Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIAZEPAM 10 MG TABLET

Facility

$1.58

Service Code	NDC 51079-286-01
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna Commercial	$1.34
Rate for Payer: Aetna New Business (MI Preferred)	$1.03
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cofinity Commercial	$1.11
Rate for Payer: Cofinity Commercial	$1.36
Rate for Payer: Healthscope Commercial	$1.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.34
Rate for Payer: PHP Commercial	$1.34
Rate for Payer: Priority Health Cigna Priority Health	$1.11
Rate for Payer: Priority Health SBD	$1.00

DIAZEPAM 10 MG TABLET

Facility

$56.40

Service Code	NDC 0172-3927-60
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$35.53
Max. Negotiated Rate	$50.76
Rate for Payer: Aetna Commercial	$47.94
Rate for Payer: Aetna New Business (MI Preferred)	$36.66
Rate for Payer: Cash Price	$45.12
Rate for Payer: Cofinity Commercial	$39.48
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Healthscope Commercial	$50.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.94
Rate for Payer: PHP Commercial	$47.94
Rate for Payer: Priority Health Cigna Priority Health	$39.48
Rate for Payer: Priority Health SBD	$35.53

DIAZEPAM 10 MG TABLET

Facility

$157.45

Service Code	NDC 51079-286-20
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$99.19
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$133.83
Rate for Payer: Aetna New Business (MI Preferred)	$102.34
Rate for Payer: Cash Price	$125.96
Rate for Payer: Cofinity Commercial	$110.22
Rate for Payer: Cofinity Commercial	$135.41
Rate for Payer: Healthscope Commercial	$141.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$133.83
Rate for Payer: PHP Commercial	$133.83
Rate for Payer: Priority Health Cigna Priority Health	$110.22
Rate for Payer: Priority Health SBD	$99.19

DIAZEPAM 2 MG TABLET

Facility

$138.65

Service Code	NDC 51079-284-20
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Cofinity Commercial	$97.06
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$117.85
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$97.06
Rate for Payer: Priority Health SBD	$87.35

DIAZEPAM 2 MG TABLET

Facility

$1.39

Service Code	NDC 51079-284-01
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.25
Rate for Payer: Aetna Commercial	$1.18
Rate for Payer: Aetna New Business (MI Preferred)	$0.90
Rate for Payer: Cash Price	$1.11
Rate for Payer: Cofinity Commercial	$0.97
Rate for Payer: Cofinity Commercial	$1.20
Rate for Payer: Healthscope Commercial	$1.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.18
Rate for Payer: PHP Commercial	$1.18
Rate for Payer: Priority Health Cigna Priority Health	$0.97
Rate for Payer: Priority Health SBD	$0.88

DIAZEPAM 2 MG TABLET

Facility

$47.00

Service Code	NDC 0172-3925-60
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna Commercial	$39.95
Rate for Payer: Aetna New Business (MI Preferred)	$30.55
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$32.90
Rate for Payer: Cofinity Commercial	$40.42
Rate for Payer: Healthscope Commercial	$42.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.95
Rate for Payer: PHP Commercial	$39.95
Rate for Payer: Priority Health Cigna Priority Health	$32.90
Rate for Payer: Priority Health SBD	$29.61

DIAZEPAM 5 MG TABLET

Facility

$98.70

Service Code	NDC 63739-073-10
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$62.18
Max. Negotiated Rate	$88.83
Rate for Payer: Aetna Commercial	$83.90
Rate for Payer: Aetna New Business (MI Preferred)	$64.16
Rate for Payer: Cash Price	$78.96
Rate for Payer: Cofinity Commercial	$69.09
Rate for Payer: Cofinity Commercial	$84.88
Rate for Payer: Healthscope Commercial	$88.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.90
Rate for Payer: PHP Commercial	$83.90
Rate for Payer: Priority Health Cigna Priority Health	$69.09
Rate for Payer: Priority Health SBD	$62.18

DIAZEPAM 5 MG TABLET

Facility

$129.25

Service Code	NDC 51079-285-20
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$116.32
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.48
Rate for Payer: Healthscope Commercial	$116.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$90.48
Rate for Payer: Priority Health SBD	$81.43

DIAZEPAM 5 MG TABLET

Facility

$1.30

Service Code	NDC 51079-285-01
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$1.17
Rate for Payer: Aetna Commercial	$1.10
Rate for Payer: Aetna New Business (MI Preferred)	$0.85
Rate for Payer: Cash Price	$1.04
Rate for Payer: Cofinity Commercial	$0.91
Rate for Payer: Cofinity Commercial	$1.12
Rate for Payer: Healthscope Commercial	$1.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.10
Rate for Payer: PHP Commercial	$1.10
Rate for Payer: Priority Health Cigna Priority Health	$0.91
Rate for Payer: Priority Health SBD	$0.82

