Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$1,228.50

Service Code	NDC 63739-478-01
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$773.96
Max. Negotiated Rate	$1,105.65
Rate for Payer: Aetna Commercial	$1,044.22
Rate for Payer: Aetna New Business (MI Preferred)	$798.52
Rate for Payer: Cash Price	$982.80
Rate for Payer: Cofinity Commercial	$1,056.51
Rate for Payer: Cofinity Commercial	$859.95
Rate for Payer: Healthscope Commercial	$1,105.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,044.22
Rate for Payer: PHP Commercial	$1,044.22
Rate for Payer: Priority Health Cigna Priority Health	$859.95
Rate for Payer: Priority Health SBD	$773.96

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$119.70

Service Code	NDC 0904-6457-60
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$75.41
Max. Negotiated Rate	$107.73
Rate for Payer: Aetna Commercial	$101.74
Rate for Payer: Aetna New Business (MI Preferred)	$77.80
Rate for Payer: Cash Price	$95.76
Rate for Payer: Cofinity Commercial	$102.94
Rate for Payer: Cofinity Commercial	$83.79
Rate for Payer: Healthscope Commercial	$107.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$101.74
Rate for Payer: PHP Commercial	$101.74
Rate for Payer: Priority Health Cigna Priority Health	$83.79
Rate for Payer: Priority Health SBD	$75.41

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$27.93

Service Code	NDC 67618-101-10
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$25.14
Rate for Payer: Aetna Commercial	$23.74
Rate for Payer: Aetna New Business (MI Preferred)	$18.15
Rate for Payer: Cash Price	$22.34
Rate for Payer: Cofinity Commercial	$19.55
Rate for Payer: Cofinity Commercial	$24.02
Rate for Payer: Healthscope Commercial	$25.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.74
Rate for Payer: PHP Commercial	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$19.55
Rate for Payer: Priority Health SBD	$17.60

DOCUSATE SODIUM 100 MG CAPSULE

Facility

$189.00

Service Code	NDC 63739-478-10
Hospital Charge Code	2566
Hospital Revenue Code	637
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$170.10
Rate for Payer: Aetna Commercial	$160.65
Rate for Payer: Aetna New Business (MI Preferred)	$122.85
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cofinity Commercial	$132.30
Rate for Payer: Cofinity Commercial	$162.54
Rate for Payer: Healthscope Commercial	$170.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$160.65
Rate for Payer: PHP Commercial	$160.65
Rate for Payer: Priority Health Cigna Priority Health	$132.30
Rate for Payer: Priority Health SBD	$119.07

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$3.61

Service Code	NDC 50383-771-11
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$3.07
Rate for Payer: Aetna New Business (MI Preferred)	$2.35
Rate for Payer: Cash Price	$2.89
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.07
Rate for Payer: PHP Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.53
Rate for Payer: Priority Health SBD	$2.27

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$3.90

Service Code	NDC 0121-0544-10
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$3.32
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cofinity Commercial	$3.35
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Healthscope Commercial	$3.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.32
Rate for Payer: PHP Commercial	$3.32
Rate for Payer: Priority Health Cigna Priority Health	$2.73
Rate for Payer: Priority Health SBD	$2.46

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.26

Service Code	NDC 0121-1870-00
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna New Business (MI Preferred)	$5.37
Rate for Payer: Cash Price	$6.61
Rate for Payer: Cofinity Commercial	$5.78
Rate for Payer: Cofinity Commercial	$7.10
Rate for Payer: Healthscope Commercial	$7.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.02
Rate for Payer: PHP Commercial	$7.02
Rate for Payer: Priority Health Cigna Priority Health	$5.78
Rate for Payer: Priority Health SBD	$5.20

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$8.26

Service Code	NDC 0121-1870-10
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$7.43
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna New Business (MI Preferred)	$5.37
Rate for Payer: Cash Price	$6.61
Rate for Payer: Cofinity Commercial	$5.78
Rate for Payer: Cofinity Commercial	$7.10
Rate for Payer: Healthscope Commercial	$7.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.02
Rate for Payer: PHP Commercial	$7.02
Rate for Payer: Priority Health Cigna Priority Health	$5.78
Rate for Payer: Priority Health SBD	$5.20

DOCUSATE SODIUM 50 MG/5 ML ORAL LIQUID

Facility

$3.61

Service Code	NDC 50383-771-10
Hospital Charge Code	36962
Hospital Revenue Code	637
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$3.07
Rate for Payer: Aetna New Business (MI Preferred)	$2.35
Rate for Payer: Cash Price	$2.89
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.07
Rate for Payer: PHP Commercial	$3.07
Rate for Payer: Priority Health Cigna Priority Health	$2.53
Rate for Payer: Priority Health SBD	$2.27

