Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DIAZEPAM 10 MG TABLET

Facility

$1.58

Service Code	NDC 51079028601
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.42
Rate for Payer: Aetna Commercial	$1.34
Rate for Payer: Aetna Medicare	$0.79
Rate for Payer: Aetna New Business (MI Preferred)	$1.03
Rate for Payer: BCBS Complete	$0.63
Rate for Payer: Cash Price	$1.26
Rate for Payer: Cofinity Commercial	$1.11
Rate for Payer: Cofinity Commercial	$1.36
Rate for Payer: Cofinity Medicare Advantage	$1.11
Rate for Payer: Encore Health Key Benefits Commercial	$1.26
Rate for Payer: Healthscope Commercial	$1.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.34
Rate for Payer: PHP Commercial	$1.34
Rate for Payer: Priority Health Cigna Priority Health	$1.03
Rate for Payer: Priority Health SBD	$1.00

DIAZEPAM 10 MG TABLET

Facility

$58.75

Service Code	NDC 00172392760
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$52.88
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Aetna Medicare	$29.38
Rate for Payer: Aetna New Business (MI Preferred)	$38.19
Rate for Payer: BCBS Complete	$23.50
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Cofinity Medicare Advantage	$41.12
Rate for Payer: Encore Health Key Benefits Commercial	$47.00
Rate for Payer: Healthscope Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.94
Rate for Payer: PHP Commercial	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$38.19
Rate for Payer: Priority Health SBD	$37.01

DIAZEPAM 10 MG TABLET

Facility

$157.45

Service Code	NDC 51079028620
Hospital Charge Code	2403
Hospital Revenue Code	637
Min. Negotiated Rate	$99.19
Max. Negotiated Rate	$141.70
Rate for Payer: Aetna Commercial	$133.83
Rate for Payer: Aetna New Business (MI Preferred)	$102.34
Rate for Payer: Cash Price	$125.96
Rate for Payer: Cofinity Commercial	$110.22
Rate for Payer: Cofinity Commercial	$135.41
Rate for Payer: Cofinity Medicare Advantage	$110.22
Rate for Payer: Encore Health Key Benefits Commercial	$125.96
Rate for Payer: Healthscope Commercial	$141.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.83
Rate for Payer: PHP Commercial	$133.83
Rate for Payer: Priority Health Cigna Priority Health	$102.34
Rate for Payer: Priority Health SBD	$99.19

DIAZEPAM 2 MG TABLET

Facility

$56.40

Service Code	NDC 00172392560
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$35.53
Max. Negotiated Rate	$50.76
Rate for Payer: Aetna Commercial	$47.94
Rate for Payer: Aetna New Business (MI Preferred)	$36.66
Rate for Payer: Cash Price	$45.12
Rate for Payer: Cofinity Commercial	$39.48
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Cofinity Medicare Advantage	$39.48
Rate for Payer: Encore Health Key Benefits Commercial	$45.12
Rate for Payer: Healthscope Commercial	$50.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.94
Rate for Payer: PHP Commercial	$47.94
Rate for Payer: Priority Health Cigna Priority Health	$36.66
Rate for Payer: Priority Health SBD	$35.53

DIAZEPAM 2 MG TABLET

Facility

$56.40

Service Code	NDC 00172392560
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$22.56
Max. Negotiated Rate	$50.76
Rate for Payer: Aetna Commercial	$47.94
Rate for Payer: Aetna Medicare	$28.20
Rate for Payer: Aetna New Business (MI Preferred)	$36.66
Rate for Payer: BCBS Complete	$22.56
Rate for Payer: Cash Price	$45.12
Rate for Payer: Cofinity Commercial	$39.48
Rate for Payer: Cofinity Commercial	$48.50
Rate for Payer: Cofinity Medicare Advantage	$39.48
Rate for Payer: Encore Health Key Benefits Commercial	$45.12
Rate for Payer: Healthscope Commercial	$50.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.94
Rate for Payer: PHP Commercial	$47.94
Rate for Payer: Priority Health Cigna Priority Health	$36.66
Rate for Payer: Priority Health SBD	$35.53

