Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID

Facility

$80.94

Service Code	NDC 6056906204
Hospital Charge Code	108397
Hospital Revenue Code	637
Min. Negotiated Rate	$50.99
Max. Negotiated Rate	$72.85
Rate for Payer: Aetna Commercial	$68.80
Rate for Payer: Aetna New Business (MI Preferred)	$52.61
Rate for Payer: Cash Price	$64.75
Rate for Payer: Cofinity Commercial	$56.66
Rate for Payer: Cofinity Commercial	$69.61
Rate for Payer: Healthscope Commercial	$72.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$68.80
Rate for Payer: PHP Commercial	$68.80
Rate for Payer: Priority Health Cigna Priority Health	$56.66
Rate for Payer: Priority Health SBD	$50.99

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID

Facility

$84.70

Service Code	NDC 61787-062-04
Hospital Charge Code	108397
Hospital Revenue Code	637
Min. Negotiated Rate	$53.36
Max. Negotiated Rate	$76.23
Rate for Payer: Aetna Commercial	$72.00
Rate for Payer: Aetna New Business (MI Preferred)	$55.06
Rate for Payer: Cash Price	$67.76
Rate for Payer: Cofinity Commercial	$59.29
Rate for Payer: Cofinity Commercial	$72.84
Rate for Payer: Healthscope Commercial	$76.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$72.00
Rate for Payer: PHP Commercial	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$59.29
Rate for Payer: Priority Health SBD	$53.36

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL LIQUID

Facility

$53.63

Service Code	NDC 0904-6759-20
Hospital Charge Code	108397
Hospital Revenue Code	637
Min. Negotiated Rate	$33.79
Max. Negotiated Rate	$48.27
Rate for Payer: Aetna Commercial	$45.59
Rate for Payer: Aetna New Business (MI Preferred)	$34.86
Rate for Payer: Cash Price	$42.90
Rate for Payer: Cofinity Commercial	$37.54
Rate for Payer: Cofinity Commercial	$46.12
Rate for Payer: Healthscope Commercial	$48.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.59
Rate for Payer: PHP Commercial	$45.59
Rate for Payer: Priority Health Cigna Priority Health	$37.54
Rate for Payer: Priority Health SBD	$33.79

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP

Facility

$8.74

Service Code	NDC 0121-1276-10
Hospital Charge Code	9774
Hospital Revenue Code	637
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$7.87
Rate for Payer: Aetna Commercial	$7.43
Rate for Payer: Aetna New Business (MI Preferred)	$5.68
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cofinity Commercial	$6.12
Rate for Payer: Cofinity Commercial	$7.52
Rate for Payer: Healthscope Commercial	$7.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.43
Rate for Payer: PHP Commercial	$7.43
Rate for Payer: Priority Health Cigna Priority Health	$6.12
Rate for Payer: Priority Health SBD	$5.51

DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP

Facility

$8.74

Service Code	NDC 0121-1276-00
Hospital Charge Code	9774
Hospital Revenue Code	637
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$7.87
Rate for Payer: Aetna Commercial	$7.43
Rate for Payer: Aetna New Business (MI Preferred)	$5.68
Rate for Payer: Cash Price	$6.99
Rate for Payer: Cofinity Commercial	$6.12
Rate for Payer: Cofinity Commercial	$7.52
Rate for Payer: Healthscope Commercial	$7.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.43
Rate for Payer: PHP Commercial	$7.43
Rate for Payer: Priority Health Cigna Priority Health	$6.12
Rate for Payer: Priority Health SBD	$5.51

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0023-04
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0023-03
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION

Facility

$61.18

Service Code	NDC 0338-0023-02
Hospital Charge Code	2357
Hospital Revenue Code	250
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.00
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$42.83
Rate for Payer: Priority Health SBD	$38.54

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 0338-0023-04
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$69.92

Service Code	NDC 0338-0023-03
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION (DOSE REQUIRED)