DOFETILIDE 125 MCG CAPSULE

Facility

$613.02

Service Code	NDC 0904-6681-08
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$386.20
Max. Negotiated Rate	$551.72
Rate for Payer: Aetna Commercial	$521.07
Rate for Payer: Aetna New Business (MI Preferred)	$398.46
Rate for Payer: Cash Price	$490.42
Rate for Payer: Cofinity Commercial	$429.11
Rate for Payer: Cofinity Commercial	$527.20
Rate for Payer: Healthscope Commercial	$551.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$521.07
Rate for Payer: PHP Commercial	$521.07
Rate for Payer: Priority Health Cigna Priority Health	$429.11
Rate for Payer: Priority Health SBD	$386.20

DOFETILIDE 125 MCG CAPSULE

Facility

$2,287.94

Service Code	NDC 0069-5800-60
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$1,441.40
Max. Negotiated Rate	$2,059.15
Rate for Payer: Aetna Commercial	$1,944.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,487.16
Rate for Payer: Cash Price	$1,830.35
Rate for Payer: Cofinity Commercial	$1,601.56
Rate for Payer: Cofinity Commercial	$1,967.63
Rate for Payer: Healthscope Commercial	$2,059.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,944.75
Rate for Payer: PHP Commercial	$1,944.75
Rate for Payer: Priority Health Cigna Priority Health	$1,601.56
Rate for Payer: Priority Health SBD	$1,441.40

DOFETILIDE 125 MCG CAPSULE

Facility

$437.76

Service Code	NDC 69452-131-17
Hospital Charge Code	26965
Hospital Revenue Code	637
Min. Negotiated Rate	$275.79
Max. Negotiated Rate	$393.98
Rate for Payer: Aetna Commercial	$372.10
Rate for Payer: Aetna New Business (MI Preferred)	$284.54
Rate for Payer: Cash Price	$350.21
Rate for Payer: Cofinity Commercial	$306.43
Rate for Payer: Cofinity Commercial	$376.47
Rate for Payer: Healthscope Commercial	$393.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$372.10
Rate for Payer: PHP Commercial	$372.10
Rate for Payer: Priority Health Cigna Priority Health	$306.43
Rate for Payer: Priority Health SBD	$275.79

DOFETILIDE 250 MCG CAPSULE

Facility

$0.94

Service Code	NDC 0069-5810-43
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna Commercial	$0.80
Rate for Payer: Aetna New Business (MI Preferred)	$0.61
Rate for Payer: Cash Price	$0.75
Rate for Payer: Cofinity Commercial	$0.66
Rate for Payer: Cofinity Commercial	$0.81
Rate for Payer: Healthscope Commercial	$0.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$0.80
Rate for Payer: PHP Commercial	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.66
Rate for Payer: Priority Health SBD	$0.59

DOFETILIDE 250 MCG CAPSULE

Facility

$437.76

Service Code	NDC 69452-132-17
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$275.79
Max. Negotiated Rate	$393.98
Rate for Payer: Aetna Commercial	$372.10
Rate for Payer: Aetna New Business (MI Preferred)	$284.54
Rate for Payer: Cash Price	$350.21
Rate for Payer: Cofinity Commercial	$306.43
Rate for Payer: Cofinity Commercial	$376.47
Rate for Payer: Healthscope Commercial	$393.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$372.10
Rate for Payer: PHP Commercial	$372.10
Rate for Payer: Priority Health Cigna Priority Health	$306.43
Rate for Payer: Priority Health SBD	$275.79

DOFETILIDE 250 MCG CAPSULE

Facility

$604.73

Service Code	NDC 0904-6682-08
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$380.98
Max. Negotiated Rate	$544.26
Rate for Payer: Aetna Commercial	$514.02
Rate for Payer: Aetna New Business (MI Preferred)	$393.07
Rate for Payer: Cash Price	$483.78
Rate for Payer: Cofinity Commercial	$423.31
Rate for Payer: Cofinity Commercial	$520.07
Rate for Payer: Healthscope Commercial	$544.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$514.02
Rate for Payer: PHP Commercial	$514.02
Rate for Payer: Priority Health Cigna Priority Health	$423.31
Rate for Payer: Priority Health SBD	$380.98

