Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AMITRIPTYLINE 100 MG TABLET

Facility

$365.28

Service Code	NDC 51079056320
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$230.13
Max. Negotiated Rate	$328.75
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna New Business (MI Preferred)	$237.43
Rate for Payer: Cash Price	$292.22
Rate for Payer: Cofinity Commercial	$255.70
Rate for Payer: Cofinity Commercial	$314.14
Rate for Payer: Cofinity Medicare Advantage	$255.70
Rate for Payer: Encore Health Key Benefits Commercial	$292.22
Rate for Payer: Healthscope Commercial	$328.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.49
Rate for Payer: PHP Commercial	$310.49
Rate for Payer: Priority Health Cigna Priority Health	$237.43
Rate for Payer: Priority Health SBD	$230.13

AMITRIPTYLINE 100 MG TABLET

Facility

$218.55

Service Code	NDC 16729017501
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.70
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.98
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.98
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

AMITRIPTYLINE 100 MG TABLET

Facility

$3.66

Service Code	NDC 51079056301
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: Aetna Medicare	$1.83
Rate for Payer: Aetna New Business (MI Preferred)	$2.38
Rate for Payer: BCBS Complete	$1.46
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cofinity Commercial	$2.56
Rate for Payer: Cofinity Commercial	$3.15
Rate for Payer: Cofinity Medicare Advantage	$2.56
Rate for Payer: Encore Health Key Benefits Commercial	$2.93
Rate for Payer: Healthscope Commercial	$3.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.11
Rate for Payer: PHP Commercial	$3.11
Rate for Payer: Priority Health Cigna Priority Health	$2.38
Rate for Payer: Priority Health SBD	$2.31

AMITRIPTYLINE 100 MG TABLET

Facility

$365.28

Service Code	NDC 51079056320
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$146.11
Max. Negotiated Rate	$328.75
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna Medicare	$182.64
Rate for Payer: Aetna New Business (MI Preferred)	$237.43
Rate for Payer: BCBS Complete	$146.11
Rate for Payer: Cash Price	$292.22
Rate for Payer: Cofinity Commercial	$255.70
Rate for Payer: Cofinity Commercial	$314.14
Rate for Payer: Cofinity Medicare Advantage	$255.70
Rate for Payer: Encore Health Key Benefits Commercial	$292.22
Rate for Payer: Healthscope Commercial	$328.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.49
Rate for Payer: PHP Commercial	$310.49
Rate for Payer: Priority Health Cigna Priority Health	$237.43
Rate for Payer: Priority Health SBD	$230.13

AMITRIPTYLINE 100 MG TABLET

Facility

$3.66

Service Code	NDC 51079056301
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: Aetna New Business (MI Preferred)	$2.38
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cofinity Commercial	$2.56
Rate for Payer: Cofinity Commercial	$3.15
Rate for Payer: Cofinity Medicare Advantage	$2.56
Rate for Payer: Encore Health Key Benefits Commercial	$2.93
Rate for Payer: Healthscope Commercial	$3.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.11
Rate for Payer: PHP Commercial	$3.11
Rate for Payer: Priority Health Cigna Priority Health	$2.38
Rate for Payer: Priority Health SBD	$2.31

AMITRIPTYLINE 10 MG TABLET

Facility

$136.30

Service Code	NDC 16729017101
Hospital Charge Code	432
Hospital Revenue Code	637
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna Medicare	$68.15
Rate for Payer: Aetna New Business (MI Preferred)	$88.60
Rate for Payer: BCBS Complete	$54.52
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Cofinity Commercial	$95.41
Rate for Payer: Cofinity Medicare Advantage	$95.41
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health Cigna Priority Health	$88.60
Rate for Payer: Priority Health SBD	$85.87

AMITRIPTYLINE 10 MG TABLET

Facility

$136.30

Service Code	NDC 16729017101
Hospital Charge Code	432
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna New Business (MI Preferred)	$88.60
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Cofinity Commercial	$95.41
Rate for Payer: Cofinity Medicare Advantage	$95.41
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health Cigna Priority Health	$88.60
Rate for Payer: Priority Health SBD	$85.87

AMITRIPTYLINE 25 MG TABLET

Facility

$221.35

Service Code	NDC 00781148701
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$139.45
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

AMITRIPTYLINE 25 MG TABLET

Facility

$240.35

Service Code	NDC 00904020161
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$96.14
Max. Negotiated Rate	$216.32
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna Medicare	$120.18
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: BCBS Complete	$96.14
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Commercial	$168.24
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Cofinity Medicare Advantage	$168.24
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health Cigna Priority Health	$156.23
Rate for Payer: Priority Health SBD	$151.42

