Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DOXYCYCLINE HYCLATE 100 MG TABLET

Facility

$6.87

Service Code	NDC 50268-279-11
Hospital Charge Code	2625
Hospital Revenue Code	637
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$6.18
Rate for Payer: Aetna Commercial	$5.84
Rate for Payer: Aetna New Business (MI Preferred)	$4.47
Rate for Payer: Cash Price	$5.50
Rate for Payer: Cofinity Commercial	$4.81
Rate for Payer: Cofinity Commercial	$5.91
Rate for Payer: Healthscope Commercial	$6.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.84
Rate for Payer: PHP Commercial	$5.84
Rate for Payer: Priority Health Cigna Priority Health	$4.81
Rate for Payer: Priority Health SBD	$4.33

DOXYCYCLINE HYCLATE 100 MG TABLET

Facility

$8.28

Service Code	NDC 62584-693-11
Hospital Charge Code	2625
Hospital Revenue Code	637
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$7.04
Rate for Payer: Aetna New Business (MI Preferred)	$5.38
Rate for Payer: Cash Price	$6.62
Rate for Payer: Cofinity Commercial	$5.80
Rate for Payer: Cofinity Commercial	$7.12
Rate for Payer: Healthscope Commercial	$7.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.04
Rate for Payer: PHP Commercial	$7.04
Rate for Payer: Priority Health Cigna Priority Health	$5.80
Rate for Payer: Priority Health SBD	$5.22

DOXYCYCLINE HYCLATE 100 MG TABLET

Facility

$245.20

Service Code	NDC 63739-168-33
Hospital Charge Code	2625
Hospital Revenue Code	637
Min. Negotiated Rate	$154.48
Max. Negotiated Rate	$220.68
Rate for Payer: Aetna Commercial	$208.42
Rate for Payer: Aetna New Business (MI Preferred)	$159.38
Rate for Payer: Cash Price	$196.16
Rate for Payer: Cofinity Commercial	$171.64
Rate for Payer: Cofinity Commercial	$210.87
Rate for Payer: Healthscope Commercial	$220.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$208.42
Rate for Payer: PHP Commercial	$208.42
Rate for Payer: Priority Health Cigna Priority Health	$171.64
Rate for Payer: Priority Health SBD	$154.48

DOXYLAMINE SUCCINATE 25 MG TABLET

Facility

$106.04

Service Code	NDC 70000-0567-1
Hospital Charge Code	14847
Hospital Revenue Code	637
Min. Negotiated Rate	$66.81
Max. Negotiated Rate	$95.44
Rate for Payer: Aetna Commercial	$90.13
Rate for Payer: Aetna New Business (MI Preferred)	$68.93
Rate for Payer: Cash Price	$84.83
Rate for Payer: Cofinity Commercial	$74.23
Rate for Payer: Cofinity Commercial	$91.19
Rate for Payer: Healthscope Commercial	$95.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$90.13
Rate for Payer: PHP Commercial	$90.13
Rate for Payer: Priority Health Cigna Priority Health	$74.23
Rate for Payer: Priority Health SBD	$66.81

DOXYLAMINE SUCCINATE 25 MG TABLET

Facility

$106.25

Service Code	NDC 4116700623
Hospital Charge Code	14847
Hospital Revenue Code	637
Min. Negotiated Rate	$66.94
Max. Negotiated Rate	$95.62
Rate for Payer: Aetna Commercial	$90.31
Rate for Payer: Aetna New Business (MI Preferred)	$69.06
Rate for Payer: Cash Price	$85.00
Rate for Payer: Cofinity Commercial	$74.38
Rate for Payer: Cofinity Commercial	$91.38
Rate for Payer: Healthscope Commercial	$95.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$90.31
Rate for Payer: PHP Commercial	$90.31
Rate for Payer: Priority Health Cigna Priority Health	$74.38
Rate for Payer: Priority Health SBD	$66.94

DRAINAGE OF SCROTAL WALL ABSCESS

Facility

$4,380.96

Service Code	CPT 55100
Hospital Revenue Code	360
Min. Negotiated Rate	$166.01
Max. Negotiated Rate	$4,380.96
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$452.56
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,380.96
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,504.77
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$182.61
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$166.01
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

