Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$32.55

Service Code	NDC 51672125801
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna Medicare	$16.27
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: BCBS Complete	$13.02
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.79
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Cofinity Medicare Advantage	$22.79
Rate for Payer: Encore Health Key Benefits Commercial	$26.04
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$21.16
Rate for Payer: Priority Health SBD	$20.51

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$52.61

Service Code	NDC 00168016315
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$21.04
Max. Negotiated Rate	$47.35
Rate for Payer: Aetna Commercial	$44.72
Rate for Payer: Aetna Medicare	$26.30
Rate for Payer: Aetna New Business (MI Preferred)	$34.20
Rate for Payer: BCBS Complete	$21.04
Rate for Payer: Cash Price	$42.09
Rate for Payer: Cofinity Commercial	$36.83
Rate for Payer: Cofinity Commercial	$45.24
Rate for Payer: Cofinity Medicare Advantage	$36.83
Rate for Payer: Encore Health Key Benefits Commercial	$42.09
Rate for Payer: Healthscope Commercial	$47.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.72
Rate for Payer: PHP Commercial	$44.72
Rate for Payer: Priority Health Cigna Priority Health	$34.20
Rate for Payer: Priority Health SBD	$33.14

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$18.84

Service Code	NDC 69238153205
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$7.54
Max. Negotiated Rate	$16.96
Rate for Payer: Aetna Commercial	$16.01
Rate for Payer: Aetna Medicare	$9.42
Rate for Payer: Aetna New Business (MI Preferred)	$12.25
Rate for Payer: BCBS Complete	$7.54
Rate for Payer: Cash Price	$15.07
Rate for Payer: Cofinity Commercial	$13.19
Rate for Payer: Cofinity Commercial	$16.20
Rate for Payer: Cofinity Medicare Advantage	$13.19
Rate for Payer: Encore Health Key Benefits Commercial	$15.07
Rate for Payer: Healthscope Commercial	$16.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.01
Rate for Payer: PHP Commercial	$16.01
Rate for Payer: Priority Health Cigna Priority Health	$12.25
Rate for Payer: Priority Health SBD	$11.87

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$52.61

Service Code	NDC 00168016315
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$33.14
Max. Negotiated Rate	$47.35
Rate for Payer: Aetna Commercial	$44.72
Rate for Payer: Aetna New Business (MI Preferred)	$34.20
Rate for Payer: Cash Price	$42.09
Rate for Payer: Cofinity Commercial	$36.83
Rate for Payer: Cofinity Commercial	$45.24
Rate for Payer: Cofinity Medicare Advantage	$36.83
Rate for Payer: Encore Health Key Benefits Commercial	$42.09
Rate for Payer: Healthscope Commercial	$47.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.72
Rate for Payer: PHP Commercial	$44.72
Rate for Payer: Priority Health Cigna Priority Health	$34.20
Rate for Payer: Priority Health SBD	$33.14

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$130.20

Service Code	NDC 51672125803
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$82.03
Max. Negotiated Rate	$117.18
Rate for Payer: Aetna Commercial	$110.67
Rate for Payer: Aetna New Business (MI Preferred)	$84.63
Rate for Payer: Cash Price	$104.16
Rate for Payer: Cofinity Commercial	$111.97
Rate for Payer: Cofinity Commercial	$91.14
Rate for Payer: Cofinity Medicare Advantage	$91.14
Rate for Payer: Encore Health Key Benefits Commercial	$104.16
Rate for Payer: Healthscope Commercial	$117.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$110.67
Rate for Payer: PHP Commercial	$110.67
Rate for Payer: Priority Health Cigna Priority Health	$84.63
Rate for Payer: Priority Health SBD	$82.03

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$18.84

Service Code	NDC 69238153205
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$11.87
Max. Negotiated Rate	$16.96
Rate for Payer: Aetna Commercial	$16.01
Rate for Payer: Aetna New Business (MI Preferred)	$12.25
Rate for Payer: Cash Price	$15.07
Rate for Payer: Cofinity Commercial	$13.19
Rate for Payer: Cofinity Commercial	$16.20
Rate for Payer: Cofinity Medicare Advantage	$13.19
Rate for Payer: Encore Health Key Benefits Commercial	$15.07
Rate for Payer: Healthscope Commercial	$16.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.01
Rate for Payer: PHP Commercial	$16.01
Rate for Payer: Priority Health Cigna Priority Health	$12.25
Rate for Payer: Priority Health SBD	$11.87

CLOBETASOL 0.05 % TOPICAL CREAM

Facility

$32.55

Service Code	NDC 51672125801
Hospital Charge Code	9630
Hospital Revenue Code	637
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.79
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Cofinity Medicare Advantage	$22.79
Rate for Payer: Encore Health Key Benefits Commercial	$26.04
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$21.16
Rate for Payer: Priority Health SBD	$20.51

