Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PHENYLEPHRINE 1 MG/10 ML (100 MCG/ML) IN 0.9 % SOD.CHLORIDE IV SYRINGE

Facility

$4.25

Service Code	NDC 69374-957-10
Hospital Charge Code	119800
Hospital Revenue Code	250
Min. Negotiated Rate	$2.68
Max. Negotiated Rate	$3.82
Rate for Payer: Aetna Commercial	$3.61
Rate for Payer: Aetna New Business (MI Preferred)	$2.76
Rate for Payer: Cash Price	$3.40
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Cofinity Commercial	$3.66
Rate for Payer: Healthscope Commercial	$3.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.61
Rate for Payer: PHP Commercial	$3.61
Rate for Payer: Priority Health Cigna Priority Health	$2.98
Rate for Payer: Priority Health SBD	$2.68

PHENYLEPHRINE 1 % NASAL SPRAY

Facility

$19.51

Service Code	NDC 0024-1352-02
Hospital Charge Code	109137
Hospital Revenue Code	637
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna Commercial	$16.58
Rate for Payer: Aetna New Business (MI Preferred)	$12.68
Rate for Payer: Cash Price	$15.61
Rate for Payer: Cofinity Commercial	$13.66
Rate for Payer: Cofinity Commercial	$16.78
Rate for Payer: Healthscope Commercial	$17.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.58
Rate for Payer: PHP Commercial	$16.58
Rate for Payer: Priority Health Cigna Priority Health	$13.66
Rate for Payer: Priority Health SBD	$12.29

PHENYLEPHRINE 1 % NASAL SPRAY

Facility

$19.51

Service Code	NDC 5032300604
Hospital Charge Code	109137
Hospital Revenue Code	637
Min. Negotiated Rate	$12.29
Max. Negotiated Rate	$17.56
Rate for Payer: Aetna Commercial	$16.58
Rate for Payer: Aetna New Business (MI Preferred)	$12.68
Rate for Payer: Cash Price	$15.61
Rate for Payer: Cofinity Commercial	$16.78
Rate for Payer: Cofinity Commercial	$13.66
Rate for Payer: Healthscope Commercial	$17.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.58
Rate for Payer: PHP Commercial	$16.58
Rate for Payer: Priority Health Cigna Priority Health	$13.66
Rate for Payer: Priority Health SBD	$12.29

PHENYLEPHRINE 1 % NASAL SPRAY

Facility

$20.93

Service Code	NDC 0225-0810-47
Hospital Charge Code	109137
Hospital Revenue Code	637
Min. Negotiated Rate	$13.19
Max. Negotiated Rate	$18.84
Rate for Payer: Aetna Commercial	$17.79
Rate for Payer: Aetna New Business (MI Preferred)	$13.60
Rate for Payer: Cash Price	$16.74
Rate for Payer: Cofinity Commercial	$18.00
Rate for Payer: Cofinity Commercial	$14.65
Rate for Payer: Healthscope Commercial	$18.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.79
Rate for Payer: PHP Commercial	$17.79
Rate for Payer: Priority Health Cigna Priority Health	$14.65
Rate for Payer: Priority Health SBD	$13.19

PHENYLEPHRINE 1 % NASAL SPRAY

Facility

$20.19

Service Code	NDC 69536-100-15
Hospital Charge Code	109137
Hospital Revenue Code	637
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$18.17
Rate for Payer: Aetna Commercial	$17.16
Rate for Payer: Aetna New Business (MI Preferred)	$13.12
Rate for Payer: Cash Price	$16.15
Rate for Payer: Cofinity Commercial	$14.13
Rate for Payer: Cofinity Commercial	$17.36
Rate for Payer: Healthscope Commercial	$18.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.16
Rate for Payer: PHP Commercial	$17.16
Rate for Payer: Priority Health Cigna Priority Health	$14.13
Rate for Payer: Priority Health SBD	$12.72

PHENYLEPHRINE 20MG/250ML NS (IV PREMIX)

Facility

$9.50

Service Code	NDC 9900-0001-62
Hospital Charge Code	500533
Hospital Revenue Code	250
Min. Negotiated Rate	$5.98
Max. Negotiated Rate	$8.55
Rate for Payer: Aetna Commercial	$8.08
Rate for Payer: Aetna New Business (MI Preferred)	$6.18
Rate for Payer: Cash Price	$7.60
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Cofinity Commercial	$8.17
Rate for Payer: Healthscope Commercial	$8.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.08
Rate for Payer: PHP Commercial	$8.08
Rate for Payer: Priority Health Cigna Priority Health	$6.65
Rate for Payer: Priority Health SBD	$5.98

