Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$215.65

Service Code	NDC 68084-643-01
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$135.86
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$150.96
Rate for Payer: Priority Health SBD	$135.86

PANTOPRAZOLE 20 MG TABLET,DELAYED RELEASE

Facility

$1.98

Service Code	NDC 60687-725-11
Hospital Charge Code	26224
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.78
Rate for Payer: Aetna Commercial	$1.68
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: Cash Price	$1.58
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Healthscope Commercial	$1.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.68
Rate for Payer: PHP Commercial	$1.68
Rate for Payer: Priority Health Cigna Priority Health	$1.39
Rate for Payer: Priority Health SBD	$1.25

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$16.54

Service Code	NDC 62756-129-40
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$14.89
Rate for Payer: Aetna Commercial	$14.06
Rate for Payer: Aetna New Business (MI Preferred)	$10.75
Rate for Payer: Cash Price	$13.23
Rate for Payer: Cofinity Commercial	$11.58
Rate for Payer: Cofinity Commercial	$14.22
Rate for Payer: Healthscope Commercial	$14.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.06
Rate for Payer: PHP Commercial	$14.06
Rate for Payer: Priority Health Cigna Priority Health	$11.58
Rate for Payer: Priority Health SBD	$10.42

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$22.47

Service Code	NDC 0781-3232-95
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$14.16
Max. Negotiated Rate	$20.22
Rate for Payer: Aetna Commercial	$19.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.61
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$15.73
Rate for Payer: Cofinity Commercial	$19.32
Rate for Payer: Healthscope Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.10
Rate for Payer: PHP Commercial	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$15.73
Rate for Payer: Priority Health SBD	$14.16

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$18.73

Service Code	NDC 0143-9284-10
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$16.86
Rate for Payer: Aetna Commercial	$15.92
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Cofinity Commercial	$16.11
Rate for Payer: Healthscope Commercial	$16.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.92
Rate for Payer: PHP Commercial	$15.92
Rate for Payer: Priority Health Cigna Priority Health	$13.11
Rate for Payer: Priority Health SBD	$11.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.00

Service Code	NDC 0008-0923-60
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$13.23
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$17.85
Rate for Payer: Aetna New Business (MI Preferred)	$13.65
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$14.70
Rate for Payer: Cofinity Commercial	$18.06
Rate for Payer: Healthscope Commercial	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: PHP Commercial	$17.85
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health SBD	$13.23

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.39

Service Code	NDC 55150-202-10
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$19.25
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.90
Rate for Payer: Cash Price	$17.11
Rate for Payer: Cofinity Commercial	$14.97
Rate for Payer: Cofinity Commercial	$18.40
Rate for Payer: Healthscope Commercial	$19.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.18
Rate for Payer: PHP Commercial	$18.18
Rate for Payer: Priority Health Cigna Priority Health	$14.97
Rate for Payer: Priority Health SBD	$13.48

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$26.31

Service Code	NDC 65219-433-01
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$22.36
Rate for Payer: Aetna New Business (MI Preferred)	$17.10
Rate for Payer: Cash Price	$21.05
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Commercial	$22.63
Rate for Payer: Healthscope Commercial	$23.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.36
Rate for Payer: PHP Commercial	$22.36
Rate for Payer: Priority Health Cigna Priority Health	$18.42
Rate for Payer: Priority Health SBD	$16.58

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.00

Service Code	NDC 0008-0923-60
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$18.90
Rate for Payer: Aetna Commercial	$17.85
Rate for Payer: Aetna New Business (MI Preferred)	$13.65
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$14.70
Rate for Payer: Cofinity Commercial	$18.06
Rate for Payer: Healthscope Commercial	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.85
Rate for Payer: PHP Commercial	$17.85
Rate for Payer: Priority Health Cigna Priority Health	$14.70
Rate for Payer: Priority Health SBD	$13.23

