Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$94.50

Service Code	NDC 70000052601
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$59.53
Max. Negotiated Rate	$85.05
Rate for Payer: Aetna Commercial	$80.33
Rate for Payer: Aetna New Business (MI Preferred)	$61.42
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cofinity Commercial	$66.15
Rate for Payer: Cofinity Commercial	$81.27
Rate for Payer: Cofinity Medicare Advantage	$66.15
Rate for Payer: Encore Health Key Benefits Commercial	$75.60
Rate for Payer: Healthscope Commercial	$85.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$80.33
Rate for Payer: PHP Commercial	$80.33
Rate for Payer: Priority Health Cigna Priority Health	$61.42
Rate for Payer: Priority Health SBD	$59.53

SENNOSIDES 8.6 MG-DOCUSATE SODIUM 50 MG TABLET

Facility

$159.50

Service Code	NDC 60687062201
Hospital Charge Code	24216
Hospital Revenue Code	637
Min. Negotiated Rate	$100.48
Max. Negotiated Rate	$143.55
Rate for Payer: Aetna Commercial	$135.57
Rate for Payer: Aetna New Business (MI Preferred)	$103.67
Rate for Payer: Cash Price	$127.60
Rate for Payer: Cofinity Commercial	$111.65
Rate for Payer: Cofinity Commercial	$137.17
Rate for Payer: Cofinity Medicare Advantage	$111.65
Rate for Payer: Encore Health Key Benefits Commercial	$127.60
Rate for Payer: Healthscope Commercial	$143.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$135.57
Rate for Payer: PHP Commercial	$135.57
Rate for Payer: Priority Health Cigna Priority Health	$103.67
Rate for Payer: Priority Health SBD	$100.48

SENNOSIDES 8.6 MG TABLET

Facility

$567.00

Service Code	NDC 49483008010
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$357.21
Max. Negotiated Rate	$510.30
Rate for Payer: Aetna Commercial	$481.95
Rate for Payer: Aetna New Business (MI Preferred)	$368.55
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cofinity Commercial	$396.90
Rate for Payer: Cofinity Commercial	$487.62
Rate for Payer: Cofinity Medicare Advantage	$396.90
Rate for Payer: Encore Health Key Benefits Commercial	$453.60
Rate for Payer: Healthscope Commercial	$510.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.95
Rate for Payer: PHP Commercial	$481.95
Rate for Payer: Priority Health Cigna Priority Health	$368.55
Rate for Payer: Priority Health SBD	$357.21

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 96295013956
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG TABLET

Facility

$122.00

Service Code	NDC 96295013289
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna Commercial	$103.70
Rate for Payer: Aetna Medicare	$61.00
Rate for Payer: Aetna New Business (MI Preferred)	$79.30
Rate for Payer: BCBS Complete	$48.80
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cofinity Commercial	$104.92
Rate for Payer: Cofinity Commercial	$85.40
Rate for Payer: Cofinity Medicare Advantage	$85.40
Rate for Payer: Encore Health Key Benefits Commercial	$97.60
Rate for Payer: Healthscope Commercial	$109.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.70
Rate for Payer: PHP Commercial	$103.70
Rate for Payer: Priority Health Cigna Priority Health	$79.30
Rate for Payer: Priority Health SBD	$76.86

SENNOSIDES 8.6 MG TABLET

Facility

$107.10

Service Code	NDC 57896045401
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.03
Rate for Payer: Aetna Medicare	$53.55
Rate for Payer: Aetna New Business (MI Preferred)	$69.61
Rate for Payer: BCBS Complete	$42.84
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Commercial	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Cofinity Medicare Advantage	$74.97
Rate for Payer: Encore Health Key Benefits Commercial	$85.68
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.03
Rate for Payer: PHP Commercial	$91.03
Rate for Payer: Priority Health Cigna Priority Health	$69.61
Rate for Payer: Priority Health SBD	$67.47

