Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$242.25

Service Code	NDC 60687-466-01
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$152.62
Max. Negotiated Rate	$218.02
Rate for Payer: Aetna Commercial	$205.91
Rate for Payer: Aetna New Business (MI Preferred)	$157.46
Rate for Payer: Cash Price	$193.80
Rate for Payer: Cofinity Commercial	$169.58
Rate for Payer: Cofinity Commercial	$208.34
Rate for Payer: Healthscope Commercial	$218.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$205.91
Rate for Payer: PHP Commercial	$205.91
Rate for Payer: Priority Health Cigna Priority Health	$169.58
Rate for Payer: Priority Health SBD	$152.62

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$3.37

Service Code	NDC 66758-160-06
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.86
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$2.36
Rate for Payer: Priority Health SBD	$2.12

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$268.85

Service Code	NDC 0574-0275-11
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$169.38
Max. Negotiated Rate	$241.96
Rate for Payer: Aetna Commercial	$228.52
Rate for Payer: Aetna New Business (MI Preferred)	$174.75
Rate for Payer: Cash Price	$215.08
Rate for Payer: Cofinity Commercial	$188.20
Rate for Payer: Cofinity Commercial	$231.21
Rate for Payer: Healthscope Commercial	$241.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$228.52
Rate for Payer: PHP Commercial	$228.52
Rate for Payer: Priority Health Cigna Priority Health	$188.20
Rate for Payer: Priority Health SBD	$169.38

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$311.60

Service Code	NDC 0245-5316-01
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$196.31
Max. Negotiated Rate	$280.44
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna New Business (MI Preferred)	$202.54
Rate for Payer: Cash Price	$249.28
Rate for Payer: Cofinity Commercial	$218.12
Rate for Payer: Cofinity Commercial	$267.98
Rate for Payer: Healthscope Commercial	$280.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$264.86
Rate for Payer: PHP Commercial	$264.86
Rate for Payer: Priority Health Cigna Priority Health	$218.12
Rate for Payer: Priority Health SBD	$196.31

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$3.37

Service Code	NDC 66758-160-06
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.86
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$2.36
Rate for Payer: Priority Health SBD	$2.12

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$65.63

Service Code	NDC 0178-0314-30
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$41.35
Max. Negotiated Rate	$59.07
Rate for Payer: Aetna Commercial	$55.79
Rate for Payer: Aetna New Business (MI Preferred)	$42.66
Rate for Payer: Cash Price	$52.50
Rate for Payer: Cofinity Commercial	$56.44
Rate for Payer: Cofinity Commercial	$45.94
Rate for Payer: Healthscope Commercial	$59.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.79
Rate for Payer: PHP Commercial	$55.79
Rate for Payer: Priority Health Cigna Priority Health	$45.94
Rate for Payer: Priority Health SBD	$41.35

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$5.63

Service Code	NDC 9900-0019-48
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Aetna New Business (MI Preferred)	$3.66
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.94
Rate for Payer: Cofinity Commercial	$4.84
Rate for Payer: Healthscope Commercial	$5.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.79
Rate for Payer: PHP Commercial	$4.79
Rate for Payer: Priority Health Cigna Priority Health	$3.94
Rate for Payer: Priority Health SBD	$3.55

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$399.12

Service Code	NDC 46287-024-15
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$251.45
Max. Negotiated Rate	$359.21
Rate for Payer: Aetna Commercial	$339.25
Rate for Payer: Aetna New Business (MI Preferred)	$259.43
Rate for Payer: Cash Price	$319.30
Rate for Payer: Cofinity Commercial	$279.38
Rate for Payer: Cofinity Commercial	$343.24
Rate for Payer: Healthscope Commercial	$359.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$339.25
Rate for Payer: PHP Commercial	$339.25
Rate for Payer: Priority Health Cigna Priority Health	$279.38
Rate for Payer: Priority Health SBD	$251.45