DIAZEPAM 2 MG TABLET

Facility

$1.41

Service Code	NDC 51079028401
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna New Business (MI Preferred)	$0.92
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cofinity Commercial	$0.99
Rate for Payer: Cofinity Commercial	$1.21
Rate for Payer: Cofinity Medicare Advantage	$0.99
Rate for Payer: Encore Health Key Benefits Commercial	$1.13
Rate for Payer: Healthscope Commercial	$1.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.20
Rate for Payer: PHP Commercial	$1.20
Rate for Payer: Priority Health Cigna Priority Health	$0.92
Rate for Payer: Priority Health SBD	$0.89

DIAZEPAM 2 MG TABLET

Facility

$141.00

Service Code	NDC 51079028420
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna Commercial	$119.85
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: Aetna New Business (MI Preferred)	$91.65
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$121.26
Rate for Payer: Cofinity Commercial	$98.70
Rate for Payer: Cofinity Medicare Advantage	$98.70
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: PHP Commercial	$119.85
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health SBD	$88.83

DIAZEPAM 2 MG TABLET

Facility

$141.00

Service Code	NDC 51079028420
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$88.83
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna Commercial	$119.85
Rate for Payer: Aetna New Business (MI Preferred)	$91.65
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$121.26
Rate for Payer: Cofinity Commercial	$98.70
Rate for Payer: Cofinity Medicare Advantage	$98.70
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: PHP Commercial	$119.85
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health SBD	$88.83

DIAZEPAM 2 MG TABLET

Facility

$1.41

Service Code	NDC 51079028401
Hospital Charge Code	2404
Hospital Revenue Code	637
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.27
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare	$0.71
Rate for Payer: Aetna New Business (MI Preferred)	$0.92
Rate for Payer: BCBS Complete	$0.56
Rate for Payer: Cash Price	$1.13
Rate for Payer: Cofinity Commercial	$0.99
Rate for Payer: Cofinity Commercial	$1.21
Rate for Payer: Cofinity Medicare Advantage	$0.99
Rate for Payer: Encore Health Key Benefits Commercial	$1.13
Rate for Payer: Healthscope Commercial	$1.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.20
Rate for Payer: PHP Commercial	$1.20
Rate for Payer: Priority Health Cigna Priority Health	$0.92
Rate for Payer: Priority Health SBD	$0.89

DIAZEPAM 5 MG TABLET

Facility

$148.05

Service Code	NDC 51079028520
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.24
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Cofinity Medicare Advantage	$103.64
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$96.23
Rate for Payer: Priority Health SBD	$93.27

DIAZEPAM 5 MG TABLET

Facility

$63.45

Service Code	NDC 00172392660
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$57.10
Rate for Payer: Aetna Commercial	$53.93
Rate for Payer: Aetna Medicare	$31.72
Rate for Payer: Aetna New Business (MI Preferred)	$41.24
Rate for Payer: BCBS Complete	$25.38
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$44.42
Rate for Payer: Cofinity Commercial	$54.57
Rate for Payer: Cofinity Medicare Advantage	$44.42
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: PHP Commercial	$53.93
Rate for Payer: Priority Health Cigna Priority Health	$41.24
Rate for Payer: Priority Health SBD	$39.97

DIAZEPAM 5 MG TABLET

Facility

$148.05

Service Code	NDC 51079028520
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$133.24
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna Medicare	$74.02
Rate for Payer: Aetna New Business (MI Preferred)	$96.23
Rate for Payer: BCBS Complete	$59.22
Rate for Payer: Cash Price	$118.44
Rate for Payer: Cofinity Commercial	$103.64
Rate for Payer: Cofinity Commercial	$127.32
Rate for Payer: Cofinity Medicare Advantage	$103.64
Rate for Payer: Encore Health Key Benefits Commercial	$118.44
Rate for Payer: Healthscope Commercial	$133.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.84
Rate for Payer: PHP Commercial	$125.84
Rate for Payer: Priority Health Cigna Priority Health	$96.23
Rate for Payer: Priority Health SBD	$93.27

