Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$33.32

Service Code	NDC 69339-148-01
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$29.99
Rate for Payer: Aetna Commercial	$28.32
Rate for Payer: Aetna New Business (MI Preferred)	$21.66
Rate for Payer: Cash Price	$26.66
Rate for Payer: Cofinity Commercial	$23.32
Rate for Payer: Cofinity Commercial	$28.66
Rate for Payer: Healthscope Commercial	$29.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.32
Rate for Payer: PHP Commercial	$28.32
Rate for Payer: Priority Health Cigna Priority Health	$23.32
Rate for Payer: Priority Health SBD	$20.99

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$46.47

Service Code	NDC 66689-790-01
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$29.28
Max. Negotiated Rate	$41.82
Rate for Payer: Aetna Commercial	$39.50
Rate for Payer: Aetna New Business (MI Preferred)	$30.21
Rate for Payer: Cash Price	$37.18
Rate for Payer: Cofinity Commercial	$32.53
Rate for Payer: Cofinity Commercial	$39.96
Rate for Payer: Healthscope Commercial	$41.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$39.50
Rate for Payer: PHP Commercial	$39.50
Rate for Payer: Priority Health Cigna Priority Health	$32.53
Rate for Payer: Priority Health SBD	$29.28

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$31.92

Service Code	NDC 50268-732-11
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$28.73
Rate for Payer: Aetna Commercial	$27.13
Rate for Payer: Aetna New Business (MI Preferred)	$20.75
Rate for Payer: Cash Price	$25.54
Rate for Payer: Cofinity Commercial	$22.34
Rate for Payer: Cofinity Commercial	$27.45
Rate for Payer: Healthscope Commercial	$28.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.13
Rate for Payer: PHP Commercial	$27.13
Rate for Payer: Priority Health Cigna Priority Health	$22.34
Rate for Payer: Priority Health SBD	$20.11

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$31.92

Service Code	NDC 50268-732-12
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$28.73
Rate for Payer: Aetna Commercial	$27.13
Rate for Payer: Aetna New Business (MI Preferred)	$20.75
Rate for Payer: Cash Price	$25.54
Rate for Payer: Cofinity Commercial	$22.34
Rate for Payer: Cofinity Commercial	$27.45
Rate for Payer: Healthscope Commercial	$28.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.13
Rate for Payer: PHP Commercial	$27.13
Rate for Payer: Priority Health Cigna Priority Health	$22.34
Rate for Payer: Priority Health SBD	$20.11

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$35.14

Service Code	NDC 60687-738-56
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$22.14
Max. Negotiated Rate	$31.63
Rate for Payer: Aetna Commercial	$29.87
Rate for Payer: Aetna New Business (MI Preferred)	$22.84
Rate for Payer: Cash Price	$28.11
Rate for Payer: Cofinity Commercial	$24.60
Rate for Payer: Cofinity Commercial	$30.22
Rate for Payer: Healthscope Commercial	$31.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.87
Rate for Payer: PHP Commercial	$29.87
Rate for Payer: Priority Health Cigna Priority Health	$24.60
Rate for Payer: Priority Health SBD	$22.14

SUCRALFATE 100 MG/ML ORAL SUSPENSION

Facility

$33.32

Service Code	NDC 69339-148-17
Hospital Charge Code	11441
Hospital Revenue Code	637
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$29.99
Rate for Payer: Aetna Commercial	$28.32
Rate for Payer: Aetna New Business (MI Preferred)	$21.66
Rate for Payer: Cash Price	$26.66
Rate for Payer: Cofinity Commercial	$23.32
Rate for Payer: Cofinity Commercial	$28.66
Rate for Payer: Healthscope Commercial	$29.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.32
Rate for Payer: PHP Commercial	$28.32
Rate for Payer: Priority Health Cigna Priority Health	$23.32
Rate for Payer: Priority Health SBD	$20.99

