Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SERTRALINE 100 MG TABLET

Facility

$86.72

Service Code	NDC 68180-353-09
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$78.05
Rate for Payer: Aetna Commercial	$73.71
Rate for Payer: Aetna New Business (MI Preferred)	$56.37
Rate for Payer: Cash Price	$69.38
Rate for Payer: Cofinity Commercial	$60.70
Rate for Payer: Cofinity Commercial	$74.58
Rate for Payer: Healthscope Commercial	$78.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$73.71
Rate for Payer: PHP Commercial	$73.71
Rate for Payer: Priority Health Cigna Priority Health	$60.70
Rate for Payer: Priority Health SBD	$54.63

SERTRALINE 100 MG TABLET

Facility

$195.05

Service Code	NDC 59762-4910-3
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Commercial	$136.54
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$165.79
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health Cigna Priority Health	$136.54
Rate for Payer: Priority Health SBD	$122.88

SERTRALINE 100 MG TABLET

Facility

$317.30

Service Code	NDC 60687-253-01
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$199.90
Max. Negotiated Rate	$285.57
Rate for Payer: Aetna Commercial	$269.70
Rate for Payer: Aetna New Business (MI Preferred)	$206.24
Rate for Payer: Cash Price	$253.84
Rate for Payer: Cofinity Commercial	$222.11
Rate for Payer: Cofinity Commercial	$272.88
Rate for Payer: Healthscope Commercial	$285.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$269.70
Rate for Payer: PHP Commercial	$269.70
Rate for Payer: Priority Health Cigna Priority Health	$222.11
Rate for Payer: Priority Health SBD	$199.90

SERTRALINE 100 MG TABLET

Facility

$3.18

Service Code	NDC 60687-253-11
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.07
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.23
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Healthscope Commercial	$2.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.70
Rate for Payer: PHP Commercial	$2.70
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health SBD	$2.00

SERTRALINE 25 MG TABLET

Facility

$4.56

Service Code	NDC 51079-149-01
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.96
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cofinity Commercial	$3.19
Rate for Payer: Cofinity Commercial	$3.92
Rate for Payer: Healthscope Commercial	$4.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.88
Rate for Payer: PHP Commercial	$3.88
Rate for Payer: Priority Health Cigna Priority Health	$3.19
Rate for Payer: Priority Health SBD	$2.87

SERTRALINE 25 MG TABLET

Facility

$57.11

Service Code	NDC 68180-351-09
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$35.98
Max. Negotiated Rate	$51.40
Rate for Payer: Aetna Commercial	$48.54
Rate for Payer: Aetna New Business (MI Preferred)	$37.12
Rate for Payer: Cash Price	$45.69
Rate for Payer: Cofinity Commercial	$39.98
Rate for Payer: Cofinity Commercial	$49.11
Rate for Payer: Healthscope Commercial	$51.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.54
Rate for Payer: PHP Commercial	$48.54
Rate for Payer: Priority Health Cigna Priority Health	$39.98
Rate for Payer: Priority Health SBD	$35.98

SERTRALINE 25 MG TABLET

Facility

$2.43

Service Code	NDC 60687-231-11
Hospital Charge Code	19882
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

SERTRALINE 25 MG TABLET

Facility

$455.90

Service Code	NDC 51079-149-20
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$287.22
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$387.52
Rate for Payer: Aetna New Business (MI Preferred)	$296.34
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$319.13
Rate for Payer: Cofinity Commercial	$392.07
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$387.52
Rate for Payer: PHP Commercial	$387.52
Rate for Payer: Priority Health Cigna Priority Health	$319.13
Rate for Payer: Priority Health SBD	$287.22

SERTRALINE 25 MG TABLET

Facility

$242.25

Service Code	NDC 60687-231-01
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$152.62
Max. Negotiated Rate	$218.02
Rate for Payer: Aetna Commercial	$205.91
Rate for Payer: Aetna New Business (MI Preferred)	$157.46
Rate for Payer: Cash Price	$193.80
Rate for Payer: Cofinity Commercial	$169.58
Rate for Payer: Cofinity Commercial	$208.34
Rate for Payer: Healthscope Commercial	$218.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$205.91
Rate for Payer: PHP Commercial	$205.91
Rate for Payer: Priority Health Cigna Priority Health	$169.58
Rate for Payer: Priority Health SBD	$152.62

SERTRALINE 50 MG TABLET

Facility

$271.70

Service Code	NDC 0904-6925-61
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$171.17
Max. Negotiated Rate	$244.53
Rate for Payer: Aetna Commercial	$230.94
Rate for Payer: Aetna New Business (MI Preferred)	$176.60
Rate for Payer: Cash Price	$217.36
Rate for Payer: Cofinity Commercial	$190.19
Rate for Payer: Cofinity Commercial	$233.66
Rate for Payer: Healthscope Commercial	$244.53
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$230.94
Rate for Payer: PHP Commercial	$230.94
Rate for Payer: Priority Health Cigna Priority Health	$190.19
Rate for Payer: Priority Health SBD	$171.17