DRONABINOL 2.5 MG CAPSULE

Facility

$1,219.92

Service Code	NDC 0904-6745-61
Hospital Charge Code	9904
Hospital Revenue Code	637
Min. Negotiated Rate	$768.55
Max. Negotiated Rate	$1,097.93
Rate for Payer: Aetna Commercial	$1,036.93
Rate for Payer: Aetna New Business (MI Preferred)	$792.95
Rate for Payer: Cash Price	$975.94
Rate for Payer: Cofinity Commercial	$1,049.13
Rate for Payer: Cofinity Commercial	$853.94
Rate for Payer: Healthscope Commercial	$1,097.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,036.93
Rate for Payer: PHP Commercial	$1,036.93
Rate for Payer: Priority Health Cigna Priority Health	$853.94
Rate for Payer: Priority Health SBD	$768.55

DRONABINOL 2.5 MG CAPSULE

Facility

$1,498.77

Service Code	NDC 60687-375-01
Hospital Charge Code	9904
Hospital Revenue Code	637
Min. Negotiated Rate	$944.23
Max. Negotiated Rate	$1,348.89
Rate for Payer: Aetna Commercial	$1,273.95
Rate for Payer: Aetna New Business (MI Preferred)	$974.20
Rate for Payer: Cash Price	$1,199.02
Rate for Payer: Cofinity Commercial	$1,049.14
Rate for Payer: Cofinity Commercial	$1,288.94
Rate for Payer: Healthscope Commercial	$1,348.89
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,273.95
Rate for Payer: PHP Commercial	$1,273.95
Rate for Payer: Priority Health Cigna Priority Health	$1,049.14
Rate for Payer: Priority Health SBD	$944.23

DRONABINOL 2.5 MG CAPSULE

Facility

$14.99

Service Code	NDC 60687-375-11
Hospital Charge Code	9904
Hospital Revenue Code	637
Min. Negotiated Rate	$9.44
Max. Negotiated Rate	$13.49
Rate for Payer: Aetna Commercial	$12.74
Rate for Payer: Aetna New Business (MI Preferred)	$9.74
Rate for Payer: Cash Price	$11.99
Rate for Payer: Cofinity Commercial	$10.49
Rate for Payer: Cofinity Commercial	$12.89
Rate for Payer: Healthscope Commercial	$13.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.74
Rate for Payer: PHP Commercial	$12.74
Rate for Payer: Priority Health Cigna Priority Health	$10.49
Rate for Payer: Priority Health SBD	$9.44

DRONEDARONE 400 MG TABLET

Facility

$2,691.09

Service Code	NDC 0024-4142-60
Hospital Charge Code	98329
Hospital Revenue Code	637
Min. Negotiated Rate	$1,695.39
Max. Negotiated Rate	$2,421.98
Rate for Payer: Aetna Commercial	$2,287.43
Rate for Payer: Aetna New Business (MI Preferred)	$1,749.21
Rate for Payer: Cash Price	$2,152.87
Rate for Payer: Cofinity Commercial	$1,883.76
Rate for Payer: Cofinity Commercial	$2,314.34
Rate for Payer: Healthscope Commercial	$2,421.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,287.43
Rate for Payer: PHP Commercial	$2,287.43
Rate for Payer: Priority Health Cigna Priority Health	$1,883.76
Rate for Payer: Priority Health SBD	$1,695.39

DRONEDARONE 400 MG TABLET

Facility

$3,724.79

Service Code	NDC 0024-4142-10
Hospital Charge Code	98329
Hospital Revenue Code	637
Min. Negotiated Rate	$2,346.62
Max. Negotiated Rate	$3,352.31
Rate for Payer: Aetna Commercial	$3,166.07
Rate for Payer: Aetna New Business (MI Preferred)	$2,421.11
Rate for Payer: Cash Price	$2,979.83
Rate for Payer: Cofinity Commercial	$2,607.35
Rate for Payer: Cofinity Commercial	$3,203.32
Rate for Payer: Healthscope Commercial	$3,352.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,166.07
Rate for Payer: PHP Commercial	$3,166.07
Rate for Payer: Priority Health Cigna Priority Health	$2,607.35
Rate for Payer: Priority Health SBD	$2,346.62

DROPERIDOL 2.5 MG/ML INJECTION SOLUTION

Facility

$52.44

Service Code	HCPCS J1790
Hospital Charge Code	2654
Hospital Revenue Code	636
Min. Negotiated Rate	$33.04
Max. Negotiated Rate	$47.20
Rate for Payer: Aetna Commercial	$44.57
Rate for Payer: Aetna New Business (MI Preferred)	$34.09
Rate for Payer: Cash Price	$41.95
Rate for Payer: Cofinity Commercial	$36.71
Rate for Payer: Cofinity Commercial	$45.10
Rate for Payer: Healthscope Commercial	$47.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.57
Rate for Payer: PHP Commercial	$44.57
Rate for Payer: Priority Health Cigna Priority Health	$36.71
Rate for Payer: Priority Health SBD	$33.04