CLONAZEPAM 0.5 MG TABLET

Facility

$64.75

Service Code	NDC 43547040610
Hospital Charge Code	9637
Hospital Revenue Code	637
Min. Negotiated Rate	$40.79
Max. Negotiated Rate	$58.27
Rate for Payer: Aetna Commercial	$55.04
Rate for Payer: Aetna New Business (MI Preferred)	$42.09
Rate for Payer: Cash Price	$51.80
Rate for Payer: Cofinity Commercial	$45.33
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Medicare Advantage	$45.33
Rate for Payer: Encore Health Key Benefits Commercial	$51.80
Rate for Payer: Healthscope Commercial	$58.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.04
Rate for Payer: PHP Commercial	$55.04
Rate for Payer: Priority Health Cigna Priority Health	$42.09
Rate for Payer: Priority Health SBD	$40.79

CLONAZEPAM 0.5 MG TABLET

Facility

$64.75

Service Code	NDC 43547040610
Hospital Charge Code	9637
Hospital Revenue Code	637
Min. Negotiated Rate	$25.90
Max. Negotiated Rate	$58.27
Rate for Payer: Aetna Commercial	$55.04
Rate for Payer: Aetna Medicare	$32.38
Rate for Payer: Aetna New Business (MI Preferred)	$42.09
Rate for Payer: BCBS Complete	$25.90
Rate for Payer: Cash Price	$51.80
Rate for Payer: Cofinity Commercial	$45.33
Rate for Payer: Cofinity Commercial	$55.69
Rate for Payer: Cofinity Medicare Advantage	$45.33
Rate for Payer: Encore Health Key Benefits Commercial	$51.80
Rate for Payer: Healthscope Commercial	$58.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.04
Rate for Payer: PHP Commercial	$55.04
Rate for Payer: Priority Health Cigna Priority Health	$42.09
Rate for Payer: Priority Health SBD	$40.79

CLONAZEPAM 1 MG TABLET

Facility

$84.00

Service Code	NDC 43547040710
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Cofinity Medicare Advantage	$58.80
Rate for Payer: Encore Health Key Benefits Commercial	$67.20
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$52.92

CLONAZEPAM 1 MG TABLET

Facility

$1,058.85

Service Code	NDC 00004005801
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$423.54
Max. Negotiated Rate	$952.97
Rate for Payer: Aetna Commercial	$900.02
Rate for Payer: Aetna Medicare	$529.42
Rate for Payer: Aetna New Business (MI Preferred)	$688.25
Rate for Payer: BCBS Complete	$423.54
Rate for Payer: Cash Price	$847.08
Rate for Payer: Cofinity Commercial	$741.20
Rate for Payer: Cofinity Commercial	$910.61
Rate for Payer: Cofinity Medicare Advantage	$741.20
Rate for Payer: Encore Health Key Benefits Commercial	$847.08
Rate for Payer: Healthscope Commercial	$952.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$900.02
Rate for Payer: PHP Commercial	$900.02
Rate for Payer: Priority Health Cigna Priority Health	$688.25
Rate for Payer: Priority Health SBD	$667.08

CLONAZEPAM 1 MG TABLET

Facility

$147.00

Service Code	NDC 51079088220
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Commercial	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Cofinity Medicare Advantage	$102.90
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health Cigna Priority Health	$95.55
Rate for Payer: Priority Health SBD	$92.61

CLONAZEPAM 1 MG TABLET

Facility

$1.47

Service Code	NDC 51079088201
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Medicare Advantage	$1.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health SBD	$0.93

CLONAZEPAM 1 MG TABLET

Facility

$84.00

Service Code	NDC 43547040710
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$75.60
Rate for Payer: Aetna Commercial	$71.40
Rate for Payer: Aetna New Business (MI Preferred)	$54.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cofinity Commercial	$58.80
Rate for Payer: Cofinity Commercial	$72.24
Rate for Payer: Cofinity Medicare Advantage	$58.80
Rate for Payer: Encore Health Key Benefits Commercial	$67.20
Rate for Payer: Healthscope Commercial	$75.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.40
Rate for Payer: PHP Commercial	$71.40
Rate for Payer: Priority Health Cigna Priority Health	$54.60
Rate for Payer: Priority Health SBD	$52.92

CLONAZEPAM 1 MG TABLET

Facility

$147.00

Service Code	NDC 51079088220
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Commercial	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Cofinity Medicare Advantage	$102.90
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health Cigna Priority Health	$95.55
Rate for Payer: Priority Health SBD	$92.61

CLONAZEPAM 1 MG TABLET

Facility

$1,058.85

Service Code	NDC 00004005801
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$667.08
Max. Negotiated Rate	$952.97
Rate for Payer: Aetna Commercial	$900.02
Rate for Payer: Aetna New Business (MI Preferred)	$688.25
Rate for Payer: Cash Price	$847.08
Rate for Payer: Cofinity Commercial	$741.20
Rate for Payer: Cofinity Commercial	$910.61
Rate for Payer: Cofinity Medicare Advantage	$741.20
Rate for Payer: Encore Health Key Benefits Commercial	$847.08
Rate for Payer: Healthscope Commercial	$952.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$900.02
Rate for Payer: PHP Commercial	$900.02
Rate for Payer: Priority Health Cigna Priority Health	$688.25
Rate for Payer: Priority Health SBD	$667.08

