Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PRIMIDONE 250 MG TABLET

Facility

$4.45

Service Code	NDC 50268068711
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna Medicare	$2.22
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: BCBS Complete	$1.78
Rate for Payer: Cash Price	$3.56
Rate for Payer: Cofinity Commercial	$3.12
Rate for Payer: Cofinity Commercial	$3.83
Rate for Payer: Cofinity Medicare Advantage	$3.12
Rate for Payer: Encore Health Key Benefits Commercial	$3.56
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.78
Rate for Payer: PHP Commercial	$3.78
Rate for Payer: Priority Health Cigna Priority Health	$2.89
Rate for Payer: Priority Health SBD	$2.80

PRIMIDONE 250 MG TABLET

Facility

$257.45

Service Code	NDC 00527123101
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$102.98
Max. Negotiated Rate	$231.70
Rate for Payer: Aetna Commercial	$218.83
Rate for Payer: Aetna Medicare	$128.72
Rate for Payer: Aetna New Business (MI Preferred)	$167.34
Rate for Payer: BCBS Complete	$102.98
Rate for Payer: Cash Price	$205.96
Rate for Payer: Cofinity Commercial	$180.22
Rate for Payer: Cofinity Commercial	$221.41
Rate for Payer: Cofinity Medicare Advantage	$180.22
Rate for Payer: Encore Health Key Benefits Commercial	$205.96
Rate for Payer: Healthscope Commercial	$231.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$218.83
Rate for Payer: PHP Commercial	$218.83
Rate for Payer: Priority Health Cigna Priority Health	$167.34
Rate for Payer: Priority Health SBD	$162.19

PRIMIDONE 250 MG TABLET

Facility

$222.30

Service Code	NDC 50268068715
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$200.07
Rate for Payer: Aetna Commercial	$188.96
Rate for Payer: Aetna Medicare	$111.15
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: BCBS Complete	$88.92
Rate for Payer: Cash Price	$177.84
Rate for Payer: Cofinity Commercial	$155.61
Rate for Payer: Cofinity Commercial	$191.18
Rate for Payer: Cofinity Medicare Advantage	$155.61
Rate for Payer: Encore Health Key Benefits Commercial	$177.84
Rate for Payer: Healthscope Commercial	$200.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.96
Rate for Payer: PHP Commercial	$188.96
Rate for Payer: Priority Health Cigna Priority Health	$144.50
Rate for Payer: Priority Health SBD	$140.05

PRIMIDONE 250 MG TABLET

Facility

$318.24

Service Code	NDC 68084020301
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$200.49
Max. Negotiated Rate	$286.42
Rate for Payer: Aetna Commercial	$270.50
Rate for Payer: Aetna New Business (MI Preferred)	$206.86
Rate for Payer: Cash Price	$254.59
Rate for Payer: Cofinity Commercial	$222.77
Rate for Payer: Cofinity Commercial	$273.69
Rate for Payer: Cofinity Medicare Advantage	$222.77
Rate for Payer: Encore Health Key Benefits Commercial	$254.59
Rate for Payer: Healthscope Commercial	$286.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.50
Rate for Payer: PHP Commercial	$270.50
Rate for Payer: Priority Health Cigna Priority Health	$206.86
Rate for Payer: Priority Health SBD	$200.49

PRIMIDONE 250 MG TABLET

Facility

$318.24

Service Code	NDC 68084020301
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$127.30
Max. Negotiated Rate	$286.42
Rate for Payer: Aetna Commercial	$270.50
Rate for Payer: Aetna Medicare	$159.12
Rate for Payer: Aetna New Business (MI Preferred)	$206.86
Rate for Payer: BCBS Complete	$127.30
Rate for Payer: Cash Price	$254.59
Rate for Payer: Cofinity Commercial	$222.77
Rate for Payer: Cofinity Commercial	$273.69
Rate for Payer: Cofinity Medicare Advantage	$222.77
Rate for Payer: Encore Health Key Benefits Commercial	$254.59
Rate for Payer: Healthscope Commercial	$286.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$270.50
Rate for Payer: PHP Commercial	$270.50
Rate for Payer: Priority Health Cigna Priority Health	$206.86
Rate for Payer: Priority Health SBD	$200.49