DIAZEPAM 5 MG TABLET

Facility

$63.45

Service Code	NDC 0172-3926-60
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$39.97
Max. Negotiated Rate	$57.10
Rate for Payer: Aetna Commercial	$53.93
Rate for Payer: Aetna New Business (MI Preferred)	$41.24
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$44.42
Rate for Payer: Cofinity Commercial	$54.57
Rate for Payer: Healthscope Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.93
Rate for Payer: PHP Commercial	$53.93
Rate for Payer: Priority Health Cigna Priority Health	$44.42
Rate for Payer: Priority Health SBD	$39.97

DICLOFENAC 1 % TOPICAL GEL

Facility

$176.75

Service Code	NDC 63481-684-47
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$111.35
Max. Negotiated Rate	$159.08
Rate for Payer: Aetna Commercial	$150.24
Rate for Payer: Aetna New Business (MI Preferred)	$114.89
Rate for Payer: Cash Price	$141.40
Rate for Payer: Cofinity Commercial	$123.72
Rate for Payer: Cofinity Commercial	$152.00
Rate for Payer: Healthscope Commercial	$159.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$150.24
Rate for Payer: PHP Commercial	$150.24
Rate for Payer: Priority Health Cigna Priority Health	$123.72
Rate for Payer: Priority Health SBD	$111.35

DICLOFENAC 1 % TOPICAL GEL

Facility

$63.35

Service Code	NDC 0067-8152-03
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$39.91
Max. Negotiated Rate	$57.02
Rate for Payer: Aetna Commercial	$53.85
Rate for Payer: Aetna New Business (MI Preferred)	$41.18
Rate for Payer: Cash Price	$50.68
Rate for Payer: Cofinity Commercial	$44.34
Rate for Payer: Cofinity Commercial	$54.48
Rate for Payer: Healthscope Commercial	$57.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$53.85
Rate for Payer: PHP Commercial	$53.85
Rate for Payer: Priority Health Cigna Priority Health	$44.34
Rate for Payer: Priority Health SBD	$39.91

DICLOFENAC 1 % TOPICAL GEL

Facility

$54.25

Service Code	NDC 41167-0574-3
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Commercial	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Healthscope Commercial	$48.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$46.11
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health Cigna Priority Health	$37.98
Rate for Payer: Priority Health SBD	$34.18

DICLOFENAC 1 % TOPICAL GEL

Facility

$49.00

Service Code	NDC 65162-833-66
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$30.87
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Commercial	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.65
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health Cigna Priority Health	$34.30
Rate for Payer: Priority Health SBD	$30.87

DICLOFENAC 1 % TOPICAL GEL

Facility

$26.95

Service Code	NDC 70000-0555-2
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$24.26
Rate for Payer: Aetna Commercial	$22.91
Rate for Payer: Aetna New Business (MI Preferred)	$17.52
Rate for Payer: Cash Price	$21.56
Rate for Payer: Cofinity Commercial	$18.86
Rate for Payer: Cofinity Commercial	$23.18
Rate for Payer: Healthscope Commercial	$24.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.91
Rate for Payer: PHP Commercial	$22.91
Rate for Payer: Priority Health Cigna Priority Health	$18.86
Rate for Payer: Priority Health SBD	$16.98

DICLOFENAC 1 % TOPICAL GEL

Facility

$32.90

Service Code	NDC 69097-524-44
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$20.73
Max. Negotiated Rate	$29.61
Rate for Payer: Aetna Commercial	$27.96
Rate for Payer: Aetna New Business (MI Preferred)	$21.38
Rate for Payer: Cash Price	$26.32
Rate for Payer: Cofinity Commercial	$23.03
Rate for Payer: Cofinity Commercial	$28.29
Rate for Payer: Healthscope Commercial	$29.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.96
Rate for Payer: PHP Commercial	$27.96
Rate for Payer: Priority Health Cigna Priority Health	$23.03
Rate for Payer: Priority Health SBD	$20.73

DICLOFENAC 1 % TOPICAL GEL

Facility

$49.00

Service Code	NDC 45802-160-00
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$30.87
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Commercial	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.65
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health Cigna Priority Health	$34.30
Rate for Payer: Priority Health SBD	$30.87

DICLOFENAC 1 % TOPICAL GEL

Facility

$36.75

Service Code	NDC 57896-140-01
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$23.15
Max. Negotiated Rate	$33.08
Rate for Payer: Aetna Commercial	$31.24
Rate for Payer: Aetna New Business (MI Preferred)	$23.89
Rate for Payer: Cash Price	$29.40
Rate for Payer: Cofinity Commercial	$25.72
Rate for Payer: Cofinity Commercial	$31.60
Rate for Payer: Healthscope Commercial	$33.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.24
Rate for Payer: PHP Commercial	$31.24
Rate for Payer: Priority Health Cigna Priority Health	$25.72
Rate for Payer: Priority Health SBD	$23.15