Facility

$61.18

Service Code	NDC 0338-0023-02
Hospital Charge Code	300135
Hospital Revenue Code	250
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.00
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: Priority Health Cigna Priority Health	$42.83
Rate for Payer: Priority Health SBD	$38.54

DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION MAXIMUM RATE 250 MR

Facility

$69.92

Service Code	NDC 0338-0023-04
Hospital Charge Code	300148
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 10 % IV BOLUS

Facility

$59.82

Service Code	NDC 0264-7520-20
Hospital Charge Code	400302
Hospital Revenue Code	250
Min. Negotiated Rate	$37.69
Max. Negotiated Rate	$53.84
Rate for Payer: Aetna Commercial	$50.85
Rate for Payer: Aetna New Business (MI Preferred)	$38.88
Rate for Payer: Cash Price	$47.86
Rate for Payer: Cofinity Commercial	$41.87
Rate for Payer: Cofinity Commercial	$51.45
Rate for Payer: Healthscope Commercial	$53.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$50.85
Rate for Payer: PHP Commercial	$50.85
Rate for Payer: Priority Health Cigna Priority Health	$41.87
Rate for Payer: Priority Health SBD	$37.69

DEXTROSE 2.45 GRAM-SOD CITRATE 2.2 GRAM-CITRIC AC 730 MG/100 ML SOLN

Facility

$79.75

Service Code	NDC 0942-0641-04
Hospital Charge Code	167293
Hospital Revenue Code	250
Min. Negotiated Rate	$50.24
Max. Negotiated Rate	$71.78
Rate for Payer: Aetna Commercial	$67.79
Rate for Payer: Aetna New Business (MI Preferred)	$51.84
Rate for Payer: Cash Price	$63.80
Rate for Payer: Cofinity Commercial	$55.82
Rate for Payer: Cofinity Commercial	$68.58
Rate for Payer: Healthscope Commercial	$71.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$67.79
Rate for Payer: PHP Commercial	$67.79
Rate for Payer: Priority Health Cigna Priority Health	$55.82
Rate for Payer: Priority Health SBD	$50.24

DEXTROSE 40 % ORAL GEL

Facility

$13.17

Service Code	NDC 574006915
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna New Business (MI Preferred)	$8.56
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cofinity Commercial	$11.33
Rate for Payer: Cofinity Commercial	$9.22
Rate for Payer: Healthscope Commercial	$11.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.19
Rate for Payer: PHP Commercial	$11.19
Rate for Payer: Priority Health Cigna Priority Health	$9.22
Rate for Payer: Priority Health SBD	$8.30

DEXTROSE 40 % ORAL GEL

Facility

$2.81

Service Code	NDC 9900-0019-11
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$2.53
Rate for Payer: Aetna Commercial	$2.39
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.25
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.42
Rate for Payer: Healthscope Commercial	$2.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.39
Rate for Payer: PHP Commercial	$2.39
Rate for Payer: Priority Health Cigna Priority Health	$1.97
Rate for Payer: Priority Health SBD	$1.77

DEXTROSE 40 % ORAL GEL

Facility

$13.17

Service Code	NDC 574006930
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna New Business (MI Preferred)	$8.56
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cofinity Commercial	$11.33
Rate for Payer: Cofinity Commercial	$9.22
Rate for Payer: Healthscope Commercial	$11.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.19
Rate for Payer: PHP Commercial	$11.19
Rate for Payer: Priority Health Cigna Priority Health	$9.22
Rate for Payer: Priority Health SBD	$8.30

DEXTROSE 40 % ORAL GEL

Facility

$13.17

Service Code	NDC 574007030
Hospital Charge Code	27466
Hospital Revenue Code	637
Min. Negotiated Rate	$8.30
Max. Negotiated Rate	$11.85
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna New Business (MI Preferred)	$8.56
Rate for Payer: Cash Price	$10.54
Rate for Payer: Cofinity Commercial	$11.33
Rate for Payer: Cofinity Commercial	$9.22
Rate for Payer: Healthscope Commercial	$11.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.19
Rate for Payer: PHP Commercial	$11.19
Rate for Payer: Priority Health Cigna Priority Health	$9.22
Rate for Payer: Priority Health SBD	$8.30