SUCRALFATE 1 GRAM TABLET

Facility

$226.10

Service Code	NDC 63739-943-10
Hospital Charge Code	11442
Hospital Revenue Code	637
Min. Negotiated Rate	$142.44
Max. Negotiated Rate	$203.49
Rate for Payer: Aetna Commercial	$192.18
Rate for Payer: Aetna New Business (MI Preferred)	$146.96
Rate for Payer: Cash Price	$180.88
Rate for Payer: Cofinity Commercial	$158.27
Rate for Payer: Cofinity Commercial	$194.45
Rate for Payer: Healthscope Commercial	$203.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$192.18
Rate for Payer: PHP Commercial	$192.18
Rate for Payer: Priority Health Cigna Priority Health	$158.27
Rate for Payer: Priority Health SBD	$142.44

SUCRALFATE 1 GRAM TABLET

Facility

$2,314.75

Service Code	NDC 0093-2210-05
Hospital Charge Code	11442
Hospital Revenue Code	637
Min. Negotiated Rate	$1,458.29
Max. Negotiated Rate	$2,083.28
Rate for Payer: Aetna Commercial	$1,967.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,504.59
Rate for Payer: Cash Price	$1,851.80
Rate for Payer: Cofinity Commercial	$1,990.68
Rate for Payer: Cofinity Commercial	$1,620.32
Rate for Payer: Healthscope Commercial	$2,083.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,967.54
Rate for Payer: PHP Commercial	$1,967.54
Rate for Payer: Priority Health Cigna Priority Health	$1,620.32
Rate for Payer: Priority Health SBD	$1,458.29

SUCRALFATE 1 GRAM TABLET

Facility

$364.25

Service Code	NDC 59762-0401-1
Hospital Charge Code	11442
Hospital Revenue Code	637
Min. Negotiated Rate	$229.48
Max. Negotiated Rate	$327.82
Rate for Payer: Aetna Commercial	$309.61
Rate for Payer: Aetna New Business (MI Preferred)	$236.76
Rate for Payer: Cash Price	$291.40
Rate for Payer: Cofinity Commercial	$313.26
Rate for Payer: Cofinity Commercial	$254.98
Rate for Payer: Healthscope Commercial	$327.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$309.61
Rate for Payer: PHP Commercial	$309.61
Rate for Payer: Priority Health Cigna Priority Health	$254.98
Rate for Payer: Priority Health SBD	$229.48

SUCRALFATE 1 GRAM TABLET

Facility

$238.45

Service Code	NDC 0093-2210-01
Hospital Charge Code	11442
Hospital Revenue Code	637
Min. Negotiated Rate	$150.22
Max. Negotiated Rate	$214.60
Rate for Payer: Aetna Commercial	$202.68
Rate for Payer: Aetna New Business (MI Preferred)	$154.99
Rate for Payer: Cash Price	$190.76
Rate for Payer: Cofinity Commercial	$166.92
Rate for Payer: Cofinity Commercial	$205.07
Rate for Payer: Healthscope Commercial	$214.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$202.68
Rate for Payer: PHP Commercial	$202.68
Rate for Payer: Priority Health Cigna Priority Health	$166.92
Rate for Payer: Priority Health SBD	$150.22

SUCRALFATE 1 GRAM TABLET

Facility

$279.30

Service Code	NDC 51079-753-20
Hospital Charge Code	11442
Hospital Revenue Code	637
Min. Negotiated Rate	$175.96
Max. Negotiated Rate	$251.37
Rate for Payer: Aetna Commercial	$237.40
Rate for Payer: Aetna New Business (MI Preferred)	$181.54
Rate for Payer: Cash Price	$223.44
Rate for Payer: Cofinity Commercial	$195.51
Rate for Payer: Cofinity Commercial	$240.20
Rate for Payer: Healthscope Commercial	$251.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$237.40
Rate for Payer: PHP Commercial	$237.40
Rate for Payer: Priority Health Cigna Priority Health	$195.51
Rate for Payer: Priority Health SBD	$175.96

SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION

Facility

$428.08

Service Code	NDC 0006-5423-02
Hospital Charge Code	177099
Hospital Revenue Code	250
Min. Negotiated Rate	$269.69
Max. Negotiated Rate	$385.27
Rate for Payer: Aetna Commercial	$363.87
Rate for Payer: Aetna New Business (MI Preferred)	$278.25
Rate for Payer: Cash Price	$342.46
Rate for Payer: Cofinity Commercial	$299.66
Rate for Payer: Cofinity Commercial	$368.15
Rate for Payer: Healthscope Commercial	$385.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.87
Rate for Payer: PHP Commercial	$363.87
Rate for Payer: Priority Health Cigna Priority Health	$299.66
Rate for Payer: Priority Health SBD	$269.69