DICLOFENAC 1 % TOPICAL GEL

Facility

$41.65

Service Code	NDC 0536-1294-97
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$37.48
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Aetna New Business (MI Preferred)	$27.07
Rate for Payer: Cash Price	$33.32
Rate for Payer: Cofinity Commercial	$29.16
Rate for Payer: Cofinity Commercial	$35.82
Rate for Payer: Healthscope Commercial	$37.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.40
Rate for Payer: PHP Commercial	$35.40
Rate for Payer: Priority Health Cigna Priority Health	$29.16
Rate for Payer: Priority Health SBD	$26.24

DICLOFENAC 1 % TOPICAL GEL

Facility

$14.85

Service Code	NDC 76282-663-39
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$13.36
Rate for Payer: Aetna Commercial	$12.62
Rate for Payer: Aetna New Business (MI Preferred)	$9.65
Rate for Payer: Cash Price	$11.88
Rate for Payer: Cofinity Commercial	$10.40
Rate for Payer: Cofinity Commercial	$12.77
Rate for Payer: Healthscope Commercial	$13.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.62
Rate for Payer: PHP Commercial	$12.62
Rate for Payer: Priority Health Cigna Priority Health	$10.40
Rate for Payer: Priority Health SBD	$9.36

DICLOFENAC 1 % TOPICAL GEL

Facility

$37.80

Service Code	NDC 45802-953-01
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$23.81
Max. Negotiated Rate	$34.02
Rate for Payer: Aetna Commercial	$32.13
Rate for Payer: Aetna New Business (MI Preferred)	$24.57
Rate for Payer: Cash Price	$30.24
Rate for Payer: Cofinity Commercial	$26.46
Rate for Payer: Cofinity Commercial	$32.51
Rate for Payer: Healthscope Commercial	$34.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.13
Rate for Payer: PHP Commercial	$32.13
Rate for Payer: Priority Health Cigna Priority Health	$26.46
Rate for Payer: Priority Health SBD	$23.81

DICLOFENAC 1 % TOPICAL GEL

Facility

$56.00

Service Code	NDC 2586659361
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna Commercial	$47.60
Rate for Payer: Aetna New Business (MI Preferred)	$36.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cofinity Commercial	$39.20
Rate for Payer: Cofinity Commercial	$48.16
Rate for Payer: Healthscope Commercial	$50.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$47.60
Rate for Payer: PHP Commercial	$47.60
Rate for Payer: Priority Health Cigna Priority Health	$39.20
Rate for Payer: Priority Health SBD	$35.28

DICLOFENAC 1 % TOPICAL GEL

Facility

$53.20

Service Code	NDC 43598-977-10
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$33.52
Max. Negotiated Rate	$47.88
Rate for Payer: Aetna Commercial	$45.22
Rate for Payer: Aetna New Business (MI Preferred)	$34.58
Rate for Payer: Cash Price	$42.56
Rate for Payer: Cofinity Commercial	$37.24
Rate for Payer: Cofinity Commercial	$45.75
Rate for Payer: Healthscope Commercial	$47.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$45.22
Rate for Payer: PHP Commercial	$45.22
Rate for Payer: Priority Health Cigna Priority Health	$37.24
Rate for Payer: Priority Health SBD	$33.52

DICLOFENAC SODIUM 25 MG TABLET,DELAYED RELEASE

Facility

$417.60

Service Code	NDC 16571-203-10
Hospital Charge Code	15339
Hospital Revenue Code	637
Min. Negotiated Rate	$263.09
Max. Negotiated Rate	$375.84
Rate for Payer: Aetna Commercial	$354.96
Rate for Payer: Aetna New Business (MI Preferred)	$271.44
Rate for Payer: Cash Price	$334.08
Rate for Payer: Cofinity Commercial	$292.32
Rate for Payer: Cofinity Commercial	$359.14
Rate for Payer: Healthscope Commercial	$375.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$354.96
Rate for Payer: PHP Commercial	$354.96
Rate for Payer: Priority Health Cigna Priority Health	$292.32
Rate for Payer: Priority Health SBD	$263.09

DICLOFENAC SODIUM 25 MG TABLET,DELAYED RELEASE

Facility

$479.04

Service Code	NDC 0781-1785-01
Hospital Charge Code	15339
Hospital Revenue Code	637
Min. Negotiated Rate	$301.80
Max. Negotiated Rate	$431.14
Rate for Payer: Aetna Commercial	$407.18
Rate for Payer: Aetna New Business (MI Preferred)	$311.38
Rate for Payer: Cash Price	$383.23
Rate for Payer: Cofinity Commercial	$335.33
Rate for Payer: Cofinity Commercial	$411.97
Rate for Payer: Healthscope Commercial	$431.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$407.18
Rate for Payer: PHP Commercial	$407.18
Rate for Payer: Priority Health Cigna Priority Health	$335.33
Rate for Payer: Priority Health SBD	$301.80

Know your out-of-pocket cost for care.

All Charges