DOFETILIDE 250 MCG CAPSULE

Facility

$2,287.94

Service Code	NDC 0069-5810-60
Hospital Charge Code	26966
Hospital Revenue Code	637
Min. Negotiated Rate	$1,441.40
Max. Negotiated Rate	$2,059.15
Rate for Payer: Aetna Commercial	$1,944.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,487.16
Rate for Payer: Cash Price	$1,830.35
Rate for Payer: Cofinity Commercial	$1,601.56
Rate for Payer: Cofinity Commercial	$1,967.63
Rate for Payer: Healthscope Commercial	$2,059.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,944.75
Rate for Payer: PHP Commercial	$1,944.75
Rate for Payer: Priority Health Cigna Priority Health	$1,601.56
Rate for Payer: Priority Health SBD	$1,441.40

DOLUTEGRAVIR 50 MG TABLET

Facility

$8,143.63

Service Code	NDC 49702-228-13
Hospital Charge Code	167672
Hospital Revenue Code	637
Min. Negotiated Rate	$5,130.49
Max. Negotiated Rate	$7,329.27
Rate for Payer: Aetna Commercial	$6,922.09
Rate for Payer: Aetna New Business (MI Preferred)	$5,293.36
Rate for Payer: Cash Price	$6,514.90
Rate for Payer: Cofinity Commercial	$5,700.54
Rate for Payer: Cofinity Commercial	$7,003.52
Rate for Payer: Healthscope Commercial	$7,329.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,922.09
Rate for Payer: PHP Commercial	$6,922.09
Rate for Payer: Priority Health Cigna Priority Health	$5,700.54
Rate for Payer: Priority Health SBD	$5,130.49

DONEPEZIL 10 MG TABLET

Facility

$220.90

Service Code	NDC 0904-6478-61
Hospital Charge Code	18787
Hospital Revenue Code	637
Min. Negotiated Rate	$139.17
Max. Negotiated Rate	$198.81
Rate for Payer: Aetna Commercial	$187.76
Rate for Payer: Aetna New Business (MI Preferred)	$143.58
Rate for Payer: Cash Price	$176.72
Rate for Payer: Cofinity Commercial	$154.63
Rate for Payer: Cofinity Commercial	$189.97
Rate for Payer: Healthscope Commercial	$198.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$187.76
Rate for Payer: PHP Commercial	$187.76
Rate for Payer: Priority Health Cigna Priority Health	$154.63
Rate for Payer: Priority Health SBD	$139.17

DONEPEZIL 5 MG TABLET

Facility

$42.30

Service Code	NDC 43547-275-03
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$38.07
Rate for Payer: Aetna Commercial	$35.96
Rate for Payer: Aetna New Business (MI Preferred)	$27.50
Rate for Payer: Cash Price	$33.84
Rate for Payer: Cofinity Commercial	$29.61
Rate for Payer: Cofinity Commercial	$36.38
Rate for Payer: Healthscope Commercial	$38.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$35.96
Rate for Payer: PHP Commercial	$35.96
Rate for Payer: Priority Health Cigna Priority Health	$29.61
Rate for Payer: Priority Health SBD	$26.65

DONEPEZIL 5 MG TABLET

Facility

$256.15

Service Code	NDC 0904-6477-61
Hospital Charge Code	18786
Hospital Revenue Code	637
Min. Negotiated Rate	$161.37
Max. Negotiated Rate	$230.54
Rate for Payer: Aetna Commercial	$217.73
Rate for Payer: Aetna New Business (MI Preferred)	$166.50
Rate for Payer: Cash Price	$204.92
Rate for Payer: Cofinity Commercial	$179.30
Rate for Payer: Cofinity Commercial	$220.29
Rate for Payer: Healthscope Commercial	$230.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$217.73
Rate for Payer: PHP Commercial	$217.73
Rate for Payer: Priority Health Cigna Priority Health	$179.30
Rate for Payer: Priority Health SBD	$161.37