CLONAZEPAM 1 MG TABLET

Facility

$1.47

Service Code	NDC 51079088201
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare	$0.74
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: BCBS Complete	$0.59
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Medicare Advantage	$1.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health SBD	$0.93

CLONAZEPAM 2 MG TABLET

Facility

$101.50

Service Code	NDC 43547040810
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$63.95
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$86.28
Rate for Payer: Aetna New Business (MI Preferred)	$65.97
Rate for Payer: Cash Price	$81.20
Rate for Payer: Cofinity Commercial	$71.05
Rate for Payer: Cofinity Commercial	$87.29
Rate for Payer: Cofinity Medicare Advantage	$71.05
Rate for Payer: Encore Health Key Benefits Commercial	$81.20
Rate for Payer: Healthscope Commercial	$91.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.28
Rate for Payer: PHP Commercial	$86.28
Rate for Payer: Priority Health Cigna Priority Health	$65.97
Rate for Payer: Priority Health SBD	$63.95

CLONAZEPAM 2 MG TABLET

Facility

$147.00

Service Code	NDC 51079088320
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Commercial	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Cofinity Medicare Advantage	$102.90
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health Cigna Priority Health	$95.55
Rate for Payer: Priority Health SBD	$92.61

CLONAZEPAM 2 MG TABLET

Facility

$101.50

Service Code	NDC 43547040810
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$91.35
Rate for Payer: Aetna Commercial	$86.28
Rate for Payer: Aetna Medicare	$50.75
Rate for Payer: Aetna New Business (MI Preferred)	$65.97
Rate for Payer: BCBS Complete	$40.60
Rate for Payer: Cash Price	$81.20
Rate for Payer: Cofinity Commercial	$71.05
Rate for Payer: Cofinity Commercial	$87.29
Rate for Payer: Cofinity Medicare Advantage	$71.05
Rate for Payer: Encore Health Key Benefits Commercial	$81.20
Rate for Payer: Healthscope Commercial	$91.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.28
Rate for Payer: PHP Commercial	$86.28
Rate for Payer: Priority Health Cigna Priority Health	$65.97
Rate for Payer: Priority Health SBD	$63.95

CLONAZEPAM 2 MG TABLET

Facility

$1.47

Service Code	NDC 51079088301
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Medicare Advantage	$1.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health SBD	$0.93

CLONAZEPAM 2 MG TABLET

Facility

$147.00

Service Code	NDC 51079088320
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Commercial	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Cofinity Medicare Advantage	$102.90
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health Cigna Priority Health	$95.55
Rate for Payer: Priority Health SBD	$92.61

CLONAZEPAM 2 MG TABLET

Facility

$1.47

Service Code	NDC 51079088301
Hospital Charge Code	9639
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare	$0.74
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: BCBS Complete	$0.59
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Commercial	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Cofinity Medicare Advantage	$1.03
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health Cigna Priority Health	$0.96
Rate for Payer: Priority Health SBD	$0.93

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$91.18

Service Code	NDC 00378087116
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$57.44
Max. Negotiated Rate	$82.06
Rate for Payer: Aetna Commercial	$77.50
Rate for Payer: Aetna New Business (MI Preferred)	$59.27
Rate for Payer: Cash Price	$72.94
Rate for Payer: Cofinity Commercial	$63.83
Rate for Payer: Cofinity Commercial	$78.41
Rate for Payer: Cofinity Medicare Advantage	$63.83
Rate for Payer: Encore Health Key Benefits Commercial	$72.94
Rate for Payer: Healthscope Commercial	$82.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.50
Rate for Payer: PHP Commercial	$77.50
Rate for Payer: Priority Health Cigna Priority Health	$59.27
Rate for Payer: Priority Health SBD	$57.44

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$364.72

Service Code	NDC 00378087199
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$229.77
Max. Negotiated Rate	$328.25
Rate for Payer: Aetna Commercial	$310.01
Rate for Payer: Aetna New Business (MI Preferred)	$237.07
Rate for Payer: Cash Price	$291.78
Rate for Payer: Cofinity Commercial	$255.30
Rate for Payer: Cofinity Commercial	$313.66
Rate for Payer: Cofinity Medicare Advantage	$255.30
Rate for Payer: Encore Health Key Benefits Commercial	$291.78
Rate for Payer: Healthscope Commercial	$328.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.01
Rate for Payer: PHP Commercial	$310.01
Rate for Payer: Priority Health Cigna Priority Health	$237.07
Rate for Payer: Priority Health SBD	$229.77

Know your out-of-pocket cost for care.

All Charges