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.39

Service Code	NDC 55150-202-00
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$19.25
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.90
Rate for Payer: Cash Price	$17.11
Rate for Payer: Cofinity Commercial	$14.97
Rate for Payer: Cofinity Commercial	$18.40
Rate for Payer: Healthscope Commercial	$19.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.18
Rate for Payer: PHP Commercial	$18.18
Rate for Payer: Priority Health Cigna Priority Health	$14.97
Rate for Payer: Priority Health SBD	$13.48

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.91

Service Code	NDC 0008-0923-51
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$19.72
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna New Business (MI Preferred)	$14.24
Rate for Payer: Cash Price	$17.53
Rate for Payer: Cofinity Commercial	$15.34
Rate for Payer: Cofinity Commercial	$18.84
Rate for Payer: Healthscope Commercial	$19.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.62
Rate for Payer: PHP Commercial	$18.62
Rate for Payer: Priority Health Cigna Priority Health	$15.34
Rate for Payer: Priority Health SBD	$13.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$18.73

Service Code	NDC 0143-9300-01
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$16.86
Rate for Payer: Aetna Commercial	$15.92
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Cofinity Commercial	$16.11
Rate for Payer: Healthscope Commercial	$16.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.92
Rate for Payer: PHP Commercial	$15.92
Rate for Payer: Priority Health Cigna Priority Health	$13.11
Rate for Payer: Priority Health SBD	$11.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$26.31

Service Code	NDC 65219-433-15
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$22.36
Rate for Payer: Aetna New Business (MI Preferred)	$17.10
Rate for Payer: Cash Price	$21.05
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Commercial	$22.63
Rate for Payer: Healthscope Commercial	$23.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.36
Rate for Payer: PHP Commercial	$22.36
Rate for Payer: Priority Health Cigna Priority Health	$18.42
Rate for Payer: Priority Health SBD	$16.58

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$21.91

Service Code	NDC 0008-0923-55
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$19.72
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna New Business (MI Preferred)	$14.24
Rate for Payer: Cash Price	$17.53
Rate for Payer: Cofinity Commercial	$15.34
Rate for Payer: Cofinity Commercial	$18.84
Rate for Payer: Healthscope Commercial	$19.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.62
Rate for Payer: PHP Commercial	$18.62
Rate for Payer: Priority Health Cigna Priority Health	$15.34
Rate for Payer: Priority Health SBD	$13.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$18.73

Service Code	NDC 0143-9284-01
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$16.86
Rate for Payer: Aetna Commercial	$15.92
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Cofinity Commercial	$16.11
Rate for Payer: Healthscope Commercial	$16.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.92
Rate for Payer: PHP Commercial	$15.92
Rate for Payer: Priority Health Cigna Priority Health	$13.11
Rate for Payer: Priority Health SBD	$11.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$18.73

Service Code	NDC 0143-9300-10
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$11.80
Max. Negotiated Rate	$16.86
Rate for Payer: Aetna Commercial	$15.92
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.11
Rate for Payer: Cofinity Commercial	$16.11
Rate for Payer: Healthscope Commercial	$16.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.92
Rate for Payer: PHP Commercial	$15.92
Rate for Payer: Priority Health Cigna Priority Health	$13.11
Rate for Payer: Priority Health SBD	$11.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION

Facility

$16.88

Service Code	NDC 62756-129-44
Hospital Charge Code	26226
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$15.19
Rate for Payer: Aetna Commercial	$14.35
Rate for Payer: Aetna New Business (MI Preferred)	$10.97
Rate for Payer: Cash Price	$13.50
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Cofinity Commercial	$14.52
Rate for Payer: Healthscope Commercial	$15.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.35
Rate for Payer: PHP Commercial	$14.35
Rate for Payer: Priority Health Cigna Priority Health	$11.82
Rate for Payer: Priority Health SBD	$10.63

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$21.91

Service Code	NDC 0008-0923-55
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$13.80
Max. Negotiated Rate	$19.72
Rate for Payer: Aetna Commercial	$18.62
Rate for Payer: Aetna New Business (MI Preferred)	$14.24
Rate for Payer: Cash Price	$17.53
Rate for Payer: Cofinity Commercial	$15.34
Rate for Payer: Cofinity Commercial	$18.84
Rate for Payer: Healthscope Commercial	$19.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.62
Rate for Payer: PHP Commercial	$18.62
Rate for Payer: Priority Health Cigna Priority Health	$15.34
Rate for Payer: Priority Health SBD	$13.80