SENNOSIDES 8.6 MG TABLET

Facility

$567.00

Service Code	NDC 49483008010
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$226.80
Max. Negotiated Rate	$510.30
Rate for Payer: Aetna Commercial	$481.95
Rate for Payer: Aetna Medicare	$283.50
Rate for Payer: Aetna New Business (MI Preferred)	$368.55
Rate for Payer: BCBS Complete	$226.80
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cofinity Commercial	$396.90
Rate for Payer: Cofinity Commercial	$487.62
Rate for Payer: Cofinity Medicare Advantage	$396.90
Rate for Payer: Encore Health Key Benefits Commercial	$453.60
Rate for Payer: Healthscope Commercial	$510.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.95
Rate for Payer: PHP Commercial	$481.95
Rate for Payer: Priority Health Cigna Priority Health	$368.55
Rate for Payer: Priority Health SBD	$357.21

SENNOSIDES 8.6 MG TABLET

Facility

$140.00

Service Code	NDC 00904725261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$98.00
Rate for Payer: Cofinity Medicare Advantage	$98.00
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health SBD	$88.20

SENNOSIDES 8.6 MG TABLET

Facility

$44.52

Service Code	NDC 67618030020
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$28.05
Max. Negotiated Rate	$40.07
Rate for Payer: Aetna Commercial	$37.84
Rate for Payer: Aetna New Business (MI Preferred)	$28.94
Rate for Payer: Cash Price	$35.62
Rate for Payer: Cofinity Commercial	$31.16
Rate for Payer: Cofinity Commercial	$38.29
Rate for Payer: Cofinity Medicare Advantage	$31.16
Rate for Payer: Encore Health Key Benefits Commercial	$35.62
Rate for Payer: Healthscope Commercial	$40.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.84
Rate for Payer: PHP Commercial	$37.84
Rate for Payer: Priority Health Cigna Priority Health	$28.94
Rate for Payer: Priority Health SBD	$28.05

SENNOSIDES 8.6 MG TABLET

Facility

$107.10

Service Code	NDC 57896045401
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.03
Rate for Payer: Aetna New Business (MI Preferred)	$69.61
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Commercial	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Cofinity Medicare Advantage	$74.97
Rate for Payer: Encore Health Key Benefits Commercial	$85.68
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.03
Rate for Payer: PHP Commercial	$91.03
Rate for Payer: Priority Health Cigna Priority Health	$69.61
Rate for Payer: Priority Health SBD	$67.47

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 96295013956
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
Rate for Payer: BCBS Complete	$65.52
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$114.66
Rate for Payer: Cofinity Commercial	$140.87
Rate for Payer: Cofinity Medicare Advantage	$114.66
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: PHP Commercial	$139.23
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: Priority Health SBD	$103.19

SENNOSIDES 8.6 MG TABLET

Facility

$132.30

Service Code	NDC 00904672559
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$83.35
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.45
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
Rate for Payer: Cash Price	$105.84
Rate for Payer: Cofinity Commercial	$113.78
Rate for Payer: Cofinity Commercial	$92.61
Rate for Payer: Cofinity Medicare Advantage	$92.61
Rate for Payer: Encore Health Key Benefits Commercial	$105.84
Rate for Payer: Healthscope Commercial	$119.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.45
Rate for Payer: PHP Commercial	$112.45
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

SENNOSIDES 8.6 MG TABLET

Facility

$299.25

Service Code	NDC 96295013519
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$269.32
Rate for Payer: Aetna Commercial	$254.36
Rate for Payer: Aetna New Business (MI Preferred)	$194.51
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cofinity Commercial	$209.47
Rate for Payer: Cofinity Commercial	$257.36
Rate for Payer: Cofinity Medicare Advantage	$209.47
Rate for Payer: Encore Health Key Benefits Commercial	$239.40
Rate for Payer: Healthscope Commercial	$269.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.36
Rate for Payer: PHP Commercial	$254.36
Rate for Payer: Priority Health Cigna Priority Health	$194.51
Rate for Payer: Priority Health SBD	$188.53

SENNOSIDES 8.6 MG TABLET

Facility

$44.52

Service Code	NDC 67618030020
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$40.07
Rate for Payer: Aetna Commercial	$37.84
Rate for Payer: Aetna Medicare	$22.26
Rate for Payer: Aetna New Business (MI Preferred)	$28.94
Rate for Payer: BCBS Complete	$17.81
Rate for Payer: Cash Price	$35.62
Rate for Payer: Cofinity Commercial	$31.16
Rate for Payer: Cofinity Commercial	$38.29
Rate for Payer: Cofinity Medicare Advantage	$31.16
Rate for Payer: Encore Health Key Benefits Commercial	$35.62
Rate for Payer: Healthscope Commercial	$40.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.84
Rate for Payer: PHP Commercial	$37.84
Rate for Payer: Priority Health Cigna Priority Health	$28.94
Rate for Payer: Priority Health SBD	$28.05