SERTRALINE 50 MG TABLET

Facility

$225.60

Service Code	NDC 59762-4900-3
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$142.13
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$157.92
Rate for Payer: Priority Health SBD	$142.13

SERTRALINE 50 MG TABLET

Facility

$2.87

Service Code	NDC 60687-242-11
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Commercial	$2.01
Rate for Payer: Cofinity Commercial	$2.47
Rate for Payer: Healthscope Commercial	$2.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.44
Rate for Payer: PHP Commercial	$2.44
Rate for Payer: Priority Health Cigna Priority Health	$2.01
Rate for Payer: Priority Health SBD	$1.81

SERTRALINE 50 MG TABLET

Facility

$286.90

Service Code	NDC 60687-242-01
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$180.75
Max. Negotiated Rate	$258.21
Rate for Payer: Aetna Commercial	$243.86
Rate for Payer: Aetna New Business (MI Preferred)	$186.48
Rate for Payer: Cash Price	$229.52
Rate for Payer: Cofinity Commercial	$200.83
Rate for Payer: Cofinity Commercial	$246.73
Rate for Payer: Healthscope Commercial	$258.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.86
Rate for Payer: PHP Commercial	$243.86
Rate for Payer: Priority Health Cigna Priority Health	$200.83
Rate for Payer: Priority Health SBD	$180.75

SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)

Facility

$4,155.00

Service Code	CPT 28315
Hospital Revenue Code	360
Min. Negotiated Rate	$323.19
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,058.03
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$355.51
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$323.19
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

SEVELAMER CARBONATE 800 MG TABLET

Facility

$766.80

Service Code	NDC 68094-034-64
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$483.08
Max. Negotiated Rate	$690.12
Rate for Payer: Aetna Commercial	$651.78
Rate for Payer: Aetna New Business (MI Preferred)	$498.42
Rate for Payer: Cash Price	$613.44
Rate for Payer: Cofinity Commercial	$536.76
Rate for Payer: Cofinity Commercial	$659.45
Rate for Payer: Healthscope Commercial	$690.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$651.78
Rate for Payer: PHP Commercial	$651.78
Rate for Payer: Priority Health Cigna Priority Health	$536.76
Rate for Payer: Priority Health SBD	$483.08

SEVELAMER CARBONATE 800 MG TABLET

Facility

$928.53

Service Code	NDC 65162-058-27
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$584.97
Max. Negotiated Rate	$835.68
Rate for Payer: Aetna Commercial	$789.25
Rate for Payer: Aetna New Business (MI Preferred)	$603.54
Rate for Payer: Cash Price	$742.82
Rate for Payer: Cofinity Commercial	$649.97
Rate for Payer: Cofinity Commercial	$798.54
Rate for Payer: Healthscope Commercial	$835.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$789.25
Rate for Payer: PHP Commercial	$789.25
Rate for Payer: Priority Health Cigna Priority Health	$649.97
Rate for Payer: Priority Health SBD	$584.97

SEVELAMER CARBONATE 800 MG TABLET

Facility

$2,051.57

Service Code	NDC 0955-1050-27
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$1,292.49
Max. Negotiated Rate	$1,846.41
Rate for Payer: Aetna Commercial	$1,743.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,333.52
Rate for Payer: Cash Price	$1,641.26
Rate for Payer: Cofinity Commercial	$1,436.10
Rate for Payer: Cofinity Commercial	$1,764.35
Rate for Payer: Healthscope Commercial	$1,846.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,743.83
Rate for Payer: PHP Commercial	$1,743.83
Rate for Payer: Priority Health Cigna Priority Health	$1,436.10
Rate for Payer: Priority Health SBD	$1,292.49

SEVELAMER CARBONATE 800 MG TABLET

Facility

$12.16

Service Code	NDC 60687-328-11
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$10.94
Rate for Payer: Aetna Commercial	$10.34
Rate for Payer: Aetna New Business (MI Preferred)	$7.90
Rate for Payer: Cash Price	$9.73
Rate for Payer: Cofinity Commercial	$10.46
Rate for Payer: Cofinity Commercial	$8.51
Rate for Payer: Healthscope Commercial	$10.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.34
Rate for Payer: PHP Commercial	$10.34
Rate for Payer: Priority Health Cigna Priority Health	$8.51
Rate for Payer: Priority Health SBD	$7.66

