Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUOXETINE 10 MG CAPSULE

Facility

$19.04

Service Code	NDC 00904578461
Hospital Charge Code	10069
Hospital Revenue Code	637
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$17.14
Rate for Payer: Aetna Commercial	$16.18
Rate for Payer: Aetna Medicare	$9.52
Rate for Payer: Aetna New Business (MI Preferred)	$12.38
Rate for Payer: BCBS Complete	$7.62
Rate for Payer: Cash Price	$15.23
Rate for Payer: Cofinity Commercial	$13.33
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Cofinity Medicare Advantage	$13.33
Rate for Payer: Encore Health Key Benefits Commercial	$15.23
Rate for Payer: Healthscope Commercial	$17.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.18
Rate for Payer: PHP Commercial	$16.18
Rate for Payer: Priority Health Cigna Priority Health	$12.38
Rate for Payer: Priority Health SBD	$12.00

FLUOXETINE 20 MG CAPSULE

Facility

$20.68

Service Code	NDC 00904578561
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$18.61
Rate for Payer: Aetna Commercial	$17.58
Rate for Payer: Aetna New Business (MI Preferred)	$13.44
Rate for Payer: Cash Price	$16.54
Rate for Payer: Cofinity Commercial	$14.48
Rate for Payer: Cofinity Commercial	$17.78
Rate for Payer: Cofinity Medicare Advantage	$14.48
Rate for Payer: Encore Health Key Benefits Commercial	$16.54
Rate for Payer: Healthscope Commercial	$18.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.58
Rate for Payer: PHP Commercial	$17.58
Rate for Payer: Priority Health Cigna Priority Health	$13.44
Rate for Payer: Priority Health SBD	$13.03

FLUOXETINE 20 MG CAPSULE

Facility

$284.35

Service Code	NDC 68084060501
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$179.14
Max. Negotiated Rate	$255.92
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Commercial	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Cofinity Medicare Advantage	$199.04
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health Cigna Priority Health	$184.83
Rate for Payer: Priority Health SBD	$179.14

FLUOXETINE 20 MG CAPSULE

Facility

$20.68

Service Code	NDC 00904578561
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$18.61
Rate for Payer: Aetna Commercial	$17.58
Rate for Payer: Aetna Medicare	$10.34
Rate for Payer: Aetna New Business (MI Preferred)	$13.44
Rate for Payer: BCBS Complete	$8.27
Rate for Payer: Cash Price	$16.54
Rate for Payer: Cofinity Commercial	$14.48
Rate for Payer: Cofinity Commercial	$17.78
Rate for Payer: Cofinity Medicare Advantage	$14.48
Rate for Payer: Encore Health Key Benefits Commercial	$16.54
Rate for Payer: Healthscope Commercial	$18.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.58
Rate for Payer: PHP Commercial	$17.58
Rate for Payer: Priority Health Cigna Priority Health	$13.44
Rate for Payer: Priority Health SBD	$13.03

FLUOXETINE 20 MG CAPSULE

Facility

$56.40

Service Code	NDC 65862019301
Hospital Charge Code	10070
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

FLUOXETINE 20 MG CAPSULE

Facility

$115.15

Service Code	NDC 23155002901
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$46.06
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna Medicare	$57.58
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: BCBS Complete	$46.06
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Commercial	$80.60
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Cofinity Medicare Advantage	$80.60
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health Cigna Priority Health	$74.85
Rate for Payer: Priority Health SBD	$72.54

FLUOXETINE 20 MG CAPSULE

Facility

$56.40

Service Code	NDC 65862019301
Hospital Charge Code	10070
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

FLUOXETINE 20 MG CAPSULE

Facility

$115.15

Service Code	NDC 23155002901
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$72.54
Max. Negotiated Rate	$103.64
Rate for Payer: Aetna Commercial	$97.88
Rate for Payer: Aetna New Business (MI Preferred)	$74.85
Rate for Payer: Cash Price	$92.12
Rate for Payer: Cofinity Commercial	$80.60
Rate for Payer: Cofinity Commercial	$99.03
Rate for Payer: Cofinity Medicare Advantage	$80.60
Rate for Payer: Encore Health Key Benefits Commercial	$92.12
Rate for Payer: Healthscope Commercial	$103.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$97.88
Rate for Payer: PHP Commercial	$97.88
Rate for Payer: Priority Health Cigna Priority Health	$74.85
Rate for Payer: Priority Health SBD	$72.54