PRIMIDONE 250 MG TABLET

Facility

$4.45

Service Code	NDC 50268068711
Hospital Charge Code	6544
Hospital Revenue Code	637
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: Cash Price	$3.56
Rate for Payer: Cofinity Commercial	$3.12
Rate for Payer: Cofinity Commercial	$3.83
Rate for Payer: Cofinity Medicare Advantage	$3.12
Rate for Payer: Encore Health Key Benefits Commercial	$3.56
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.78
Rate for Payer: PHP Commercial	$3.78
Rate for Payer: Priority Health Cigna Priority Health	$2.89
Rate for Payer: Priority Health SBD	$2.80

PRIMIDONE 50 MG TABLET

Facility

$356.16

Service Code	NDC 68084020201
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$142.46
Max. Negotiated Rate	$320.54
Rate for Payer: Aetna Commercial	$302.74
Rate for Payer: Aetna Medicare	$178.08
Rate for Payer: Aetna New Business (MI Preferred)	$231.50
Rate for Payer: BCBS Complete	$142.46
Rate for Payer: Cash Price	$284.93
Rate for Payer: Cofinity Commercial	$249.31
Rate for Payer: Cofinity Commercial	$306.30
Rate for Payer: Cofinity Medicare Advantage	$249.31
Rate for Payer: Encore Health Key Benefits Commercial	$284.93
Rate for Payer: Healthscope Commercial	$320.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.74
Rate for Payer: PHP Commercial	$302.74
Rate for Payer: Priority Health Cigna Priority Health	$231.50
Rate for Payer: Priority Health SBD	$224.38

PRIMIDONE 50 MG TABLET

Facility

$3.57

Service Code	NDC 68084020211
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna Medicare	$1.78
Rate for Payer: Aetna New Business (MI Preferred)	$2.32
Rate for Payer: BCBS Complete	$1.43
Rate for Payer: Cash Price	$2.86
Rate for Payer: Cofinity Commercial	$2.50
Rate for Payer: Cofinity Commercial	$3.07
Rate for Payer: Cofinity Medicare Advantage	$2.50
Rate for Payer: Encore Health Key Benefits Commercial	$2.86
Rate for Payer: Healthscope Commercial	$3.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.03
Rate for Payer: PHP Commercial	$3.03
Rate for Payer: Priority Health Cigna Priority Health	$2.32
Rate for Payer: Priority Health SBD	$2.25

PRIMIDONE 50 MG TABLET

Facility

$168.63

Service Code	NDC 50268068615
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$67.45
Max. Negotiated Rate	$151.77
Rate for Payer: Aetna Commercial	$143.34
Rate for Payer: Aetna Medicare	$84.32
Rate for Payer: Aetna New Business (MI Preferred)	$109.61
Rate for Payer: BCBS Complete	$67.45
Rate for Payer: Cash Price	$134.90
Rate for Payer: Cofinity Commercial	$118.04
Rate for Payer: Cofinity Commercial	$145.02
Rate for Payer: Cofinity Medicare Advantage	$118.04
Rate for Payer: Encore Health Key Benefits Commercial	$134.90
Rate for Payer: Healthscope Commercial	$151.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.34
Rate for Payer: PHP Commercial	$143.34
Rate for Payer: Priority Health Cigna Priority Health	$109.61
Rate for Payer: Priority Health SBD	$106.24

PRIMIDONE 50 MG TABLET

Facility

$168.63

Service Code	NDC 50268068615
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$106.24
Max. Negotiated Rate	$151.77
Rate for Payer: Aetna Commercial	$143.34
Rate for Payer: Aetna New Business (MI Preferred)	$109.61
Rate for Payer: Cash Price	$134.90
Rate for Payer: Cofinity Commercial	$118.04
Rate for Payer: Cofinity Commercial	$145.02
Rate for Payer: Cofinity Medicare Advantage	$118.04
Rate for Payer: Encore Health Key Benefits Commercial	$134.90
Rate for Payer: Healthscope Commercial	$151.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$143.34
Rate for Payer: PHP Commercial	$143.34
Rate for Payer: Priority Health Cigna Priority Health	$109.61
Rate for Payer: Priority Health SBD	$106.24