SEVELAMER CARBONATE 800 MG TABLET

Facility

$607.73

Service Code	NDC 60687-328-65
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$382.87
Max. Negotiated Rate	$546.96
Rate for Payer: Aetna Commercial	$516.57
Rate for Payer: Aetna New Business (MI Preferred)	$395.02
Rate for Payer: Cash Price	$486.18
Rate for Payer: Cofinity Commercial	$425.41
Rate for Payer: Cofinity Commercial	$522.65
Rate for Payer: Healthscope Commercial	$546.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$516.57
Rate for Payer: PHP Commercial	$516.57
Rate for Payer: Priority Health Cigna Priority Health	$425.41
Rate for Payer: Priority Health SBD	$382.87

SEVELAMER CARBONATE 800 MG TABLET

Facility

$8.52

Service Code	NDC 68094-034-59
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$7.67
Rate for Payer: Aetna Commercial	$7.24
Rate for Payer: Aetna New Business (MI Preferred)	$5.54
Rate for Payer: Cash Price	$6.82
Rate for Payer: Cofinity Commercial	$5.96
Rate for Payer: Cofinity Commercial	$7.33
Rate for Payer: Healthscope Commercial	$7.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.24
Rate for Payer: PHP Commercial	$7.24
Rate for Payer: Priority Health Cigna Priority Health	$5.96
Rate for Payer: Priority Health SBD	$5.37

SEVELAMER CARBONATE 800 MG TABLET

Facility

$5,499.50

Service Code	NDC 58468-0130-1
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$3,464.68
Max. Negotiated Rate	$4,949.55
Rate for Payer: Aetna Commercial	$4,674.58
Rate for Payer: Aetna New Business (MI Preferred)	$3,574.68
Rate for Payer: Cash Price	$4,399.60
Rate for Payer: Cofinity Commercial	$3,849.65
Rate for Payer: Cofinity Commercial	$4,729.57
Rate for Payer: Healthscope Commercial	$4,949.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,674.58
Rate for Payer: PHP Commercial	$4,674.58
Rate for Payer: Priority Health Cigna Priority Health	$3,849.65
Rate for Payer: Priority Health SBD	$3,464.68

SEVELAMER HCL 800 MG TABLET

Facility

$4,583.42

Service Code	NDC 58468-0021-1
Hospital Charge Code	28715
Hospital Revenue Code	637
Min. Negotiated Rate	$2,887.55
Max. Negotiated Rate	$4,125.08
Rate for Payer: Aetna Commercial	$3,895.91
Rate for Payer: Aetna New Business (MI Preferred)	$2,979.22
Rate for Payer: Cash Price	$3,666.74
Rate for Payer: Cofinity Commercial	$3,208.39
Rate for Payer: Cofinity Commercial	$3,941.74
Rate for Payer: Healthscope Commercial	$4,125.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,895.91
Rate for Payer: PHP Commercial	$3,895.91
Rate for Payer: Priority Health Cigna Priority Health	$3,208.39
Rate for Payer: Priority Health SBD	$2,887.55

SEVOFLURANE INHALATION LIQUID

Facility

$211.75

Service Code	NDC 66794-022-25
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$190.58
Rate for Payer: Aetna Commercial	$179.99
Rate for Payer: Aetna New Business (MI Preferred)	$137.64
Rate for Payer: Cash Price	$169.40
Rate for Payer: Cofinity Commercial	$148.22
Rate for Payer: Cofinity Commercial	$182.10
Rate for Payer: Healthscope Commercial	$190.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.99
Rate for Payer: PHP Commercial	$179.99
Rate for Payer: Priority Health Cigna Priority Health	$148.22
Rate for Payer: Priority Health SBD	$133.40

SEVOFLURANE INHALATION LIQUID

Facility

$214.38

Service Code	NDC 0074-4456-04
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$135.06
Max. Negotiated Rate	$192.94
Rate for Payer: Aetna Commercial	$182.22
Rate for Payer: Aetna New Business (MI Preferred)	$139.35
Rate for Payer: Cash Price	$171.50
Rate for Payer: Cofinity Commercial	$150.07
Rate for Payer: Cofinity Commercial	$184.37
Rate for Payer: Healthscope Commercial	$192.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$182.22
Rate for Payer: PHP Commercial	$182.22
Rate for Payer: Priority Health Cigna Priority Health	$150.07
Rate for Payer: Priority Health SBD	$135.06

SEVOFLURANE INHALATION LIQUID

Facility

$223.13

Service Code	NDC 10019-651-64
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$140.57
Max. Negotiated Rate	$200.82
Rate for Payer: Aetna Commercial	$189.66
Rate for Payer: Aetna New Business (MI Preferred)	$145.03
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cofinity Commercial	$156.19
Rate for Payer: Cofinity Commercial	$191.89
Rate for Payer: Healthscope Commercial	$200.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$189.66
Rate for Payer: PHP Commercial	$189.66
Rate for Payer: Priority Health Cigna Priority Health	$156.19
Rate for Payer: Priority Health SBD	$140.57

Know your out-of-pocket cost for care.

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