DRUG-INDUCED SLEEP ENDOSCOPY, WITH DYNAMIC EVALUATION OF VELUM, PHARYNX, TONGUE BASE, AND LARYNX FOR EVALUATION OF SLEEP-DISORDERED BREATHING, FLEXIBLE, DIAGNOSTIC

Facility

$1,887.76

Service Code	CPT 42975
Hospital Revenue Code	360
Min. Negotiated Rate	$57.09
Max. Negotiated Rate	$1,887.76
Rate for Payer: Aetna Medicare	$1,570.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,887.76
Rate for Payer: Amish Plain Church Group Commercial	$1,887.76
Rate for Payer: BCBS Complete	$867.46
Rate for Payer: BCBS MAPPO	$1,510.21
Rate for Payer: BCBS Trust/PPO	$57.09
Rate for Payer: BCN Medicare Advantage	$1,510.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,510.21
Rate for Payer: Mclaren Medicaid	$826.08
Rate for Payer: Mclaren Medicare	$1,510.21
Rate for Payer: Meridian Medicaid	$867.46
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,585.72
Rate for Payer: MI Amish Medical Board Commercial	$1,736.74
Rate for Payer: PACE Medicare	$1,434.70
Rate for Payer: PACE SWMI	$1,510.21
Rate for Payer: PHP Medicare Advantage	$1,510.21
Rate for Payer: Priority Health Choice Medicaid	$826.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$512.54
Rate for Payer: Priority Health Medicare	$1,510.21
Rate for Payer: Priority Health Narrow Network	$410.03
Rate for Payer: Railroad Medicare Medicare	$1,510.21
Rate for Payer: UHC All Payor (Choice/PPO)	$104.82
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$1,510.21
Rate for Payer: UHC Exchange	$95.29
Rate for Payer: UHC Medicare Advantage	$1,555.52
Rate for Payer: VA VA	$1,510.21

DRUG TEST PRESUMPTIVE READ BY INSTR ASSISTED DIRECT OPTICAL OBS

Professional

Both

$16.00

Service Code	HCPCS G0478
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$16.78
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.78
Rate for Payer: Priority Health Narrow Network	$16.78
Rate for Payer: Priority Health SBD	$16.78

DRUG TEST PRESUMPTIVE USING IMMUNOASSAY

Professional

Both

$80.00

Service Code	HCPCS G0479
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$67.44
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Priority Health Cigna Priority Health	$56.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.44
Rate for Payer: Priority Health Narrow Network	$67.44
Rate for Payer: Priority Health SBD	$67.44

DRUG TEST(S), PRESUMPTIVE READ BY DIRECT OPTICAL OBSERVATION

Professional

Both

$12.00

Service Code	HCPCS G0477
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$12.82
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.82
Rate for Payer: Priority Health Narrow Network	$12.82
Rate for Payer: Priority Health SBD	$12.82

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$3.93

Service Code	NDC 60687-723-11
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$2.48
Max. Negotiated Rate	$3.54
Rate for Payer: Aetna Commercial	$3.34
Rate for Payer: Aetna New Business (MI Preferred)	$2.55
Rate for Payer: Cash Price	$3.14
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Cofinity Commercial	$3.38
Rate for Payer: Healthscope Commercial	$3.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.34
Rate for Payer: PHP Commercial	$3.34
Rate for Payer: Priority Health Cigna Priority Health	$2.75
Rate for Payer: Priority Health SBD	$2.48

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$1,721.84

Service Code	NDC 0002-3235-60
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$1,084.76
Max. Negotiated Rate	$1,549.66
Rate for Payer: Aetna Commercial	$1,463.56
Rate for Payer: Aetna New Business (MI Preferred)	$1,119.20
Rate for Payer: Cash Price	$1,377.47
Rate for Payer: Cofinity Commercial	$1,205.29
Rate for Payer: Cofinity Commercial	$1,480.78
Rate for Payer: Healthscope Commercial	$1,549.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,463.56
Rate for Payer: PHP Commercial	$1,463.56
Rate for Payer: Priority Health Cigna Priority Health	$1,205.29
Rate for Payer: Priority Health SBD	$1,084.76