PRIMIDONE 50 MG TABLET

Facility

$3.57

Service Code	NDC 68084020211
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$3.21
Rate for Payer: Aetna Commercial	$3.03
Rate for Payer: Aetna New Business (MI Preferred)	$2.32
Rate for Payer: Cash Price	$2.86
Rate for Payer: Cofinity Commercial	$2.50
Rate for Payer: Cofinity Commercial	$3.07
Rate for Payer: Cofinity Medicare Advantage	$2.50
Rate for Payer: Encore Health Key Benefits Commercial	$2.86
Rate for Payer: Healthscope Commercial	$3.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.03
Rate for Payer: PHP Commercial	$3.03
Rate for Payer: Priority Health Cigna Priority Health	$2.32
Rate for Payer: Priority Health SBD	$2.25

PRIMIDONE 50 MG TABLET

Facility

$3.38

Service Code	NDC 50268068611
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.37
Rate for Payer: Cofinity Commercial	$2.91
Rate for Payer: Cofinity Medicare Advantage	$2.37
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: PHP Commercial	$2.87
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$2.13

PRIMIDONE 50 MG TABLET

Facility

$3.38

Service Code	NDC 50268068611
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$3.04
Rate for Payer: Aetna Commercial	$2.87
Rate for Payer: Aetna Medicare	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Commercial	$2.37
Rate for Payer: Cofinity Commercial	$2.91
Rate for Payer: Cofinity Medicare Advantage	$2.37
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.87
Rate for Payer: PHP Commercial	$2.87
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$2.13

PRIMIDONE 50 MG TABLET

Facility

$356.16

Service Code	NDC 68084020201
Hospital Charge Code	11129
Hospital Revenue Code	637
Min. Negotiated Rate	$224.38
Max. Negotiated Rate	$320.54
Rate for Payer: Aetna Commercial	$302.74
Rate for Payer: Aetna New Business (MI Preferred)	$231.50
Rate for Payer: Cash Price	$284.93
Rate for Payer: Cofinity Commercial	$249.31
Rate for Payer: Cofinity Commercial	$306.30
Rate for Payer: Cofinity Medicare Advantage	$249.31
Rate for Payer: Encore Health Key Benefits Commercial	$284.93
Rate for Payer: Healthscope Commercial	$320.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.74
Rate for Payer: PHP Commercial	$302.74
Rate for Payer: Priority Health Cigna Priority Health	$231.50
Rate for Payer: Priority Health SBD	$224.38

PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE

Professional

Both

$41.00

Service Code	HCPCS 0011A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$18.75
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE

Professional

Both

$41.00

Service Code	HCPCS 0012A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE

Professional

Both

$41.00

Service Code	HCPCS 0013A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$377.55
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST

Professional

Both

$41.00

Service Code	HCPCS 0071A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$320.45
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND

Professional

Both

$41.00

Service Code	HCPCS 0072A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD

Professional

Both

$41.00

Service Code	HCPCS 0073A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BST

Professional

Both

$41.00

Service Code	HCPCS 0074A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 1ST DOSE

Professional

Both

$41.00

Service Code	HCPCS 0111A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$979.03
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 2ND DOSE

Professional

Both

$41.00

Service Code	HCPCS 0112A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$2,617.22
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE

Professional

Both

$41.00

Service Code	HCPCS 0001A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE

Professional

Both

$41.00

Service Code	HCPCS 0002A
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$5,465.00
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$540.00
Rate for Payer: BCN Commercial	$26.78
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,465.00
Rate for Payer: Priority Health Cigna Priority Health	$26.65

Know your out-of-pocket cost for care.

All Charges