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$26.31

Service Code	NDC 65219-433-15
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$22.36
Rate for Payer: Aetna New Business (MI Preferred)	$17.10
Rate for Payer: Cash Price	$21.05
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Commercial	$22.63
Rate for Payer: Healthscope Commercial	$23.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.36
Rate for Payer: PHP Commercial	$22.36
Rate for Payer: Priority Health Cigna Priority Health	$18.42
Rate for Payer: Priority Health SBD	$16.58

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$21.39

Service Code	NDC 55150-202-00
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$19.25
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.90
Rate for Payer: Cash Price	$17.11
Rate for Payer: Cofinity Commercial	$14.97
Rate for Payer: Cofinity Commercial	$18.40
Rate for Payer: Healthscope Commercial	$19.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.18
Rate for Payer: PHP Commercial	$18.18
Rate for Payer: Priority Health Cigna Priority Health	$14.97
Rate for Payer: Priority Health SBD	$13.48

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$21.39

Service Code	NDC 55150-202-10
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$19.25
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.90
Rate for Payer: Cash Price	$17.11
Rate for Payer: Cofinity Commercial	$14.97
Rate for Payer: Cofinity Commercial	$18.40
Rate for Payer: Healthscope Commercial	$19.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.18
Rate for Payer: PHP Commercial	$18.18
Rate for Payer: Priority Health Cigna Priority Health	$14.97
Rate for Payer: Priority Health SBD	$13.48

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$26.31

Service Code	NDC 65219-433-01
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$16.58
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$22.36
Rate for Payer: Aetna New Business (MI Preferred)	$17.10
Rate for Payer: Cash Price	$21.05
Rate for Payer: Cofinity Commercial	$18.42
Rate for Payer: Cofinity Commercial	$22.63
Rate for Payer: Healthscope Commercial	$23.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.36
Rate for Payer: PHP Commercial	$22.36
Rate for Payer: Priority Health Cigna Priority Health	$18.42
Rate for Payer: Priority Health SBD	$16.58

PANTOPRAZOLE 40 MG INTRAVENOUS SOLUTION FOR DRIP

Facility

$22.47

Service Code	NDC 0781-3232-95
Hospital Charge Code	301183
Hospital Revenue Code	250
Min. Negotiated Rate	$14.16
Max. Negotiated Rate	$20.22
Rate for Payer: Aetna Commercial	$19.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.61
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$15.73
Rate for Payer: Cofinity Commercial	$19.32
Rate for Payer: Healthscope Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.10
Rate for Payer: PHP Commercial	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$15.73
Rate for Payer: Priority Health SBD	$14.16

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$2.99

Service Code	NDC 50268-639-11
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$2.69
Rate for Payer: Aetna Commercial	$2.54
Rate for Payer: Aetna New Business (MI Preferred)	$1.94
Rate for Payer: Cash Price	$2.39
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Commercial	$2.57
Rate for Payer: Healthscope Commercial	$2.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.54
Rate for Payer: PHP Commercial	$2.54
Rate for Payer: Priority Health Cigna Priority Health	$2.09
Rate for Payer: Priority Health SBD	$1.88

PANTOPRAZOLE 40 MG TABLET,DELAYED RELEASE

Facility

$2.08

Service Code	NDC 35573-428-51
Hospital Charge Code	26225
Hospital Revenue Code	637
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.87
Rate for Payer: Aetna Commercial	$1.77
Rate for Payer: Aetna New Business (MI Preferred)	$1.35
Rate for Payer: Cash Price	$1.66
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.79
Rate for Payer: Healthscope Commercial	$1.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.77
Rate for Payer: PHP Commercial	$1.77
Rate for Payer: Priority Health Cigna Priority Health	$1.46
Rate for Payer: Priority Health SBD	$1.31

Know your out-of-pocket cost for care.

All Charges