PHENYLEPHRINE 2.5 % EYE DROPS

Facility

$99.40

Service Code	NDC 17478-201-02
Hospital Charge Code	6246
Hospital Revenue Code	637
Min. Negotiated Rate	$62.62
Max. Negotiated Rate	$89.46
Rate for Payer: Aetna Commercial	$84.49
Rate for Payer: Aetna New Business (MI Preferred)	$64.61
Rate for Payer: Cash Price	$79.52
Rate for Payer: Cofinity Commercial	$69.58
Rate for Payer: Cofinity Commercial	$85.48
Rate for Payer: Healthscope Commercial	$89.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.49
Rate for Payer: PHP Commercial	$84.49
Rate for Payer: Priority Health Cigna Priority Health	$69.58
Rate for Payer: Priority Health SBD	$62.62

PHENYLEPHRINE IV INFUSION (INTRA-OP)

Facility

$16.25

Service Code	NDC 9900-0003-62
Hospital Charge Code	155179
Hospital Revenue Code	250
Min. Negotiated Rate	$10.24
Max. Negotiated Rate	$14.62
Rate for Payer: Aetna Commercial	$13.81
Rate for Payer: Aetna New Business (MI Preferred)	$10.56
Rate for Payer: Cash Price	$13.00
Rate for Payer: Cofinity Commercial	$11.38
Rate for Payer: Cofinity Commercial	$13.98
Rate for Payer: Healthscope Commercial	$14.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.81
Rate for Payer: PHP Commercial	$13.81
Rate for Payer: Priority Health Cigna Priority Health	$11.38
Rate for Payer: Priority Health SBD	$10.24

PHENYTOIN 100 MG/4 ML ORAL SUSPENSION

Facility

$3.47

Service Code	NDC 9900-0004-06
Hospital Charge Code	118124
Hospital Revenue Code	637
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$3.12
Rate for Payer: Aetna Commercial	$2.95
Rate for Payer: Aetna New Business (MI Preferred)	$2.26
Rate for Payer: Cash Price	$2.78
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Cofinity Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.95
Rate for Payer: PHP Commercial	$2.95
Rate for Payer: Priority Health Cigna Priority Health	$2.43
Rate for Payer: Priority Health SBD	$2.19

PHENYTOIN 100 MG/4 ML ORAL SUSPENSION

Facility

$21.17

Service Code	NDC 66689-036-50
Hospital Charge Code	118124
Hospital Revenue Code	637
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$19.05
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna New Business (MI Preferred)	$13.76
Rate for Payer: Cash Price	$16.94
Rate for Payer: Cofinity Commercial	$14.82
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Healthscope Commercial	$19.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.99
Rate for Payer: PHP Commercial	$17.99
Rate for Payer: Priority Health Cigna Priority Health	$14.82
Rate for Payer: Priority Health SBD	$13.34

PHENYTOIN 100 MG/4 ML ORAL SUSPENSION

Facility

$21.17

Service Code	NDC 66689-036-01
Hospital Charge Code	118124
Hospital Revenue Code	637
Min. Negotiated Rate	$13.34
Max. Negotiated Rate	$19.05
Rate for Payer: Aetna Commercial	$17.99
Rate for Payer: Aetna New Business (MI Preferred)	$13.76
Rate for Payer: Cash Price	$16.94
Rate for Payer: Cofinity Commercial	$14.82
Rate for Payer: Cofinity Commercial	$18.21
Rate for Payer: Healthscope Commercial	$19.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.99
Rate for Payer: PHP Commercial	$17.99
Rate for Payer: Priority Health Cigna Priority Health	$14.82
Rate for Payer: Priority Health SBD	$13.34

PHENYTOIN 125 MG/5 ML ORAL SUSPENSION

Facility

$590.37

Service Code	NDC 60432-131-08
Hospital Charge Code	6255
Hospital Revenue Code	637
Min. Negotiated Rate	$371.93
Max. Negotiated Rate	$531.33
Rate for Payer: Aetna Commercial	$501.81
Rate for Payer: Aetna New Business (MI Preferred)	$383.74
Rate for Payer: Cash Price	$472.30
Rate for Payer: Cofinity Commercial	$413.26
Rate for Payer: Cofinity Commercial	$507.72
Rate for Payer: Healthscope Commercial	$531.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$501.81
Rate for Payer: PHP Commercial	$501.81
Rate for Payer: Priority Health Cigna Priority Health	$413.26
Rate for Payer: Priority Health SBD	$371.93

PHENYTOIN 125 MG/5 ML ORAL SUSPENSION

Facility

$256.20

Service Code	NDC 51672-4069-1
Hospital Charge Code	6255
Hospital Revenue Code	637
Min. Negotiated Rate	$161.41
Max. Negotiated Rate	$230.58
Rate for Payer: Aetna Commercial	$217.77
Rate for Payer: Aetna New Business (MI Preferred)	$166.53
Rate for Payer: Cash Price	$204.96
Rate for Payer: Cofinity Commercial	$220.33
Rate for Payer: Cofinity Commercial	$179.34
Rate for Payer: Healthscope Commercial	$230.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$217.77
Rate for Payer: PHP Commercial	$217.77
Rate for Payer: Priority Health Cigna Priority Health	$179.34
Rate for Payer: Priority Health SBD	$161.41