SUGAMMADEX 100 MG/ML INTRAVENOUS SOLUTION

Facility

$428.08

Service Code	NDC 0006-5423-12
Hospital Charge Code	177099
Hospital Revenue Code	250
Min. Negotiated Rate	$269.69
Max. Negotiated Rate	$385.27
Rate for Payer: Aetna Commercial	$363.87
Rate for Payer: Aetna New Business (MI Preferred)	$278.25
Rate for Payer: Cash Price	$342.46
Rate for Payer: Cofinity Commercial	$368.15
Rate for Payer: Cofinity Commercial	$299.66
Rate for Payer: Healthscope Commercial	$385.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.87
Rate for Payer: PHP Commercial	$363.87
Rate for Payer: Priority Health Cigna Priority Health	$299.66
Rate for Payer: Priority Health SBD	$269.69

SULFACETAMIDE SODIUM 10 % EYE DROPS

Facility

$120.07

Service Code	NDC 24208-670-04
Hospital Charge Code	7359
Hospital Revenue Code	637
Min. Negotiated Rate	$75.64
Max. Negotiated Rate	$108.06
Rate for Payer: Aetna Commercial	$102.06
Rate for Payer: Aetna New Business (MI Preferred)	$78.05
Rate for Payer: Cash Price	$96.06
Rate for Payer: Cofinity Commercial	$103.26
Rate for Payer: Cofinity Commercial	$84.05
Rate for Payer: Healthscope Commercial	$108.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$102.06
Rate for Payer: PHP Commercial	$102.06
Rate for Payer: Priority Health Cigna Priority Health	$84.05
Rate for Payer: Priority Health SBD	$75.64

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$51.29

Service Code	NDC 0121-0853-20
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$32.31
Max. Negotiated Rate	$46.16
Rate for Payer: Aetna Commercial	$43.60
Rate for Payer: Aetna New Business (MI Preferred)	$33.34
Rate for Payer: Cash Price	$41.03
Rate for Payer: Cofinity Commercial	$35.90
Rate for Payer: Cofinity Commercial	$44.11
Rate for Payer: Healthscope Commercial	$46.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.60
Rate for Payer: PHP Commercial	$43.60
Rate for Payer: Priority Health Cigna Priority Health	$35.90
Rate for Payer: Priority Health SBD	$32.31

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$51.29

Service Code	NDC 0121-0853-40
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$32.31
Max. Negotiated Rate	$46.16
Rate for Payer: Aetna Commercial	$43.60
Rate for Payer: Aetna New Business (MI Preferred)	$33.34
Rate for Payer: Cash Price	$41.03
Rate for Payer: Cofinity Commercial	$35.90
Rate for Payer: Cofinity Commercial	$44.11
Rate for Payer: Healthscope Commercial	$46.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$43.60
Rate for Payer: PHP Commercial	$43.60
Rate for Payer: Priority Health Cigna Priority Health	$35.90
Rate for Payer: Priority Health SBD	$32.31

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383-824-21
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$9.02
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Facility

$12.88

Service Code	NDC 50383-824-20
Hospital Charge Code	22560
Hospital Revenue Code	637
Min. Negotiated Rate	$8.11
Max. Negotiated Rate	$11.59
Rate for Payer: Aetna Commercial	$10.95
Rate for Payer: Aetna New Business (MI Preferred)	$8.37
Rate for Payer: Cash Price	$10.30
Rate for Payer: Cofinity Commercial	$11.08
Rate for Payer: Cofinity Commercial	$9.02
Rate for Payer: Healthscope Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.95
Rate for Payer: PHP Commercial	$10.95
Rate for Payer: Priority Health Cigna Priority Health	$9.02
Rate for Payer: Priority Health SBD	$8.11

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069-362-10
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$18.34
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$32.76