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$399.12

Service Code	NDC 46287-024-10
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$251.45
Max. Negotiated Rate	$359.21
Rate for Payer: Aetna Commercial	$339.25
Rate for Payer: Aetna New Business (MI Preferred)	$259.43
Rate for Payer: Cash Price	$319.30
Rate for Payer: Cofinity Commercial	$279.38
Rate for Payer: Cofinity Commercial	$343.24
Rate for Payer: Healthscope Commercial	$359.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$339.25
Rate for Payer: PHP Commercial	$339.25
Rate for Payer: Priority Health Cigna Priority Health	$279.38
Rate for Payer: Priority Health SBD	$251.45

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$410.64

Service Code	NDC 63323-086-15
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$258.70
Max. Negotiated Rate	$369.58
Rate for Payer: Aetna Commercial	$349.04
Rate for Payer: Aetna New Business (MI Preferred)	$266.92
Rate for Payer: Cash Price	$328.51
Rate for Payer: Cofinity Commercial	$287.45
Rate for Payer: Cofinity Commercial	$353.15
Rate for Payer: Healthscope Commercial	$369.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$349.04
Rate for Payer: PHP Commercial	$349.04
Rate for Payer: Priority Health Cigna Priority Health	$287.45
Rate for Payer: Priority Health SBD	$258.70

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$759.80

Service Code	NDC 65219-056-09
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$478.67
Max. Negotiated Rate	$683.82
Rate for Payer: Aetna Commercial	$645.83
Rate for Payer: Aetna New Business (MI Preferred)	$493.87
Rate for Payer: Cash Price	$607.84
Rate for Payer: Cofinity Commercial	$531.86
Rate for Payer: Cofinity Commercial	$653.43
Rate for Payer: Healthscope Commercial	$683.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$645.83
Rate for Payer: PHP Commercial	$645.83
Rate for Payer: Priority Health Cigna Priority Health	$531.86
Rate for Payer: Priority Health SBD	$478.67

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$759.80

Service Code	NDC 65219-056-29
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$478.67
Max. Negotiated Rate	$683.82
Rate for Payer: Aetna Commercial	$645.83
Rate for Payer: Aetna New Business (MI Preferred)	$493.87
Rate for Payer: Cash Price	$607.84
Rate for Payer: Cofinity Commercial	$531.86
Rate for Payer: Cofinity Commercial	$653.43
Rate for Payer: Healthscope Commercial	$683.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$645.83
Rate for Payer: PHP Commercial	$645.83
Rate for Payer: Priority Health Cigna Priority Health	$531.86
Rate for Payer: Priority Health SBD	$478.67

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$183.79

Service Code	NDC 0409-7295-01
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$73.52
Max. Negotiated Rate	$165.41
Rate for Payer: Aetna Commercial	$156.22
Rate for Payer: Aetna New Business (MI Preferred)	$119.46
Rate for Payer: BCBS Complete	$73.52
Rate for Payer: Cash Price	$147.03
Rate for Payer: Cofinity Commercial	$128.65
Rate for Payer: Cofinity Commercial	$158.06
Rate for Payer: Healthscope Commercial	$165.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$156.22
Rate for Payer: PHP Commercial	$156.22
Rate for Payer: Priority Health Cigna Priority Health	$128.65
Rate for Payer: Priority Health SBD	$115.79

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$330.01

Service Code	NDC 0517-2102-01
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$207.91
Max. Negotiated Rate	$297.01
Rate for Payer: Aetna Commercial	$280.51
Rate for Payer: Aetna New Business (MI Preferred)	$214.51
Rate for Payer: Cash Price	$264.01
Rate for Payer: Cofinity Commercial	$231.01
Rate for Payer: Cofinity Commercial	$283.81
Rate for Payer: Healthscope Commercial	$297.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$280.51
Rate for Payer: PHP Commercial	$280.51
Rate for Payer: Priority Health Cigna Priority Health	$231.01
Rate for Payer: Priority Health SBD	$207.91