DIAZEPAM 5 MG TABLET

Facility

$63.45

Service Code	NDC 00172392660
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$39.97
Max. Negotiated Rate	$57.10
Rate for Payer: Aetna Commercial	$53.93
Rate for Payer: Aetna New Business (MI Preferred)	$41.24
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$44.42
Rate for Payer: Cofinity Commercial	$54.57
Rate for Payer: Cofinity Medicare Advantage	$44.42
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: PHP Commercial	$53.93
Rate for Payer: Priority Health Cigna Priority Health	$41.24
Rate for Payer: Priority Health SBD	$39.97

DIAZEPAM 5 MG TABLET

Facility

$1.49

Service Code	NDC 51079028501
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare	$0.75
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: BCBS Complete	$0.60
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Cofinity Medicare Advantage	$1.04
Rate for Payer: Encore Health Key Benefits Commercial	$1.19
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.27
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health Cigna Priority Health	$0.97
Rate for Payer: Priority Health SBD	$0.94

DIAZEPAM 5 MG TABLET

Facility

$1.49

Service Code	NDC 51079028501
Hospital Charge Code	2405
Hospital Revenue Code	637
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Cofinity Medicare Advantage	$1.04
Rate for Payer: Encore Health Key Benefits Commercial	$1.19
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.27
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health Cigna Priority Health	$0.97
Rate for Payer: Priority Health SBD	$0.94

DICLOFENAC 1 % TOPICAL GEL

Facility

$63.35

Service Code	NDC 00067815203
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$39.91
Max. Negotiated Rate	$57.02
Rate for Payer: Aetna Commercial	$53.85
Rate for Payer: Aetna New Business (MI Preferred)	$41.18
Rate for Payer: Cash Price	$50.68
Rate for Payer: Cofinity Commercial	$44.34
Rate for Payer: Cofinity Commercial	$54.48
Rate for Payer: Cofinity Medicare Advantage	$44.34
Rate for Payer: Encore Health Key Benefits Commercial	$50.68
Rate for Payer: Healthscope Commercial	$57.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.85
Rate for Payer: PHP Commercial	$53.85
Rate for Payer: Priority Health Cigna Priority Health	$41.18
Rate for Payer: Priority Health SBD	$39.91

DICLOFENAC 1 % TOPICAL GEL

Facility

$54.25

Service Code	NDC 41167057403
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$34.18
Max. Negotiated Rate	$48.82
Rate for Payer: Aetna Commercial	$46.11
Rate for Payer: Aetna New Business (MI Preferred)	$35.26
Rate for Payer: Cash Price	$43.40
Rate for Payer: Cofinity Commercial	$37.98
Rate for Payer: Cofinity Commercial	$46.66
Rate for Payer: Cofinity Medicare Advantage	$37.98
Rate for Payer: Encore Health Key Benefits Commercial	$43.40
Rate for Payer: Healthscope Commercial	$48.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$46.11
Rate for Payer: PHP Commercial	$46.11
Rate for Payer: Priority Health Cigna Priority Health	$35.26
Rate for Payer: Priority Health SBD	$34.18

DICLOFENAC 1 % TOPICAL GEL

Facility

$38.85

Service Code	NDC 43598097710
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$34.96
Rate for Payer: Aetna Commercial	$33.02
Rate for Payer: Aetna Medicare	$19.42
Rate for Payer: Aetna New Business (MI Preferred)	$25.25
Rate for Payer: BCBS Complete	$15.54
Rate for Payer: Cash Price	$31.08
Rate for Payer: Cofinity Commercial	$27.20
Rate for Payer: Cofinity Commercial	$33.41
Rate for Payer: Cofinity Medicare Advantage	$27.20
Rate for Payer: Encore Health Key Benefits Commercial	$31.08
Rate for Payer: Healthscope Commercial	$34.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.02
Rate for Payer: PHP Commercial	$33.02
Rate for Payer: Priority Health Cigna Priority Health	$25.25
Rate for Payer: Priority Health SBD	$24.48

DICLOFENAC 1 % TOPICAL GEL

Facility

$49.00

Service Code	NDC 45802016000
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$30.87
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Commercial	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Cofinity Medicare Advantage	$34.30
Rate for Payer: Encore Health Key Benefits Commercial	$39.20
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.65
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health Cigna Priority Health	$31.85
Rate for Payer: Priority Health SBD	$30.87