FLUOXETINE 20 MG CAPSULE

Facility

$2.85

Service Code	NDC 68084060511
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna Medicare	$1.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: BCBS Complete	$1.14
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Cofinity Medicare Advantage	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.80

FLUOXETINE 20 MG CAPSULE

Facility

$2.85

Service Code	NDC 68084060511
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$2.56
Rate for Payer: Aetna Commercial	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.85
Rate for Payer: Cash Price	$2.28
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Cofinity Commercial	$2.45
Rate for Payer: Cofinity Medicare Advantage	$2.00
Rate for Payer: Encore Health Key Benefits Commercial	$2.28
Rate for Payer: Healthscope Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.42
Rate for Payer: PHP Commercial	$2.42
Rate for Payer: Priority Health Cigna Priority Health	$1.85
Rate for Payer: Priority Health SBD	$1.80

FLUOXETINE 20 MG CAPSULE

Facility

$284.35

Service Code	NDC 68084060501
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$113.74
Max. Negotiated Rate	$255.92
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna Medicare	$142.18
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: BCBS Complete	$113.74
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Commercial	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Cofinity Medicare Advantage	$199.04
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health Cigna Priority Health	$184.83
Rate for Payer: Priority Health SBD	$179.14

FLUOXETINE 20 MG CAPSULE

Facility

$129.25

Service Code	NDC 50111064801
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$81.43
Max. Negotiated Rate	$116.32
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.48
Rate for Payer: Cofinity Medicare Advantage	$90.48
Rate for Payer: Encore Health Key Benefits Commercial	$103.40
Rate for Payer: Healthscope Commercial	$116.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$84.01
Rate for Payer: Priority Health SBD	$81.43

FLUOXETINE 20 MG CAPSULE

Facility

$129.25

Service Code	NDC 50111064801
Hospital Charge Code	10070
Hospital Revenue Code	637
Min. Negotiated Rate	$51.70
Max. Negotiated Rate	$116.32
Rate for Payer: Aetna Commercial	$109.86
Rate for Payer: Aetna Medicare	$64.62
Rate for Payer: Aetna New Business (MI Preferred)	$84.01
Rate for Payer: BCBS Complete	$51.70
Rate for Payer: Cash Price	$103.40
Rate for Payer: Cofinity Commercial	$111.16
Rate for Payer: Cofinity Commercial	$90.48
Rate for Payer: Cofinity Medicare Advantage	$90.48
Rate for Payer: Encore Health Key Benefits Commercial	$103.40
Rate for Payer: Healthscope Commercial	$116.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.86
Rate for Payer: PHP Commercial	$109.86
Rate for Payer: Priority Health Cigna Priority Health	$84.01
Rate for Payer: Priority Health SBD	$81.43

FLUPHENAZINE 10 MG TABLET

Facility

$967.74

Service Code	NDC 50268036915
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$609.68
Max. Negotiated Rate	$870.97
Rate for Payer: Aetna Commercial	$822.58
Rate for Payer: Aetna New Business (MI Preferred)	$629.03
Rate for Payer: Cash Price	$774.19
Rate for Payer: Cofinity Commercial	$677.42
Rate for Payer: Cofinity Commercial	$832.26
Rate for Payer: Cofinity Medicare Advantage	$677.42
Rate for Payer: Encore Health Key Benefits Commercial	$774.19
Rate for Payer: Healthscope Commercial	$870.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.58
Rate for Payer: PHP Commercial	$822.58
Rate for Payer: Priority Health Cigna Priority Health	$629.03
Rate for Payer: Priority Health SBD	$609.68

FLUPHENAZINE 10 MG TABLET

Facility

$967.74

Service Code	NDC 50268036915
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$387.10
Max. Negotiated Rate	$870.97
Rate for Payer: Aetna Commercial	$822.58
Rate for Payer: Aetna Medicare	$483.87
Rate for Payer: Aetna New Business (MI Preferred)	$629.03
Rate for Payer: BCBS Complete	$387.10
Rate for Payer: Cash Price	$774.19
Rate for Payer: Cofinity Commercial	$677.42
Rate for Payer: Cofinity Commercial	$832.26
Rate for Payer: Cofinity Medicare Advantage	$677.42
Rate for Payer: Encore Health Key Benefits Commercial	$774.19
Rate for Payer: Healthscope Commercial	$870.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.58
Rate for Payer: PHP Commercial	$822.58
Rate for Payer: Priority Health Cigna Priority Health	$629.03
Rate for Payer: Priority Health SBD	$609.68