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$183.79

Service Code	NDC 0409-7295-01
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$115.79
Max. Negotiated Rate	$165.41
Rate for Payer: Aetna Commercial	$156.22
Rate for Payer: Aetna New Business (MI Preferred)	$119.46
Rate for Payer: Cash Price	$147.03
Rate for Payer: Cofinity Commercial	$128.65
Rate for Payer: Cofinity Commercial	$158.06
Rate for Payer: Healthscope Commercial	$165.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$156.22
Rate for Payer: PHP Commercial	$156.22
Rate for Payer: Priority Health Cigna Priority Health	$128.65
Rate for Payer: Priority Health SBD	$115.79

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$330.01

Service Code	NDC 0517-2102-25
Hospital Charge Code	6451
Hospital Revenue Code	250
Min. Negotiated Rate	$207.91
Max. Negotiated Rate	$297.01
Rate for Payer: Aetna Commercial	$280.51
Rate for Payer: Aetna New Business (MI Preferred)	$214.51
Rate for Payer: Cash Price	$264.01
Rate for Payer: Cofinity Commercial	$231.01
Rate for Payer: Cofinity Commercial	$283.81
Rate for Payer: Healthscope Commercial	$297.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$280.51
Rate for Payer: PHP Commercial	$280.51
Rate for Payer: Priority Health Cigna Priority Health	$231.01
Rate for Payer: Priority Health SBD	$207.91

POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$777.74

Service Code	NDC 9900-0019-21
Hospital Charge Code	301289
Hospital Revenue Code	250
Min. Negotiated Rate	$489.98
Max. Negotiated Rate	$699.97
Rate for Payer: Aetna Commercial	$661.08
Rate for Payer: Aetna New Business (MI Preferred)	$505.53
Rate for Payer: Cash Price	$622.19
Rate for Payer: Cofinity Commercial	$544.42
Rate for Payer: Cofinity Commercial	$668.86
Rate for Payer: Healthscope Commercial	$699.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$661.08
Rate for Payer: PHP Commercial	$661.08
Rate for Payer: Priority Health Cigna Priority Health	$544.42
Rate for Payer: Priority Health SBD	$489.98

POT BICARB 344 MG-SOD BICARB 1,050 MG-CITRIC ACID 1,000 MG EFFERV TAB

Facility

$109.98

Service Code	NDC 1650004108
Hospital Charge Code	174294
Hospital Revenue Code	637
Min. Negotiated Rate	$69.29
Max. Negotiated Rate	$98.98
Rate for Payer: Aetna Commercial	$93.48
Rate for Payer: Aetna New Business (MI Preferred)	$71.49
Rate for Payer: Cash Price	$87.98
Rate for Payer: Cofinity Commercial	$76.99
Rate for Payer: Cofinity Commercial	$94.58
Rate for Payer: Healthscope Commercial	$98.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.48
Rate for Payer: PHP Commercial	$93.48
Rate for Payer: Priority Health Cigna Priority Health	$76.99
Rate for Payer: Priority Health SBD	$69.29

POT BICARB 344 MG-SOD BICARB 1,050 MG-CITRIC ACID 1,000 MG EFFERV TAB

Facility

$148.05

Service Code	NDC 1650056675
Hospital Charge Code	174294
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.24
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Healthscope Commercial	$133.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$125.84
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$103.64
Rate for Payer: Priority Health SBD	$93.27

POVIDONE-IODINE 10 % TOPICAL SOLUTION

Facility

$14.94

Service Code	NDC 52380-1905-8
Hospital Charge Code	6458
Hospital Revenue Code	637
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$13.45
Rate for Payer: Aetna Commercial	$12.70
Rate for Payer: Aetna New Business (MI Preferred)	$9.71
Rate for Payer: Cash Price	$11.95
Rate for Payer: Cofinity Commercial	$10.46
Rate for Payer: Cofinity Commercial	$12.85
Rate for Payer: Healthscope Commercial	$13.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.70
Rate for Payer: PHP Commercial	$12.70
Rate for Payer: Priority Health Cigna Priority Health	$10.46
Rate for Payer: Priority Health SBD	$9.41