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$58.22

Service Code	NDC 0409-6648-16
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$49.49
Rate for Payer: Aetna New Business (MI Preferred)	$37.84
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.75
Rate for Payer: Cofinity Commercial	$50.07
Rate for Payer: Healthscope Commercial	$52.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.49
Rate for Payer: PHP Commercial	$49.49
Rate for Payer: Priority Health Cigna Priority Health	$40.75
Rate for Payer: Priority Health SBD	$36.68

DEXTROSE 50 % IN WATER (D50W) INTRAVENOUS SOLUTION

Facility

$58.22

Service Code	NDC 0409-6648-02
Hospital Charge Code	2365
Hospital Revenue Code	250
Min. Negotiated Rate	$36.68
Max. Negotiated Rate	$52.40
Rate for Payer: Aetna Commercial	$49.49
Rate for Payer: Aetna New Business (MI Preferred)	$37.84
Rate for Payer: Cash Price	$46.58
Rate for Payer: Cofinity Commercial	$40.75
Rate for Payer: Cofinity Commercial	$50.07
Rate for Payer: Healthscope Commercial	$52.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.49
Rate for Payer: PHP Commercial	$49.49
Rate for Payer: Priority Health Cigna Priority Health	$40.75
Rate for Payer: Priority Health SBD	$36.68

DEXTROSE 50% IN WATER (D50W) IV SYRINGE (CODE)

Facility

$98.23

Service Code	NDC 76329-3301-1
Hospital Charge Code	163718
Hospital Revenue Code	250
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$83.50
Rate for Payer: Aetna New Business (MI Preferred)	$63.85
Rate for Payer: Cash Price	$78.58
Rate for Payer: Cofinity Commercial	$84.48
Rate for Payer: Cofinity Commercial	$68.76
Rate for Payer: Healthscope Commercial	$88.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.50
Rate for Payer: PHP Commercial	$83.50
Rate for Payer: Priority Health Cigna Priority Health	$68.76
Rate for Payer: Priority Health SBD	$61.88

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0077-04
Hospital Charge Code	9812
Hospital Revenue Code	250
Min. Negotiated Rate	$27.97
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: BCBS Complete	$27.97
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	NDC 0338-0077-03
Hospital Charge Code	9812
Hospital Revenue Code	250
Min. Negotiated Rate	$42.33
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health SBD	$42.33

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$69.92

Service Code	NDC 0338-0077-04
Hospital Charge Code	9812
Hospital Revenue Code	250
Min. Negotiated Rate	$44.05
Max. Negotiated Rate	$62.93
Rate for Payer: Aetna Commercial	$59.43
Rate for Payer: Aetna New Business (MI Preferred)	$45.45
Rate for Payer: Cash Price	$55.94
Rate for Payer: Cofinity Commercial	$48.94
Rate for Payer: Cofinity Commercial	$60.13
Rate for Payer: Healthscope Commercial	$62.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.43
Rate for Payer: PHP Commercial	$59.43
Rate for Payer: Priority Health Cigna Priority Health	$48.94
Rate for Payer: Priority Health SBD	$44.05

DEXTROSE 5 % AND 0.2 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$67.19

Service Code	NDC 0338-0077-03
Hospital Charge Code	9812
Hospital Revenue Code	250
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$60.47
Rate for Payer: Aetna Commercial	$57.11
Rate for Payer: Aetna New Business (MI Preferred)	$43.67
Rate for Payer: BCBS Complete	$26.88
Rate for Payer: Cash Price	$53.75
Rate for Payer: Cofinity Commercial	$47.03
Rate for Payer: Cofinity Commercial	$57.78
Rate for Payer: Healthscope Commercial	$60.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.11
Rate for Payer: PHP Commercial	$57.11
Rate for Payer: Priority Health Cigna Priority Health	$47.03
Rate for Payer: Priority Health SBD	$42.33

Know your out-of-pocket cost for care.

All Charges