DICLOFENAC 1 % TOPICAL GEL

Facility

$49.00

Service Code	NDC 69097052444
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$30.87
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Commercial	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Cofinity Medicare Advantage	$34.30
Rate for Payer: Encore Health Key Benefits Commercial	$39.20
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.65
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health Cigna Priority Health	$31.85
Rate for Payer: Priority Health SBD	$30.87

DICLOFENAC 1 % TOPICAL GEL

Facility

$56.00

Service Code	NDC 25866059361
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna Commercial	$47.60
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: Aetna New Business (MI Preferred)	$36.40
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cofinity Commercial	$39.20
Rate for Payer: Cofinity Commercial	$48.16
Rate for Payer: Cofinity Medicare Advantage	$39.20
Rate for Payer: Encore Health Key Benefits Commercial	$44.80
Rate for Payer: Healthscope Commercial	$50.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.60
Rate for Payer: PHP Commercial	$47.60
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health SBD	$35.28

DICLOFENAC 1 % TOPICAL GEL

Facility

$39.90

Service Code	NDC 45802095301
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$15.96
Max. Negotiated Rate	$35.91
Rate for Payer: Aetna Commercial	$33.92
Rate for Payer: Aetna Medicare	$19.95
Rate for Payer: Aetna New Business (MI Preferred)	$25.94
Rate for Payer: BCBS Complete	$15.96
Rate for Payer: Cash Price	$31.92
Rate for Payer: Cofinity Commercial	$27.93
Rate for Payer: Cofinity Commercial	$34.31
Rate for Payer: Cofinity Medicare Advantage	$27.93
Rate for Payer: Encore Health Key Benefits Commercial	$31.92
Rate for Payer: Healthscope Commercial	$35.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.92
Rate for Payer: PHP Commercial	$33.92
Rate for Payer: Priority Health Cigna Priority Health	$25.94
Rate for Payer: Priority Health SBD	$25.14

DICLOFENAC 1 % TOPICAL GEL

Facility

$14.85

Service Code	NDC 76282066339
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$13.36
Rate for Payer: Aetna Commercial	$12.62
Rate for Payer: Aetna New Business (MI Preferred)	$9.65
Rate for Payer: Cash Price	$11.88
Rate for Payer: Cofinity Commercial	$10.40
Rate for Payer: Cofinity Commercial	$12.77
Rate for Payer: Cofinity Medicare Advantage	$10.40
Rate for Payer: Encore Health Key Benefits Commercial	$11.88
Rate for Payer: Healthscope Commercial	$13.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.62
Rate for Payer: PHP Commercial	$12.62
Rate for Payer: Priority Health Cigna Priority Health	$9.65
Rate for Payer: Priority Health SBD	$9.36

DICLOFENAC 1 % TOPICAL GEL

Facility

$49.00

Service Code	NDC 45802016000
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Commercial	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Cofinity Medicare Advantage	$34.30
Rate for Payer: Encore Health Key Benefits Commercial	$39.20
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.65
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health Cigna Priority Health	$31.85
Rate for Payer: Priority Health SBD	$30.87

DICLOFENAC 1 % TOPICAL GEL

Facility

$41.65

Service Code	NDC 00536129497
Hospital Charge Code	100611
Hospital Revenue Code	637
Min. Negotiated Rate	$26.24
Max. Negotiated Rate	$37.48
Rate for Payer: Aetna Commercial	$35.40
Rate for Payer: Aetna New Business (MI Preferred)	$27.07
Rate for Payer: Cash Price	$33.32
Rate for Payer: Cofinity Commercial	$29.16
Rate for Payer: Cofinity Commercial	$35.82
Rate for Payer: Cofinity Medicare Advantage	$29.16
Rate for Payer: Encore Health Key Benefits Commercial	$33.32
Rate for Payer: Healthscope Commercial	$37.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.40
Rate for Payer: PHP Commercial	$35.40
Rate for Payer: Priority Health Cigna Priority Health	$27.07
Rate for Payer: Priority Health SBD	$26.24

Know your out-of-pocket cost for care.

All Charges