POVIDONE-IODINE 10 % TOPICAL SOLUTION

Facility

$21.29

Service Code	NDC 0395-2325-16
Hospital Charge Code	6458
Hospital Revenue Code	637
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$19.16
Rate for Payer: Aetna Commercial	$18.10
Rate for Payer: Aetna New Business (MI Preferred)	$13.84
Rate for Payer: Cash Price	$17.03
Rate for Payer: Cofinity Commercial	$14.90
Rate for Payer: Cofinity Commercial	$18.31
Rate for Payer: Healthscope Commercial	$19.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.10
Rate for Payer: PHP Commercial	$18.10
Rate for Payer: Priority Health Cigna Priority Health	$14.90
Rate for Payer: Priority Health SBD	$13.41

POVIDONE-IODINE 5 % EYE SOLUTION

Facility

$31.82

Service Code	NDC 0065-0411-30
Hospital Charge Code	19791
Hospital Revenue Code	637
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$28.64
Rate for Payer: Aetna Commercial	$27.05
Rate for Payer: Aetna New Business (MI Preferred)	$20.68
Rate for Payer: Cash Price	$25.46
Rate for Payer: Cofinity Commercial	$22.27
Rate for Payer: Cofinity Commercial	$27.37
Rate for Payer: Healthscope Commercial	$28.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.05
Rate for Payer: PHP Commercial	$27.05
Rate for Payer: Priority Health Cigna Priority Health	$22.27
Rate for Payer: Priority Health SBD	$20.05

PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR

Professional

Both

$2,057.00

Service Code	HCPCS 54332
Min. Negotiated Rate	$640.92
Max. Negotiated Rate	$2,967.99
Rate for Payer: Aetna Commercial	$1,298.52
Rate for Payer: BCBS Complete	$672.97
Rate for Payer: BCBS Trust/PPO	$2,967.99
Rate for Payer: Cash Price	$1,645.60
Rate for Payer: Cash Price	$1,645.60
Rate for Payer: Mclaren Medicaid	$640.92
Rate for Payer: Meridian Medicaid	$672.97
Rate for Payer: Priority Health Choice Medicaid	$640.92
Rate for Payer: Priority Health Cigna Priority Health	$1,439.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,606.49
Rate for Payer: Priority Health Narrow Network	$1,606.49
Rate for Payer: Priority Health SBD	$1,606.49

PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS

Professional

Both

$1,739.00

Service Code	HCPCS 54326
Min. Negotiated Rate	$598.53
Max. Negotiated Rate	$2,714.41
Rate for Payer: Aetna Commercial	$1,210.28
Rate for Payer: BCBS Complete	$628.46
Rate for Payer: BCBS Trust/PPO	$2,714.41
Rate for Payer: Cash Price	$1,391.20
Rate for Payer: Cash Price	$1,391.20
Rate for Payer: Mclaren Medicaid	$598.53
Rate for Payer: Meridian Medicaid	$628.46
Rate for Payer: Priority Health Choice Medicaid	$598.53
Rate for Payer: Priority Health Cigna Priority Health	$1,217.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,500.04
Rate for Payer: Priority Health Narrow Network	$1,500.04
Rate for Payer: Priority Health SBD	$1,500.04

PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT

Professional

Both

$4,902.00

Service Code	HCPCS 54322
Min. Negotiated Rate	$362.41
Max. Negotiated Rate	$3,431.40
Rate for Payer: Aetna Commercial	$1,003.62
Rate for Payer: BCBS Complete	$521.56
Rate for Payer: BCBS Trust/PPO	$362.41
Rate for Payer: Cash Price	$3,921.60
Rate for Payer: Cash Price	$3,921.60
Rate for Payer: Mclaren Medicaid	$496.72
Rate for Payer: Meridian Medicaid	$521.56
Rate for Payer: Priority Health Choice Medicaid	$496.72
Rate for Payer: Priority Health Cigna Priority Health	$3,431.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,245.52
Rate for Payer: Priority Health Narrow Network	$1,245.52
Rate for Payer: Priority Health SBD	$1,245.52

Know your out-of-pocket cost for care.

All Charges