Service Code	NDC 0703-9514-91
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$29.48
Rate for Payer: Aetna Commercial	$27.85
Rate for Payer: Aetna New Business (MI Preferred)	$21.29
Rate for Payer: Cash Price	$26.21
Rate for Payer: Cofinity Commercial	$22.93
Rate for Payer: Cofinity Commercial	$28.17
Rate for Payer: Healthscope Commercial	$29.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.85
Rate for Payer: PHP Commercial	$27.85
Rate for Payer: Priority Health Cigna Priority Health	$22.93
Rate for Payer: Priority Health SBD	$20.64

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$26.20

Service Code	NDC 70069-362-01
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$23.58
Rate for Payer: Aetna Commercial	$22.27
Rate for Payer: Aetna New Business (MI Preferred)	$17.03
Rate for Payer: Cash Price	$20.96
Rate for Payer: Cofinity Commercial	$18.34
Rate for Payer: Cofinity Commercial	$22.53
Rate for Payer: Healthscope Commercial	$23.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.27
Rate for Payer: PHP Commercial	$22.27
Rate for Payer: Priority Health Cigna Priority Health	$18.34
Rate for Payer: Priority Health SBD	$16.51

SULFAMETHOXAZOLE 400 MG-TRIMETHOPRIM 80 MG/5 ML INTRAVENOUS SOLUTION

Facility

$32.76

Service Code	NDC 0703-9514-93
Hospital Charge Code	7556
Hospital Revenue Code	250
Min. Negotiated Rate	$20.64
Max. Negotiated Rate	$29.48
Rate for Payer: Aetna Commercial	$27.85
Rate for Payer: Aetna New Business (MI Preferred)	$21.29
Rate for Payer: Cash Price	$26.21
Rate for Payer: Cofinity Commercial	$22.93
Rate for Payer: Cofinity Commercial	$28.17
Rate for Payer: Healthscope Commercial	$29.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.85
Rate for Payer: PHP Commercial	$27.85
Rate for Payer: Priority Health Cigna Priority Health	$22.93
Rate for Payer: Priority Health SBD	$20.64

SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET

Facility

$298.45

Service Code	NDC 63739-228-10
Hospital Charge Code	7555
Hospital Revenue Code	637
Min. Negotiated Rate	$188.02
Max. Negotiated Rate	$268.60
Rate for Payer: Aetna Commercial	$253.68
Rate for Payer: Aetna New Business (MI Preferred)	$193.99
Rate for Payer: Cash Price	$238.76
Rate for Payer: Cofinity Commercial	$208.92
Rate for Payer: Cofinity Commercial	$256.67
Rate for Payer: Healthscope Commercial	$268.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.68
Rate for Payer: PHP Commercial	$253.68
Rate for Payer: Priority Health Cigna Priority Health	$208.92
Rate for Payer: Priority Health SBD	$188.02

SULFAMETHOXAZOLE 800 MG-TRIMETHOPRIM 160 MG TABLET

Facility

$286.70

Service Code	NDC 0904-2725-61
Hospital Charge Code	7555
Hospital Revenue Code	637
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$258.03
Rate for Payer: Aetna Commercial	$243.70
Rate for Payer: Aetna New Business (MI Preferred)	$186.36
Rate for Payer: Cash Price	$229.36
Rate for Payer: Cofinity Commercial	$200.69
Rate for Payer: Cofinity Commercial	$246.56
Rate for Payer: Healthscope Commercial	$258.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.70
Rate for Payer: PHP Commercial	$243.70
Rate for Payer: Priority Health Cigna Priority Health	$200.69
Rate for Payer: Priority Health SBD	$180.62

SULFASALAZINE 500 MG TABLET

Facility

$175.28

Service Code	NDC 50268-730-15
Hospital Charge Code	7562
Hospital Revenue Code	637
Min. Negotiated Rate	$110.43
Max. Negotiated Rate	$157.75
Rate for Payer: Aetna Commercial	$148.99
Rate for Payer: Aetna New Business (MI Preferred)	$113.93
Rate for Payer: Cash Price	$140.22
Rate for Payer: Cofinity Commercial	$122.70
Rate for Payer: Cofinity Commercial	$150.74
Rate for Payer: Healthscope Commercial	$157.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$148.99
Rate for Payer: PHP Commercial	$148.99
Rate for Payer: Priority Health Cigna Priority Health	$122.70
Rate for Payer: Priority Health SBD	$110.43

Know your out-of-pocket cost for care.

All Charges