DOPAMINE 200 MG/5 ML (40 MG/ML) INTRAVENOUS SOLUTION

Facility

$18.80

Service Code	HCPCS J1265
Hospital Charge Code	2595
Hospital Revenue Code	636
Min. Negotiated Rate	$11.84
Max. Negotiated Rate	$16.92
Rate for Payer: Aetna Commercial	$15.98
Rate for Payer: Aetna Commercial	$16.26
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Aetna New Business (MI Preferred)	$12.22
Rate for Payer: Cash Price	$15.04
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Commercial	$13.39
Rate for Payer: Cofinity Commercial	$13.16
Rate for Payer: Cofinity Commercial	$16.17
Rate for Payer: Cofinity Commercial	$16.45
Rate for Payer: Healthscope Commercial	$16.92
Rate for Payer: Healthscope Commercial	$17.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.98
Rate for Payer: PHP Commercial	$15.98
Rate for Payer: PHP Commercial	$16.26
Rate for Payer: Priority Health Cigna Priority Health	$13.39
Rate for Payer: Priority Health Cigna Priority Health	$13.16
Rate for Payer: Priority Health SBD	$11.84
Rate for Payer: Priority Health SBD	$12.05

DOPAMINE 400 MG/250 ML (1,600 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS SOLN

Facility

$66.56

Service Code	HCPCS J1265
Hospital Charge Code	14845
Hospital Revenue Code	636
Min. Negotiated Rate	$41.93
Max. Negotiated Rate	$59.90
Rate for Payer: Aetna Commercial	$56.58
Rate for Payer: Aetna Commercial	$60.48
Rate for Payer: Aetna New Business (MI Preferred)	$46.25
Rate for Payer: Aetna New Business (MI Preferred)	$43.26
Rate for Payer: Cash Price	$53.25
Rate for Payer: Cash Price	$56.92
Rate for Payer: Cofinity Commercial	$57.24
Rate for Payer: Cofinity Commercial	$46.59
Rate for Payer: Cofinity Commercial	$49.80
Rate for Payer: Cofinity Commercial	$61.19
Rate for Payer: Healthscope Commercial	$59.90
Rate for Payer: Healthscope Commercial	$64.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.58
Rate for Payer: PHP Commercial	$60.48
Rate for Payer: PHP Commercial	$56.58
Rate for Payer: Priority Health Cigna Priority Health	$46.59
Rate for Payer: Priority Health Cigna Priority Health	$49.80
Rate for Payer: Priority Health SBD	$41.93
Rate for Payer: Priority Health SBD	$44.82

DOPAMINE 400 MG/5 ML (80 MG/ML) INTRAVENOUS SOLUTION

Facility

$22.65

Service Code	HCPCS J1265
Hospital Charge Code	118602
Hospital Revenue Code	636
Min. Negotiated Rate	$14.27
Max. Negotiated Rate	$20.38
Rate for Payer: Aetna Commercial	$19.25
Rate for Payer: Aetna New Business (MI Preferred)	$14.72
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cofinity Commercial	$15.86
Rate for Payer: Cofinity Commercial	$19.48
Rate for Payer: Healthscope Commercial	$20.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.25
Rate for Payer: PHP Commercial	$19.25
Rate for Payer: Priority Health Cigna Priority Health	$15.86
Rate for Payer: Priority Health SBD	$14.27

DORNASE ALFA 1 MG/ML SOLUTION FOR INHALATION

Facility

$446.92

Service Code	HCPCS J7639
Hospital Charge Code	12211
Hospital Revenue Code	250
Min. Negotiated Rate	$281.56
Max. Negotiated Rate	$402.23
Rate for Payer: Aetna Commercial	$379.88
Rate for Payer: Aetna New Business (MI Preferred)	$290.50
Rate for Payer: Cash Price	$357.54
Rate for Payer: Cofinity Commercial	$312.84
Rate for Payer: Cofinity Commercial	$384.35
Rate for Payer: Healthscope Commercial	$402.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$379.88
Rate for Payer: PHP Commercial	$379.88
Rate for Payer: Priority Health Cigna Priority Health	$312.84
Rate for Payer: Priority Health SBD	$281.56

DORZOLAMIDE 22.3 MG-TIMOLOL 6.8 MG/ML EYE DROPS

Facility

$162.75

Service Code	NDC 50383-233-10
Hospital Charge Code	22982
Hospital Revenue Code	637
Min. Negotiated Rate	$102.53
Max. Negotiated Rate	$146.48
Rate for Payer: Aetna Commercial	$138.34
Rate for Payer: Aetna New Business (MI Preferred)	$105.79
Rate for Payer: Cash Price	$130.20
Rate for Payer: Cofinity Commercial	$113.92
Rate for Payer: Cofinity Commercial	$139.96
Rate for Payer: Healthscope Commercial	$146.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$138.34
Rate for Payer: PHP Commercial	$138.34
Rate for Payer: Priority Health Cigna Priority Health	$113.92
Rate for Payer: Priority Health SBD	$102.53

Know your out-of-pocket cost for care.

All Charges