Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PROPRANOLOL 20 MG TABLET

Facility

$39.95

Service Code	NDC 23155-111-01
Hospital Charge Code	6657
Hospital Revenue Code	637
Min. Negotiated Rate	$25.17
Max. Negotiated Rate	$35.96
Rate for Payer: Aetna Commercial	$33.96
Rate for Payer: Aetna New Business (MI Preferred)	$25.97
Rate for Payer: Cash Price	$31.96
Rate for Payer: Cofinity Commercial	$27.96
Rate for Payer: Cofinity Commercial	$34.36
Rate for Payer: Healthscope Commercial	$35.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.96
Rate for Payer: PHP Commercial	$33.96
Rate for Payer: Priority Health Cigna Priority Health	$27.96
Rate for Payer: Priority Health SBD	$25.17

PROPRANOLOL 40 MG TABLET

Facility

$51.70

Service Code	NDC 23155-112-01
Hospital Charge Code	6658
Hospital Revenue Code	637
Min. Negotiated Rate	$32.57
Max. Negotiated Rate	$46.53
Rate for Payer: Aetna Commercial	$43.94
Rate for Payer: Aetna New Business (MI Preferred)	$33.60
Rate for Payer: Cash Price	$41.36
Rate for Payer: Cofinity Commercial	$36.19
Rate for Payer: Cofinity Commercial	$44.46
Rate for Payer: Healthscope Commercial	$46.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.94
Rate for Payer: PHP Commercial	$43.94
Rate for Payer: Priority Health Cigna Priority Health	$36.19
Rate for Payer: Priority Health SBD	$32.57

PROPRANOLOL 40 MG TABLET

Facility

$225.15

Service Code	NDC 0115-1661-01
Hospital Charge Code	6658
Hospital Revenue Code	637
Min. Negotiated Rate	$141.84
Max. Negotiated Rate	$202.64
Rate for Payer: Aetna Commercial	$191.38
Rate for Payer: Aetna New Business (MI Preferred)	$146.35
Rate for Payer: Cash Price	$180.12
Rate for Payer: Cofinity Commercial	$157.60
Rate for Payer: Cofinity Commercial	$193.63
Rate for Payer: Healthscope Commercial	$202.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.38
Rate for Payer: PHP Commercial	$191.38
Rate for Payer: Priority Health Cigna Priority Health	$157.60
Rate for Payer: Priority Health SBD	$141.84

PROPRANOLOL 40 MG TABLET

Facility

$121.20

Service Code	NDC 50268-702-15
Hospital Charge Code	6658
Hospital Revenue Code	637
Min. Negotiated Rate	$76.36
Max. Negotiated Rate	$109.08
Rate for Payer: Aetna Commercial	$103.02
Rate for Payer: Aetna New Business (MI Preferred)	$78.78
Rate for Payer: Cash Price	$96.96
Rate for Payer: Cofinity Commercial	$104.23
Rate for Payer: Cofinity Commercial	$84.84
Rate for Payer: Healthscope Commercial	$109.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$103.02
Rate for Payer: PHP Commercial	$103.02
Rate for Payer: Priority Health Cigna Priority Health	$84.84
Rate for Payer: Priority Health SBD	$76.36

PROPRANOLOL 40 MG TABLET

Facility

$2.43

Service Code	NDC 50268-702-11
Hospital Charge Code	6658
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.70
Rate for Payer: Priority Health SBD	$1.53

PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$243.84

Service Code	NDC 51991-817-01
Hospital Charge Code	38224
Hospital Revenue Code	637
Min. Negotiated Rate	$153.62
Max. Negotiated Rate	$219.46
Rate for Payer: Aetna Commercial	$207.26
Rate for Payer: Aetna New Business (MI Preferred)	$158.50
Rate for Payer: Cash Price	$195.07
Rate for Payer: Cofinity Commercial	$170.69
Rate for Payer: Cofinity Commercial	$209.70
Rate for Payer: Healthscope Commercial	$219.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.26
Rate for Payer: PHP Commercial	$207.26
Rate for Payer: Priority Health Cigna Priority Health	$170.69
Rate for Payer: Priority Health SBD	$153.62

PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$8.54

Service Code	NDC 60687-215-11
Hospital Charge Code	38224
Hospital Revenue Code	637
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$7.69
Rate for Payer: Aetna Commercial	$7.26
Rate for Payer: Aetna New Business (MI Preferred)	$5.55
Rate for Payer: Cash Price	$6.83
Rate for Payer: Cofinity Commercial	$5.98
Rate for Payer: Cofinity Commercial	$7.34
Rate for Payer: Healthscope Commercial	$7.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.26
Rate for Payer: PHP Commercial	$7.26
Rate for Payer: Priority Health Cigna Priority Health	$5.98
Rate for Payer: Priority Health SBD	$5.38

PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$853.44

Service Code	NDC 60687-215-01
Hospital Charge Code	38224
Hospital Revenue Code	637
Min. Negotiated Rate	$537.67
Max. Negotiated Rate	$768.10
Rate for Payer: Aetna Commercial	$725.42
Rate for Payer: Aetna New Business (MI Preferred)	$554.74
Rate for Payer: Cash Price	$682.75
Rate for Payer: Cofinity Commercial	$597.41
Rate for Payer: Cofinity Commercial	$733.96
Rate for Payer: Healthscope Commercial	$768.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$725.42
Rate for Payer: PHP Commercial	$725.42
Rate for Payer: Priority Health Cigna Priority Health	$597.41
Rate for Payer: Priority Health SBD	$537.67

PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$7.90

Service Code	NDC 60687-226-11
Hospital Charge Code	38225
Hospital Revenue Code	637
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna Commercial	$6.72
Rate for Payer: Aetna New Business (MI Preferred)	$5.14
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Commercial	$5.53
Rate for Payer: Cofinity Commercial	$6.79
Rate for Payer: Healthscope Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.72
Rate for Payer: PHP Commercial	$6.72
Rate for Payer: Priority Health Cigna Priority Health	$5.53
Rate for Payer: Priority Health SBD	$4.98

PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$789.21

Service Code	NDC 60687-226-01
Hospital Charge Code	38225
Hospital Revenue Code	637
Min. Negotiated Rate	$497.20
Max. Negotiated Rate	$710.29
Rate for Payer: Aetna Commercial	$670.83
Rate for Payer: Aetna New Business (MI Preferred)	$512.99
Rate for Payer: Cash Price	$631.37
Rate for Payer: Cofinity Commercial	$552.45
Rate for Payer: Cofinity Commercial	$678.72
Rate for Payer: Healthscope Commercial	$710.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$670.83
Rate for Payer: PHP Commercial	$670.83
Rate for Payer: Priority Health Cigna Priority Health	$552.45
Rate for Payer: Priority Health SBD	$497.20

PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$441.75

Service Code	NDC 62559-531-01
Hospital Charge Code	38225
Hospital Revenue Code	637
Min. Negotiated Rate	$278.30
Max. Negotiated Rate	$397.58
Rate for Payer: Aetna Commercial	$375.49
Rate for Payer: Aetna New Business (MI Preferred)	$287.14
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cofinity Commercial	$309.22
Rate for Payer: Cofinity Commercial	$379.90
Rate for Payer: Healthscope Commercial	$397.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$375.49
Rate for Payer: PHP Commercial	$375.49
Rate for Payer: Priority Health Cigna Priority Health	$309.22
Rate for Payer: Priority Health SBD	$278.30

PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE

Facility

$198.55

Service Code	NDC 0527-4117-37
Hospital Charge Code	38225
Hospital Revenue Code	637
Min. Negotiated Rate	$125.09
Max. Negotiated Rate	$178.70
Rate for Payer: Aetna Commercial	$168.77
Rate for Payer: Aetna New Business (MI Preferred)	$129.06
Rate for Payer: Cash Price	$158.84
Rate for Payer: Cofinity Commercial	$138.98
Rate for Payer: Cofinity Commercial	$170.75
Rate for Payer: Healthscope Commercial	$178.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.77
Rate for Payer: PHP Commercial	$168.77
Rate for Payer: Priority Health Cigna Priority Health	$138.98
Rate for Payer: Priority Health SBD	$125.09

PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC

Professional

Both

$32.00

Service Code	HCPCS 92544
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$2,260.07
Rate for Payer: Aetna Commercial	$19.86
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$2,260.07
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4.94
Rate for Payer: Priority Health Narrow Network	$4.94
Rate for Payer: Priority Health SBD	$23.80

PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

Professional

Both

$3,403.00

Service Code	HCPCS 23552
Min. Negotiated Rate	$421.53
Max. Negotiated Rate	$2,382.10
Rate for Payer: Aetna Commercial	$873.19
Rate for Payer: BCBS Complete	$442.61
Rate for Payer: BCBS Trust/PPO	$455.39
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Mclaren Medicaid	$421.53
Rate for Payer: Meridian Medicaid	$442.61
Rate for Payer: Priority Health Choice Medicaid	$421.53
Rate for Payer: Priority Health Cigna Priority Health	$2,382.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$999.34
Rate for Payer: Priority Health Narrow Network	$999.34
Rate for Payer: Priority Health SBD	$999.34

PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT

Professional

Both

$3,813.42

Service Code	HCPCS 27228
Min. Negotiated Rate	$70.26
Max. Negotiated Rate	$2,860.15
Rate for Payer: Aetna Commercial	$2,513.09
Rate for Payer: BCBS Complete	$1,259.37
Rate for Payer: BCBS Trust/PPO	$70.26
Rate for Payer: Cash Price	$3,050.74
Rate for Payer: Cash Price	$3,050.74
Rate for Payer: Mclaren Medicaid	$1,199.40
Rate for Payer: Meridian Medicaid	$1,259.37
Rate for Payer: Priority Health Choice Medicaid	$1,199.40
Rate for Payer: Priority Health Cigna Priority Health	$2,669.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,860.15
Rate for Payer: Priority Health Narrow Network	$2,860.15
Rate for Payer: Priority Health SBD	$2,860.15

PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT

Professional

Both

$4,574.00

Service Code	HCPCS 27227
Min. Negotiated Rate	$1,056.05
Max. Negotiated Rate	$3,201.80
Rate for Payer: Aetna Commercial	$2,211.26
Rate for Payer: BCBS Complete	$1,108.85
Rate for Payer: BCBS Trust/PPO	$1,137.43
Rate for Payer: Cash Price	$3,659.20
Rate for Payer: Cash Price	$3,659.20
Rate for Payer: Mclaren Medicaid	$1,056.05
Rate for Payer: Meridian Medicaid	$1,108.85
Rate for Payer: Priority Health Choice Medicaid	$1,056.05
Rate for Payer: Priority Health Cigna Priority Health	$3,201.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,514.94
Rate for Payer: Priority Health Narrow Network	$2,514.94
Rate for Payer: Priority Health SBD	$2,514.94

PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ

Professional

Both

$2,946.00

Service Code	HCPCS 27846
Min. Negotiated Rate	$470.30
Max. Negotiated Rate	$2,062.20
Rate for Payer: Aetna Commercial	$956.02
Rate for Payer: BCBS Complete	$493.82
Rate for Payer: BCBS Trust/PPO	$1,258.80
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Mclaren Medicaid	$470.30
Rate for Payer: Meridian Medicaid	$493.82
Rate for Payer: Priority Health Choice Medicaid	$470.30
Rate for Payer: Priority Health Cigna Priority Health	$2,062.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,104.02
Rate for Payer: Priority Health Narrow Network	$1,104.02
Rate for Payer: Priority Health SBD	$1,104.02

PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ

Professional

Both

$3,183.00

Service Code	HCPCS 27848
Min. Negotiated Rate	$509.07
Max. Negotiated Rate	$2,228.10
Rate for Payer: Aetna Commercial	$1,065.44
Rate for Payer: BCBS Complete	$534.52
Rate for Payer: BCBS Trust/PPO	$1,309.99
Rate for Payer: Cash Price	$2,546.40
Rate for Payer: Cash Price	$2,546.40
Rate for Payer: Mclaren Medicaid	$509.07
Rate for Payer: Meridian Medicaid	$534.52
Rate for Payer: Priority Health Choice Medicaid	$509.07
Rate for Payer: Priority Health Cigna Priority Health	$2,228.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,204.11
Rate for Payer: Priority Health Narrow Network	$1,204.11
Rate for Payer: Priority Health SBD	$1,204.11

PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR

Professional

Both

$3,073.00

Service Code	HCPCS 27217
Min. Negotiated Rate	$537.61
Max. Negotiated Rate	$2,151.10
Rate for Payer: Aetna Commercial	$1,119.55
Rate for Payer: BCBS Complete	$564.49
Rate for Payer: BCBS Trust/PPO	$1,869.65
Rate for Payer: Cash Price	$2,458.40
Rate for Payer: Cash Price	$2,458.40
Rate for Payer: Mclaren Medicaid	$537.61
Rate for Payer: Meridian Medicaid	$564.49
Rate for Payer: Priority Health Choice Medicaid	$537.61
Rate for Payer: Priority Health Cigna Priority Health	$2,151.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,279.68
Rate for Payer: Priority Health Narrow Network	$1,279.68
Rate for Payer: Priority Health SBD	$1,279.68

PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ

Professional

Both

$3,175.00

Service Code	HCPCS 26686
Min. Negotiated Rate	$75.56
Max. Negotiated Rate	$2,222.50
Rate for Payer: Aetna Commercial	$833.37
Rate for Payer: BCBS Complete	$425.39
Rate for Payer: BCBS Trust/PPO	$75.56
Rate for Payer: Cash Price	$2,540.00
Rate for Payer: Cash Price	$2,540.00
Rate for Payer: Mclaren Medicaid	$405.13
Rate for Payer: Meridian Medicaid	$425.39
Rate for Payer: Priority Health Choice Medicaid	$405.13
Rate for Payer: Priority Health Cigna Priority Health	$2,222.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$962.57
Rate for Payer: Priority Health Narrow Network	$962.57
Rate for Payer: Priority Health SBD	$962.57

PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION

Professional

Both

$2,413.00

Service Code	HCPCS 21470
Min. Negotiated Rate	$745.07
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$1,539.08
Rate for Payer: BCBS Complete	$782.32
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$1,930.40
Rate for Payer: Cash Price	$1,930.40
Rate for Payer: Mclaren Medicaid	$745.07
Rate for Payer: Meridian Medicaid	$782.32
Rate for Payer: Priority Health Choice Medicaid	$745.07
Rate for Payer: Priority Health Cigna Priority Health	$1,689.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,768.38
Rate for Payer: Priority Health Narrow Network	$1,768.38
Rate for Payer: Priority Health SBD	$1,768.38

PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG

Professional

Both

$2,373.00

Service Code	HCPCS 25608
Min. Negotiated Rate	$25.36
Max. Negotiated Rate	$1,661.10
Rate for Payer: Aetna Commercial	$1,100.22
Rate for Payer: BCBS Complete	$564.27
Rate for Payer: BCBS Trust/PPO	$25.36
Rate for Payer: Cash Price	$1,898.40
Rate for Payer: Cash Price	$1,898.40
Rate for Payer: Mclaren Medicaid	$537.40
Rate for Payer: Meridian Medicaid	$564.27
Rate for Payer: Priority Health Choice Medicaid	$537.40
Rate for Payer: Priority Health Cigna Priority Health	$1,661.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,275.09
Rate for Payer: Priority Health Narrow Network	$1,275.09
Rate for Payer: Priority Health SBD	$1,275.09

PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG

Professional

Both

$2,901.00

Service Code	HCPCS 25609
Min. Negotiated Rate	$166.94
Max. Negotiated Rate	$2,030.70
Rate for Payer: Aetna Commercial	$1,398.32
Rate for Payer: BCBS Complete	$714.34
Rate for Payer: BCBS Trust/PPO	$166.94
Rate for Payer: Cash Price	$2,320.80
Rate for Payer: Cash Price	$2,320.80
Rate for Payer: Mclaren Medicaid	$680.32
Rate for Payer: Meridian Medicaid	$714.34
Rate for Payer: Priority Health Choice Medicaid	$680.32
Rate for Payer: Priority Health Cigna Priority Health	$2,030.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,616.72
Rate for Payer: Priority Health Narrow Network	$1,616.72
Rate for Payer: Priority Health SBD	$1,616.72

PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

Professional

Both

$1,906.00

Service Code	HCPCS 25607
Hospital Charge Code	25607
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$1,334.20
Rate for Payer: Aetna Commercial	$981.85
Rate for Payer: BCBS Complete	$505.45
Rate for Payer: BCBS Trust/PPO	$17.96
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Mclaren Medicaid	$481.38
Rate for Payer: Meridian Medicaid	$505.45
Rate for Payer: Priority Health Choice Medicaid	$481.38
Rate for Payer: Priority Health Cigna Priority Health	$1,334.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,142.33
Rate for Payer: Priority Health Narrow Network	$1,142.33
Rate for Payer: Priority Health SBD	$1,142.33

PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

Professional

Both

$1,906.00

Service Code	HCPCS 25607
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$1,334.20
Rate for Payer: Aetna Commercial	$981.85
Rate for Payer: BCBS Complete	$505.45
Rate for Payer: BCBS Trust/PPO	$17.96
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Mclaren Medicaid	$481.38
Rate for Payer: Meridian Medicaid	$505.45
Rate for Payer: Priority Health Choice Medicaid	$481.38
Rate for Payer: Priority Health Cigna Priority Health	$1,334.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,142.33
Rate for Payer: Priority Health Narrow Network	$1,142.33
Rate for Payer: Priority Health SBD	$1,142.33

Know your out-of-pocket cost for care.

All Charges