SENNOSIDES 8.6 MG TABLET

Facility

$113.40

Service Code	NDC 49483008001
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

SENNOSIDES 8.6 MG TABLET

Facility

$132.30

Service Code	NDC 00904672559
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.45
Rate for Payer: Aetna Medicare	$66.15
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
Rate for Payer: BCBS Complete	$52.92
Rate for Payer: Cash Price	$105.84
Rate for Payer: Cofinity Commercial	$113.78
Rate for Payer: Cofinity Commercial	$92.61
Rate for Payer: Cofinity Medicare Advantage	$92.61
Rate for Payer: Encore Health Key Benefits Commercial	$105.84
Rate for Payer: Healthscope Commercial	$119.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.45
Rate for Payer: PHP Commercial	$112.45
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

SENNOSIDES 8.6 MG TABLET

Facility

$299.25

Service Code	NDC 96295013519
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$119.70
Max. Negotiated Rate	$269.32
Rate for Payer: Aetna Commercial	$254.36
Rate for Payer: Aetna Medicare	$149.62
Rate for Payer: Aetna New Business (MI Preferred)	$194.51
Rate for Payer: BCBS Complete	$119.70
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cofinity Commercial	$209.47
Rate for Payer: Cofinity Commercial	$257.36
Rate for Payer: Cofinity Medicare Advantage	$209.47
Rate for Payer: Encore Health Key Benefits Commercial	$239.40
Rate for Payer: Healthscope Commercial	$269.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.36
Rate for Payer: PHP Commercial	$254.36
Rate for Payer: Priority Health Cigna Priority Health	$194.51
Rate for Payer: Priority Health SBD	$188.53

SENNOSIDES 8.6 MG TABLET

Facility

$184.00

Service Code	NDC 70000044703
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna Commercial	$156.40
Rate for Payer: Aetna New Business (MI Preferred)	$119.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cofinity Commercial	$128.80
Rate for Payer: Cofinity Commercial	$158.24
Rate for Payer: Cofinity Medicare Advantage	$128.80
Rate for Payer: Encore Health Key Benefits Commercial	$147.20
Rate for Payer: Healthscope Commercial	$165.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.40
Rate for Payer: PHP Commercial	$156.40
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health SBD	$115.92

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 57896045101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG TABLET

Facility

$132.00

Service Code	NDC 00904652261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Cofinity Medicare Advantage	$92.40
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$85.80
Rate for Payer: Priority Health SBD	$83.16

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 57896045101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$114.66
Rate for Payer: Cofinity Commercial	$140.87
Rate for Payer: Cofinity Medicare Advantage	$114.66
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: PHP Commercial	$139.23
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: Priority Health SBD	$103.19

SENNOSIDES 8.6 MG TABLET

Facility

$132.00

Service Code	NDC 00904652261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$83.16
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Cofinity Medicare Advantage	$92.40
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$85.80
Rate for Payer: Priority Health SBD	$83.16

SENNOSIDES 8.6 MG TABLET

Facility

$149.10

Service Code	NDC 67618030010
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$134.19
Rate for Payer: Aetna Commercial	$126.73
Rate for Payer: Aetna Medicare	$74.55
Rate for Payer: Aetna New Business (MI Preferred)	$96.92
Rate for Payer: BCBS Complete	$59.64
Rate for Payer: Cash Price	$119.28
Rate for Payer: Cofinity Commercial	$104.37
Rate for Payer: Cofinity Commercial	$128.23
Rate for Payer: Cofinity Medicare Advantage	$104.37
Rate for Payer: Encore Health Key Benefits Commercial	$119.28
Rate for Payer: Healthscope Commercial	$134.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.73
Rate for Payer: PHP Commercial	$126.73
Rate for Payer: Priority Health Cigna Priority Health	$96.92
Rate for Payer: Priority Health SBD	$93.93

Know your out-of-pocket cost for care.

All Charges