92
Rate for Payer: Aetna Commercial	$7.48
Rate for Payer: Aetna New Business (MI Preferred)	$5.72
Rate for Payer: BCBS Complete	$3.52
Rate for Payer: Cash Price	$7.04
Rate for Payer: Cofinity Commercial	$6.16
Rate for Payer: Cofinity Commercial	$7.57
Rate for Payer: Healthscope Commercial	$7.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.48
Rate for Payer: PHP Commercial	$7.48
Rate for Payer: Priority Health Cigna Priority Health	$6.16
Rate for Payer: Priority Health SBD	$5.54

OMEGA-3 ACID ETHYL ESTERS 1 GRAM CAPSULE

Facility

$439.75

Service Code	NDC 60687-127-65
Hospital Charge Code	41822
Hospital Revenue Code	637
Min. Negotiated Rate	$175.90
Max. Negotiated Rate	$395.78
Rate for Payer: Aetna Commercial	$373.79
Rate for Payer: Aetna New Business (MI Preferred)	$285.84
Rate for Payer: BCBS Complete	$175.90
Rate for Payer: Cash Price	$351.80
Rate for Payer: Cofinity Commercial	$307.82
Rate for Payer: Cofinity Commercial	$378.18
Rate for Payer: Healthscope Commercial	$395.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$373.79
Rate for Payer: PHP Commercial	$373.79
Rate for Payer: Priority Health Cigna Priority Health	$307.82
Rate for Payer: Priority Health SBD	$277.04

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,028.80

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$1,278.14
Max. Negotiated Rate	$1,825.92
Rate for Payer: Aetna Commercial	$1,724.48
Rate for Payer: Aetna New Business (MI Preferred)	$1,318.72
Rate for Payer: Cash Price	$1,623.04
Rate for Payer: Cofinity Commercial	$1,744.77
Rate for Payer: Cofinity Commercial	$1,420.16
Rate for Payer: Healthscope Commercial	$1,825.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,724.48
Rate for Payer: PHP Commercial	$1,724.48
Rate for Payer: Priority Health Cigna Priority Health	$1,420.16
Rate for Payer: Priority Health SBD	$1,278.14

ONABOTULINUMTOXINA 100 UNIT SOLUTION FOR INJECTION

Facility

$2,028.80

Service Code	HCPCS J0585
Hospital Charge Code	32700
Hospital Revenue Code	636
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$1,825.92
Rate for Payer: Aetna Commercial	$1,724.48
Rate for Payer: Aetna Medicare	$6.58
Rate for Payer: Aetna New Business (MI Preferred)	$1,318.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$7.91
Rate for Payer: Amish Plain Church Group Commercial	$7.91
Rate for Payer: BCBS Complete	$3.63
Rate for Payer: BCBS MAPPO	$6.33
Rate for Payer: BCBS Trust/PPO	$18.71
Rate for Payer: BCN Medicare Advantage	$6.33
Rate for Payer: Cash Price	$1,623.04
Rate for Payer: Cash Price	$1,623.04
Rate for Payer: Cofinity Commercial	$1,744.77
Rate for Payer: Cofinity Commercial	$1,420.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.33
Rate for Payer: Healthscope Commercial	$1,825.92
Rate for Payer: Mclaren Medicaid	$3.46
Rate for Payer: Mclaren Medicare	$6.33
Rate for Payer: Meridian Medicaid	$3.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6.64
Rate for Payer: MI Amish Medical Board Commercial	$7.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,724.48
Rate for Payer: PACE Medicare	$6.01
Rate for Payer: PACE SWMI	$6.33
Rate for Payer: PHP Commercial	$1,724.48
Rate for Payer: PHP Medicare Advantage	$6.33
Rate for Payer: Priority Health Choice Medicaid	$3.46
Rate for Payer: Priority Health Cigna Priority Health	$1,420.16
Rate for Payer: Priority Health Medicare	$6.33
Rate for Payer: Priority Health SBD	$1,278.14
Rate for Payer: Railroad Medicare Medicare	$6.33
Rate for Payer: UHC Dual Complete DSNP	$6.33
Rate for Payer: UHC Medicare Advantage	$6.52
Rate for Payer: VA VA	$6.33

ONDANSETRON 4 MG DISINTEGRATING TABLET

Facility

$83.67

Service Code	NDC 65862-390-10
Hospital Charge Code	27697
Hospital Revenue Code	637
Min. Negotiated Rate	$52.71
Max. Negotiated Rate	$75.30
Rate for Payer: Aetna Commercial	$71.12
Rate for Payer: Aetna New Business (MI Preferred)	$54.39
Rate for Payer: Cash Price	$66.94
Rate for Payer: Cofinity Commercial	$58.57
Rate for Payer: Cofinity Commercial	$71.96
Rate for Payer: Healthscope Commercial	$75.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.12
Rate for Payer: PHP Commercial	$71.12
Rate for Payer: Priority Health Cigna Priority Health	$58.57
Rate for Payer: Priority Health SBD	$52.71

Know your out-of-pocket cost for care.

All Charges