AMITRIPTYLINE 25 MG TABLET

Facility

$240.35

Service Code	NDC 00904020161
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$151.42
Max. Negotiated Rate	$216.32
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Commercial	$168.24
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Cofinity Medicare Advantage	$168.24
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health Cigna Priority Health	$156.23
Rate for Payer: Priority Health SBD	$151.42

AMITRIPTYLINE 25 MG TABLET

Facility

$221.35

Service Code	NDC 00781148701
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$88.54
Max. Negotiated Rate	$199.22
Rate for Payer: Aetna Commercial	$188.15
Rate for Payer: Aetna Medicare	$110.68
Rate for Payer: Aetna New Business (MI Preferred)	$143.88
Rate for Payer: BCBS Complete	$88.54
Rate for Payer: Cash Price	$177.08
Rate for Payer: Cofinity Commercial	$154.94
Rate for Payer: Cofinity Commercial	$190.36
Rate for Payer: Cofinity Medicare Advantage	$154.94
Rate for Payer: Encore Health Key Benefits Commercial	$177.08
Rate for Payer: Healthscope Commercial	$199.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.15
Rate for Payer: PHP Commercial	$188.15
Rate for Payer: Priority Health Cigna Priority Health	$143.88
Rate for Payer: Priority Health SBD	$139.45

AMITRIPTYLINE 50 MG TABLET

Facility

$409.45

Service Code	NDC 00904020261
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$257.95
Max. Negotiated Rate	$368.50
Rate for Payer: Aetna Commercial	$348.03
Rate for Payer: Aetna New Business (MI Preferred)	$266.14
Rate for Payer: Cash Price	$327.56
Rate for Payer: Cofinity Commercial	$286.62
Rate for Payer: Cofinity Commercial	$352.13
Rate for Payer: Cofinity Medicare Advantage	$286.62
Rate for Payer: Encore Health Key Benefits Commercial	$327.56
Rate for Payer: Healthscope Commercial	$368.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.03
Rate for Payer: PHP Commercial	$348.03
Rate for Payer: Priority Health Cigna Priority Health	$266.14
Rate for Payer: Priority Health SBD	$257.95

AMITRIPTYLINE 50 MG TABLET

Facility

$409.45

Service Code	NDC 00904020261
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$163.78
Max. Negotiated Rate	$368.50
Rate for Payer: Aetna Commercial	$348.03
Rate for Payer: Aetna Medicare	$204.72
Rate for Payer: Aetna New Business (MI Preferred)	$266.14
Rate for Payer: BCBS Complete	$163.78
Rate for Payer: Cash Price	$327.56
Rate for Payer: Cofinity Commercial	$286.62
Rate for Payer: Cofinity Commercial	$352.13
Rate for Payer: Cofinity Medicare Advantage	$286.62
Rate for Payer: Encore Health Key Benefits Commercial	$327.56
Rate for Payer: Healthscope Commercial	$368.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.03
Rate for Payer: PHP Commercial	$348.03
Rate for Payer: Priority Health Cigna Priority Health	$266.14
Rate for Payer: Priority Health SBD	$257.95

AMITRIPTYLINE 50 MG TABLET

Facility

$331.55

Service Code	NDC 51079013320
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$208.88
Max. Negotiated Rate	$298.40
Rate for Payer: Aetna Commercial	$281.82
Rate for Payer: Aetna New Business (MI Preferred)	$215.51
Rate for Payer: Cash Price	$265.24
Rate for Payer: Cofinity Commercial	$232.08
Rate for Payer: Cofinity Commercial	$285.13
Rate for Payer: Cofinity Medicare Advantage	$232.08
Rate for Payer: Encore Health Key Benefits Commercial	$265.24
Rate for Payer: Healthscope Commercial	$298.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.82
Rate for Payer: PHP Commercial	$281.82
Rate for Payer: Priority Health Cigna Priority Health	$215.51
Rate for Payer: Priority Health SBD	$208.88

AMITRIPTYLINE 50 MG TABLET

Facility

$4.66

Service Code	NDC 50268003911
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Commercial	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Cofinity Medicare Advantage	$3.26
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health Cigna Priority Health	$3.03
Rate for Payer: Priority Health SBD	$2.94

AMITRIPTYLINE 50 MG TABLET

Facility

$331.55

Service Code	NDC 51079013320
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$132.62
Max. Negotiated Rate	$298.40
Rate for Payer: Aetna Commercial	$281.82
Rate for Payer: Aetna Medicare	$165.78
Rate for Payer: Aetna New Business (MI Preferred)	$215.51
Rate for Payer: BCBS Complete	$132.62
Rate for Payer: Cash Price	$265.24
Rate for Payer: Cofinity Commercial	$232.08
Rate for Payer: Cofinity Commercial	$285.13
Rate for Payer: Cofinity Medicare Advantage	$232.08
Rate for Payer: Encore Health Key Benefits Commercial	$265.24
Rate for Payer: Healthscope Commercial	$298.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.82
Rate for Payer: PHP Commercial	$281.82
Rate for Payer: Priority Health Cigna Priority Health	$215.51
Rate for Payer: Priority Health SBD	$208.88