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$584.64

Service Code	NDC 0904-6452-61
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$368.32
Max. Negotiated Rate	$526.18
Rate for Payer: Aetna Commercial	$496.94
Rate for Payer: Aetna New Business (MI Preferred)	$380.02
Rate for Payer: Cash Price	$467.71
Rate for Payer: Cofinity Commercial	$409.25
Rate for Payer: Cofinity Commercial	$502.79
Rate for Payer: Healthscope Commercial	$526.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$496.94
Rate for Payer: PHP Commercial	$496.94
Rate for Payer: Priority Health Cigna Priority Health	$409.25
Rate for Payer: Priority Health SBD	$368.32

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$117.65

Service Code	NDC 60687-723-21
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$105.88
Rate for Payer: Aetna Commercial	$100.00
Rate for Payer: Aetna New Business (MI Preferred)	$76.47
Rate for Payer: Cash Price	$94.12
Rate for Payer: Cofinity Commercial	$101.18
Rate for Payer: Cofinity Commercial	$82.36
Rate for Payer: Healthscope Commercial	$105.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.00
Rate for Payer: PHP Commercial	$100.00
Rate for Payer: Priority Health Cigna Priority Health	$82.36
Rate for Payer: Priority Health SBD	$74.12

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$121.54

Service Code	NDC 0904-6452-04
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$76.57
Max. Negotiated Rate	$109.39
Rate for Payer: Aetna Commercial	$103.31
Rate for Payer: Aetna New Business (MI Preferred)	$79.00
Rate for Payer: Cash Price	$97.23
Rate for Payer: Cofinity Commercial	$104.52
Rate for Payer: Cofinity Commercial	$85.08
Rate for Payer: Healthscope Commercial	$109.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.31
Rate for Payer: PHP Commercial	$103.31
Rate for Payer: Priority Health Cigna Priority Health	$85.08
Rate for Payer: Priority Health SBD	$76.57

DULOXETINE 20 MG CAPSULE,DELAYED RELEASE

Facility

$113.62

Service Code	NDC 0904-7043-04
Hospital Charge Code	39275
Hospital Revenue Code	637
Min. Negotiated Rate	$71.58
Max. Negotiated Rate	$102.26
Rate for Payer: Aetna Commercial	$96.58
Rate for Payer: Aetna New Business (MI Preferred)	$73.85
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cofinity Commercial	$97.71
Rate for Payer: Cofinity Commercial	$79.53
Rate for Payer: Healthscope Commercial	$102.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$96.58
Rate for Payer: PHP Commercial	$96.58
Rate for Payer: Priority Health Cigna Priority Health	$79.53
Rate for Payer: Priority Health SBD	$71.58

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$349.44

Service Code	NDC 0904-6453-61
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$220.15
Max. Negotiated Rate	$314.50
Rate for Payer: Aetna Commercial	$297.02
Rate for Payer: Aetna New Business (MI Preferred)	$227.14
Rate for Payer: Cash Price	$279.55
Rate for Payer: Cofinity Commercial	$244.61
Rate for Payer: Cofinity Commercial	$300.52
Rate for Payer: Healthscope Commercial	$314.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$297.02
Rate for Payer: PHP Commercial	$297.02
Rate for Payer: Priority Health Cigna Priority Health	$244.61
Rate for Payer: Priority Health SBD	$220.15

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$714.24

Service Code	NDC 68084-683-01
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$449.97
Max. Negotiated Rate	$642.82
Rate for Payer: Aetna Commercial	$607.10
Rate for Payer: Aetna New Business (MI Preferred)	$464.26
Rate for Payer: Cash Price	$571.39
Rate for Payer: Cofinity Commercial	$499.97
Rate for Payer: Cofinity Commercial	$614.25
Rate for Payer: Healthscope Commercial	$642.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$607.10
Rate for Payer: PHP Commercial	$607.10
Rate for Payer: Priority Health Cigna Priority Health	$499.97
Rate for Payer: Priority Health SBD	$449.97

DULOXETINE 30 MG CAPSULE,DELAYED RELEASE

Facility

$270.72

Service Code	NDC 57237-018-90
Hospital Charge Code	39276
Hospital Revenue Code	637
Min. Negotiated Rate	$170.55
Max. Negotiated Rate	$243.65
Rate for Payer: Aetna Commercial	$230.11
Rate for Payer: Aetna New Business (MI Preferred)	$175.97
Rate for Payer: Cash Price	$216.58
Rate for Payer: Cofinity Commercial	$189.50
Rate for Payer: Cofinity Commercial	$232.82
Rate for Payer: Healthscope Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$230.11
Rate for Payer: PHP Commercial	$230.11
Rate for Payer: Priority Health Cigna Priority Health	$189.50
Rate for Payer: Priority Health SBD	$170.55

Know your out-of-pocket cost for care.

All Charges