FLUPHENAZINE 10 MG TABLET

Facility

$19.36

Service Code	NDC 50268036911
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$17.42
Rate for Payer: Aetna Commercial	$16.46
Rate for Payer: Aetna New Business (MI Preferred)	$12.58
Rate for Payer: Cash Price	$15.49
Rate for Payer: Cofinity Commercial	$13.55
Rate for Payer: Cofinity Commercial	$16.65
Rate for Payer: Cofinity Medicare Advantage	$13.55
Rate for Payer: Encore Health Key Benefits Commercial	$15.49
Rate for Payer: Healthscope Commercial	$17.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.46
Rate for Payer: PHP Commercial	$16.46
Rate for Payer: Priority Health Cigna Priority Health	$12.58
Rate for Payer: Priority Health SBD	$12.20

FLUPHENAZINE 10 MG TABLET

Facility

$19.36

Service Code	NDC 50268036911
Hospital Charge Code	3219
Hospital Revenue Code	637
Min. Negotiated Rate	$7.74
Max. Negotiated Rate	$17.42
Rate for Payer: Aetna Commercial	$16.46
Rate for Payer: Aetna Medicare	$9.68
Rate for Payer: Aetna New Business (MI Preferred)	$12.58
Rate for Payer: BCBS Complete	$7.74
Rate for Payer: Cash Price	$15.49
Rate for Payer: Cofinity Commercial	$13.55
Rate for Payer: Cofinity Commercial	$16.65
Rate for Payer: Cofinity Medicare Advantage	$13.55
Rate for Payer: Encore Health Key Benefits Commercial	$15.49
Rate for Payer: Healthscope Commercial	$17.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.46
Rate for Payer: PHP Commercial	$16.46
Rate for Payer: Priority Health Cigna Priority Health	$12.58
Rate for Payer: Priority Health SBD	$12.20

FLUPHENAZINE 1 MG TABLET

Facility

$669.12

Service Code	NDC 00527178801
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$421.55
Max. Negotiated Rate	$602.21
Rate for Payer: Aetna Commercial	$568.75
Rate for Payer: Aetna New Business (MI Preferred)	$434.93
Rate for Payer: Cash Price	$535.30
Rate for Payer: Cofinity Commercial	$468.38
Rate for Payer: Cofinity Commercial	$575.44
Rate for Payer: Cofinity Medicare Advantage	$468.38
Rate for Payer: Encore Health Key Benefits Commercial	$535.30
Rate for Payer: Healthscope Commercial	$602.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$568.75
Rate for Payer: PHP Commercial	$568.75
Rate for Payer: Priority Health Cigna Priority Health	$434.93
Rate for Payer: Priority Health SBD	$421.55

FLUPHENAZINE 1 MG TABLET

Facility

$3.35

Service Code	NDC 51079048501
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.18
Rate for Payer: Cash Price	$2.68
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Medicare Advantage	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.68
Rate for Payer: Healthscope Commercial	$3.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.85
Rate for Payer: PHP Commercial	$2.85
Rate for Payer: Priority Health Cigna Priority Health	$2.18
Rate for Payer: Priority Health SBD	$2.11

FLUPHENAZINE 1 MG TABLET

Facility

$669.12

Service Code	NDC 00527178801
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$267.65
Max. Negotiated Rate	$602.21
Rate for Payer: Aetna Commercial	$568.75
Rate for Payer: Aetna Medicare	$334.56
Rate for Payer: Aetna New Business (MI Preferred)	$434.93
Rate for Payer: BCBS Complete	$267.65
Rate for Payer: Cash Price	$535.30
Rate for Payer: Cofinity Commercial	$468.38
Rate for Payer: Cofinity Commercial	$575.44
Rate for Payer: Cofinity Medicare Advantage	$468.38
Rate for Payer: Encore Health Key Benefits Commercial	$535.30
Rate for Payer: Healthscope Commercial	$602.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$568.75
Rate for Payer: PHP Commercial	$568.75
Rate for Payer: Priority Health Cigna Priority Health	$434.93
Rate for Payer: Priority Health SBD	$421.55