AMITRIPTYLINE 50 MG TABLET

Facility

$4.66

Service Code	NDC 50268003911
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$4.19
Rate for Payer: Aetna Commercial	$3.96
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.03
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.73
Rate for Payer: Cofinity Commercial	$3.26
Rate for Payer: Cofinity Commercial	$4.01
Rate for Payer: Cofinity Medicare Advantage	$3.26
Rate for Payer: Encore Health Key Benefits Commercial	$3.73
Rate for Payer: Healthscope Commercial	$4.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.96
Rate for Payer: PHP Commercial	$3.96
Rate for Payer: Priority Health Cigna Priority Health	$3.03
Rate for Payer: Priority Health SBD	$2.94

AMITRIPTYLINE 50 MG TABLET

Facility

$3.32

Service Code	NDC 51079013301
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: BCBS Complete	$1.33
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

AMITRIPTYLINE 50 MG TABLET

Facility

$232.75

Service Code	NDC 50268003915
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$209.48
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna Medicare	$116.38
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: BCBS Complete	$93.10
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.92
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$151.29
Rate for Payer: Priority Health SBD	$146.63

AMITRIPTYLINE 50 MG TABLET

Facility

$232.75

Service Code	NDC 50268003915
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.48
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Cofinity Medicare Advantage	$162.92
Rate for Payer: Encore Health Key Benefits Commercial	$186.20
Rate for Payer: Healthscope Commercial	$209.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$151.29
Rate for Payer: Priority Health SBD	$146.63

AMITRIPTYLINE 50 MG TABLET

Facility

$254.40

Service Code	NDC 00378265001
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$160.27
Max. Negotiated Rate	$228.96
Rate for Payer: Aetna Commercial	$216.24
Rate for Payer: Aetna New Business (MI Preferred)	$165.36
Rate for Payer: Cash Price	$203.52
Rate for Payer: Cofinity Commercial	$178.08
Rate for Payer: Cofinity Commercial	$218.78
Rate for Payer: Cofinity Medicare Advantage	$178.08
Rate for Payer: Encore Health Key Benefits Commercial	$203.52
Rate for Payer: Healthscope Commercial	$228.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.24
Rate for Payer: PHP Commercial	$216.24
Rate for Payer: Priority Health Cigna Priority Health	$165.36
Rate for Payer: Priority Health SBD	$160.27

AMITRIPTYLINE 50 MG TABLET

Facility

$3.32

Service Code	NDC 51079013301
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Cofinity Medicare Advantage	$2.32
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health	$2.16
Rate for Payer: Priority Health SBD	$2.09

AMITRIPTYLINE 50 MG TABLET

Facility

$254.40

Service Code	NDC 00378265001
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$101.76
Max. Negotiated Rate	$228.96
Rate for Payer: Aetna Commercial	$216.24
Rate for Payer: Aetna Medicare	$127.20
Rate for Payer: Aetna New Business (MI Preferred)	$165.36
Rate for Payer: BCBS Complete	$101.76
Rate for Payer: Cash Price	$203.52
Rate for Payer: Cofinity Commercial	$178.08
Rate for Payer: Cofinity Commercial	$218.78
Rate for Payer: Cofinity Medicare Advantage	$178.08
Rate for Payer: Encore Health Key Benefits Commercial	$203.52
Rate for Payer: Healthscope Commercial	$228.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.24
Rate for Payer: PHP Commercial	$216.24
Rate for Payer: Priority Health Cigna Priority Health	$165.36
Rate for Payer: Priority Health SBD	$160.27

AMLODIPINE 10 MG TABLET

Facility

$338.40

Service Code	NDC 60687049601
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$135.36
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Cofinity Medicare Advantage	$236.88
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health SBD	$213.19

AMLODIPINE 10 MG TABLET

Facility

$38.07

Service Code	NDC 69097012805
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$34.26
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna New Business (MI Preferred)	$24.75
Rate for Payer: Cash Price	$30.46
Rate for Payer: Cofinity Commercial	$26.65
Rate for Payer: Cofinity Commercial	$32.74
Rate for Payer: Cofinity Medicare Advantage	$26.65
Rate for Payer: Encore Health Key Benefits Commercial	$30.46
Rate for Payer: Healthscope Commercial	$34.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.36
Rate for Payer: PHP Commercial	$32.36
Rate for Payer: Priority Health Cigna Priority Health	$24.75
Rate for Payer: Priority Health SBD	$23.98

Know your out-of-pocket cost for care.

All Charges