PHENYTOIN 50 MG CHEWABLE TABLET

Facility

$216.60

Service Code	NDC 51672-4146-1
Hospital Charge Code	11018
Hospital Revenue Code	637
Min. Negotiated Rate	$136.46
Max. Negotiated Rate	$194.94
Rate for Payer: Aetna Commercial	$184.11
Rate for Payer: Aetna New Business (MI Preferred)	$140.79
Rate for Payer: Cash Price	$173.28
Rate for Payer: Cofinity Commercial	$151.62
Rate for Payer: Cofinity Commercial	$186.28
Rate for Payer: Healthscope Commercial	$194.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$184.11
Rate for Payer: PHP Commercial	$184.11
Rate for Payer: Priority Health Cigna Priority Health	$151.62
Rate for Payer: Priority Health SBD	$136.46

PHENYTOIN 50 MG CHEWABLE TABLET

Facility

$670.08

Service Code	NDC 0071-0007-24
Hospital Charge Code	11018
Hospital Revenue Code	637
Min. Negotiated Rate	$422.15
Max. Negotiated Rate	$603.07
Rate for Payer: Aetna Commercial	$569.57
Rate for Payer: Aetna New Business (MI Preferred)	$435.55
Rate for Payer: Cash Price	$536.06
Rate for Payer: Cofinity Commercial	$469.06
Rate for Payer: Cofinity Commercial	$576.27
Rate for Payer: Healthscope Commercial	$603.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$569.57
Rate for Payer: PHP Commercial	$569.57
Rate for Payer: Priority Health Cigna Priority Health	$469.06
Rate for Payer: Priority Health SBD	$422.15

PHENYTOIN 50 MG CHEWABLE TABLET

Facility

$2.82

Service Code	NDC 51079-129-01
Hospital Charge Code	11018
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.97
Rate for Payer: Priority Health SBD	$1.78

PHENYTOIN 50 MG CHEWABLE TABLET

Facility

$140.64

Service Code	NDC 51079-129-06
Hospital Charge Code	11018
Hospital Revenue Code	637
Min. Negotiated Rate	$88.60
Max. Negotiated Rate	$126.58
Rate for Payer: Aetna Commercial	$119.54
Rate for Payer: Aetna New Business (MI Preferred)	$91.42
Rate for Payer: Cash Price	$112.51
Rate for Payer: Cofinity Commercial	$120.95
Rate for Payer: Cofinity Commercial	$98.45
Rate for Payer: Healthscope Commercial	$126.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.54
Rate for Payer: PHP Commercial	$119.54
Rate for Payer: Priority Health Cigna Priority Health	$98.45
Rate for Payer: Priority Health SBD	$88.60

PHENYTOIN 50 MG CHEWABLE TABLET

Facility

$374.30

Service Code	NDC 0378-3850-01
Hospital Charge Code	11018
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.16
Rate for Payer: Aetna New Business (MI Preferred)	$243.30
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$318.16
Rate for Payer: PHP Commercial	$318.16
Rate for Payer: Priority Health Cigna Priority Health	$262.01
Rate for Payer: Priority Health SBD	$235.81

PHENYTOIN SODIUM 50 MG/ML INTRAVENOUS SOLUTION

Facility

$21.54

Service Code	HCPCS J1165
Hospital Charge Code	6256
Hospital Revenue Code	636
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$19.39
Rate for Payer: Aetna Commercial	$18.31
Rate for Payer: Aetna Commercial	$12.72
Rate for Payer: Aetna New Business (MI Preferred)	$14.00
Rate for Payer: Aetna New Business (MI Preferred)	$9.73
Rate for Payer: Cash Price	$17.23
Rate for Payer: Cash Price	$11.98
Rate for Payer: Cofinity Commercial	$18.52
Rate for Payer: Cofinity Commercial	$10.48
Rate for Payer: Cofinity Commercial	$12.87
Rate for Payer: Cofinity Commercial	$15.08
Rate for Payer: Healthscope Commercial	$13.47
Rate for Payer: Healthscope Commercial	$19.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.31
Rate for Payer: PHP Commercial	$18.31
Rate for Payer: PHP Commercial	$12.72
Rate for Payer: Priority Health Cigna Priority Health	$10.48
Rate for Payer: Priority Health Cigna Priority Health	$15.08
Rate for Payer: Priority Health SBD	$9.43
Rate for Payer: Priority Health SBD	$13.57

PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE

Facility

$382.85

Service Code	NDC 0904-6187-61
Hospital Charge Code	6257
Hospital Revenue Code	637
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$344.56
Rate for Payer: Aetna Commercial	$325.42
Rate for Payer: Aetna New Business (MI Preferred)	$248.85
Rate for Payer: Cash Price	$306.28
Rate for Payer: Cofinity Commercial	$329.25
Rate for Payer: Cofinity Commercial	$268.00
Rate for Payer: Healthscope Commercial	$344.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$325.42
Rate for Payer: PHP Commercial	$325.42
Rate for Payer: Priority Health Cigna Priority Health	$268.00
Rate for Payer: Priority Health SBD	$241.20

PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE

Facility

$789.12

Service Code	NDC 0071-0369-40
Hospital Charge Code	6257
Hospital Revenue Code	637
Min. Negotiated Rate	$497.15
Max. Negotiated Rate	$710.21
Rate for Payer: Aetna Commercial	$670.75
Rate for Payer: Aetna New Business (MI Preferred)	$512.93
Rate for Payer: Cash Price	$631.30
Rate for Payer: Cofinity Commercial	$552.38
Rate for Payer: Cofinity Commercial	$678.64
Rate for Payer: Healthscope Commercial	$710.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$670.75
Rate for Payer: PHP Commercial	$670.75
Rate for Payer: Priority Health Cigna Priority Health	$552.38
Rate for Payer: Priority Health SBD	$497.15

PHENYTOIN SODIUM EXTENDED 100 MG CAPSULE

Facility

$253.44

Service Code	NDC 51079-905-20
Hospital Charge Code	6257
Hospital Revenue Code	637
Min. Negotiated Rate	$159.67
Max. Negotiated Rate	$228.10
Rate for Payer: Aetna Commercial	$215.42
Rate for Payer: Aetna New Business (MI Preferred)	$164.74
Rate for Payer: Cash Price	$202.75
Rate for Payer: Cofinity Commercial	$217.96
Rate for Payer: Cofinity Commercial	$177.41
Rate for Payer: Healthscope Commercial	$228.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.42
Rate for Payer: PHP Commercial	$215.42
Rate for Payer: Priority Health Cigna Priority Health	$177.41
Rate for Payer: Priority Health SBD	$159.67

PHENYTOIN SODIUM EXTENDED 30 MG CAPSULE

Facility

$616.80

Service Code	NDC 0071-3740-66
Hospital Charge Code	11019
Hospital Revenue Code	637
Min. Negotiated Rate	$388.58
Max. Negotiated Rate	$555.12
Rate for Payer: Aetna Commercial	$524.28
Rate for Payer: Aetna New Business (MI Preferred)	$400.92
Rate for Payer: Cash Price	$493.44
Rate for Payer: Cofinity Commercial	$431.76
Rate for Payer: Cofinity Commercial	$530.45
Rate for Payer: Healthscope Commercial	$555.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$524.28
Rate for Payer: PHP Commercial	$524.28
Rate for Payer: Priority Health Cigna Priority Health	$431.76
Rate for Payer: Priority Health SBD	$388.58

PHYSOSTIGMINE 1 MG/ML INJECTION SOLUTION

Facility

$258.47

Service Code	NDC 17478-510-02
Hospital Charge Code	6270
Hospital Revenue Code	250
Min. Negotiated Rate	$162.84
Max. Negotiated Rate	$232.62
Rate for Payer: Aetna Commercial	$219.70
Rate for Payer: Aetna New Business (MI Preferred)	$168.01
Rate for Payer: Cash Price	$206.78
Rate for Payer: Cofinity Commercial	$180.93
Rate for Payer: Cofinity Commercial	$222.28
Rate for Payer: Healthscope Commercial	$232.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$219.70
Rate for Payer: PHP Commercial	$219.70
Rate for Payer: Priority Health Cigna Priority Health	$180.93
Rate for Payer: Priority Health SBD	$162.84

PHYTONADIONE ORAL SOLUTION 10 MG/ML

Facility

$88.13

Service Code	NDC 0409-9158-01
Hospital Charge Code	150708
Hospital Revenue Code	250
Min. Negotiated Rate	$55.52
Max. Negotiated Rate	$79.32
Rate for Payer: Aetna Commercial	$74.91
Rate for Payer: Aetna New Business (MI Preferred)	$57.28
Rate for Payer: Cash Price	$70.50
Rate for Payer: Cofinity Commercial	$61.69
Rate for Payer: Cofinity Commercial	$75.79
Rate for Payer: Healthscope Commercial	$79.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.91
Rate for Payer: PHP Commercial	$74.91
Rate for Payer: Priority Health Cigna Priority Health	$61.69
Rate for Payer: Priority Health SBD	$55.52

Know your out-of-pocket cost for care.

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