FLUPHENAZINE 1 MG TABLET

Facility

$3.35

Service Code	NDC 51079048501
Hospital Charge Code	3218
Hospital Revenue Code	637
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$3.02
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$1.68
Rate for Payer: Aetna New Business (MI Preferred)	$2.18
Rate for Payer: BCBS Complete	$1.34
Rate for Payer: Cash Price	$2.68
Rate for Payer: Cofinity Commercial	$2.34
Rate for Payer: Cofinity Commercial	$2.88
Rate for Payer: Cofinity Medicare Advantage	$2.34
Rate for Payer: Encore Health Key Benefits Commercial	$2.68
Rate for Payer: Healthscope Commercial	$3.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.85
Rate for Payer: PHP Commercial	$2.85
Rate for Payer: Priority Health Cigna Priority Health	$2.18
Rate for Payer: Priority Health SBD	$2.11

FLUPHENAZINE 2.5 MG TABLET

Facility

$12.39

Service Code	NDC 50268036711
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna New Business (MI Preferred)	$8.05
Rate for Payer: Cash Price	$9.91
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$8.67
Rate for Payer: Encore Health Key Benefits Commercial	$9.91
Rate for Payer: Healthscope Commercial	$11.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.53
Rate for Payer: PHP Commercial	$10.53
Rate for Payer: Priority Health Cigna Priority Health	$8.05
Rate for Payer: Priority Health SBD	$7.81

FLUPHENAZINE 2.5 MG TABLET

Facility

$619.38

Service Code	NDC 50268036715
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$390.21
Max. Negotiated Rate	$557.44
Rate for Payer: Aetna Commercial	$526.47
Rate for Payer: Aetna New Business (MI Preferred)	$402.60
Rate for Payer: Cash Price	$495.50
Rate for Payer: Cofinity Commercial	$433.57
Rate for Payer: Cofinity Commercial	$532.67
Rate for Payer: Cofinity Medicare Advantage	$433.57
Rate for Payer: Encore Health Key Benefits Commercial	$495.50
Rate for Payer: Healthscope Commercial	$557.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.47
Rate for Payer: PHP Commercial	$526.47
Rate for Payer: Priority Health Cigna Priority Health	$402.60
Rate for Payer: Priority Health SBD	$390.21

FLUPHENAZINE 2.5 MG TABLET

Facility

$619.38

Service Code	NDC 50268036715
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$247.75
Max. Negotiated Rate	$557.44
Rate for Payer: Aetna Commercial	$526.47
Rate for Payer: Aetna Medicare	$309.69
Rate for Payer: Aetna New Business (MI Preferred)	$402.60
Rate for Payer: BCBS Complete	$247.75
Rate for Payer: Cash Price	$495.50
Rate for Payer: Cofinity Commercial	$433.57
Rate for Payer: Cofinity Commercial	$532.67
Rate for Payer: Cofinity Medicare Advantage	$433.57
Rate for Payer: Encore Health Key Benefits Commercial	$495.50
Rate for Payer: Healthscope Commercial	$557.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$526.47
Rate for Payer: PHP Commercial	$526.47
Rate for Payer: Priority Health Cigna Priority Health	$402.60
Rate for Payer: Priority Health SBD	$390.21

FLUPHENAZINE 2.5 MG TABLET

Facility

$12.39

Service Code	NDC 50268036711
Hospital Charge Code	3220
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$11.15
Rate for Payer: Aetna Commercial	$10.53
Rate for Payer: Aetna Medicare	$6.20
Rate for Payer: Aetna New Business (MI Preferred)	$8.05
Rate for Payer: BCBS Complete	$4.96
Rate for Payer: Cash Price	$9.91
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$8.67
Rate for Payer: Encore Health Key Benefits Commercial	$9.91
Rate for Payer: Healthscope Commercial	$11.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10.53
Rate for Payer: PHP Commercial	$10.53
Rate for Payer: Priority Health Cigna Priority Health	$8.05
Rate for Payer: Priority Health SBD	$7.81

Know your out-of-pocket cost for care.

All Charges