Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LISINOPRIL 10 MG TABLET

Facility

$2.50

Service Code	NDC 60687032511
Hospital Charge Code	10449
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$2.12
Rate for Payer: Aetna Medicare	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$1.62
Rate for Payer: BCBS Complete	$1.00
Rate for Payer: Cash Price	$2.00
Rate for Payer: Cofinity Commercial	$1.75
Rate for Payer: Cofinity Commercial	$2.15
Rate for Payer: Cofinity Medicare Advantage	$1.75
Rate for Payer: Encore Health Key Benefits Commercial	$2.00
Rate for Payer: Healthscope Commercial	$2.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.12
Rate for Payer: PHP Commercial	$2.12
Rate for Payer: Priority Health Cigna Priority Health	$1.62
Rate for Payer: Priority Health SBD	$1.57

LISINOPRIL 20 MG TABLET

Facility

$267.90

Service Code	NDC 60687033301
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$107.16
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna Medicare	$133.95
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: BCBS Complete	$107.16
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

LISINOPRIL 20 MG TABLET

Facility

$267.90

Service Code	NDC 60687033301
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

LISINOPRIL 20 MG TABLET

Facility

$148.05

Service Code	NDC 00904679961
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Commercial	$125.84
Rate for Payer: Aetna Medicare	$74.03
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	$133.25
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

LISINOPRIL 20 MG TABLET

Facility

$61.10

Service Code	NDC 68180098101
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$24.44
Max. Negotiated Rate	$54.99
Rate for Payer: Aetna Commercial	$51.94
Rate for Payer: Aetna Medicare	$30.55
Rate for Payer: Aetna New Business (MI Preferred)	$39.72
Rate for Payer: BCBS Complete	$24.44
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Commercial	$42.77
Rate for Payer: Cofinity Commercial	$52.55
Rate for Payer: Cofinity Medicare Advantage	$42.77
Rate for Payer: Encore Health Key Benefits Commercial	$48.88
Rate for Payer: Healthscope Commercial	$54.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.94
Rate for Payer: PHP Commercial	$51.94
Rate for Payer: Priority Health Cigna Priority Health	$39.72
Rate for Payer: Priority Health SBD	$38.49

LISINOPRIL 20 MG TABLET

Facility

$61.10

Service Code	NDC 68180098101
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$38.49
Max. Negotiated Rate	$54.99
Rate for Payer: Aetna Commercial	$51.94
Rate for Payer: Aetna New Business (MI Preferred)	$39.72
Rate for Payer: Cash Price	$48.88
Rate for Payer: Cofinity Commercial	$42.77
Rate for Payer: Cofinity Commercial	$52.55
Rate for Payer: Cofinity Medicare Advantage	$42.77
Rate for Payer: Encore Health Key Benefits Commercial	$48.88
Rate for Payer: Healthscope Commercial	$54.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.94
Rate for Payer: PHP Commercial	$51.94
Rate for Payer: Priority Health Cigna Priority Health	$39.72
Rate for Payer: Priority Health SBD	$38.49

LISINOPRIL 20 MG TABLET

Facility

$2.68

Service Code	NDC 60687033311
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.69

LISINOPRIL 20 MG TABLET

Facility

$2.68

Service Code	NDC 60687033311
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare	$1.34
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: BCBS Complete	$1.07
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.69

LISINOPRIL 20 MG TABLET

Facility

$148.05

Service Code	NDC 00904679961
Hospital Charge Code	4526
Hospital Revenue Code	637
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$133.25
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	$133.25
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

LISINOPRIL 2.5 MG TABLET

Facility

$4.40

Service Code	NDC 60687065611
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna Medicare	$2.20
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: BCBS Complete	$1.76
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
Rate for Payer: Priority Health SBD	$2.77

LISINOPRIL 2.5 MG TABLET

Facility

$131.96

Service Code	NDC 60687065621
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$52.78
Max. Negotiated Rate	$118.76
Rate for Payer: Aetna Commercial	$112.17
Rate for Payer: Aetna Medicare	$65.98
Rate for Payer: Aetna New Business (MI Preferred)	$85.77
Rate for Payer: BCBS Complete	$52.78
Rate for Payer: Cash Price	$105.57
Rate for Payer: Cofinity Commercial	$113.49
Rate for Payer: Cofinity Commercial	$92.37
Rate for Payer: Cofinity Medicare Advantage	$92.37
Rate for Payer: Encore Health Key Benefits Commercial	$105.57
Rate for Payer: Healthscope Commercial	$118.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.17
Rate for Payer: PHP Commercial	$112.17
Rate for Payer: Priority Health Cigna Priority Health	$85.77
Rate for Payer: Priority Health SBD	$83.13

LISINOPRIL 2.5 MG TABLET

Facility

$131.96

Service Code	NDC 60687065621
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$83.13
Max. Negotiated Rate	$118.76
Rate for Payer: Aetna Commercial	$112.17
Rate for Payer: Aetna New Business (MI Preferred)	$85.77
Rate for Payer: Cash Price	$105.57
Rate for Payer: Cofinity Commercial	$113.49
Rate for Payer: Cofinity Commercial	$92.37
Rate for Payer: Cofinity Medicare Advantage	$92.37
Rate for Payer: Encore Health Key Benefits Commercial	$105.57
Rate for Payer: Healthscope Commercial	$118.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.17
Rate for Payer: PHP Commercial	$112.17
Rate for Payer: Priority Health Cigna Priority Health	$85.77
Rate for Payer: Priority Health SBD	$83.13

LISINOPRIL 2.5 MG TABLET

Facility

$4.40

Service Code	NDC 60687065611
Hospital Charge Code	13089
Hospital Revenue Code	637
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.74
Rate for Payer: Aetna New Business (MI Preferred)	$2.86
Rate for Payer: Cash Price	$3.52
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Commercial	$3.78
Rate for Payer: Cofinity Medicare Advantage	$3.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.52
Rate for Payer: Healthscope Commercial	$3.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.74
Rate for Payer: PHP Commercial	$3.74
Rate for Payer: Priority Health Cigna Priority Health	$2.86
Rate for Payer: Priority Health SBD	$2.77

LISINOPRIL 40 MG TABLET

Facility

$267.90

Service Code	NDC 43547035610
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$107.16
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna Medicare	$133.95
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: BCBS Complete	$107.16
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

LISINOPRIL 40 MG TABLET

Facility

$251.45

Service Code	NDC 00904720061
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$100.58
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: BCBS Complete	$100.58
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.01
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.01
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

LISINOPRIL 40 MG TABLET

Facility

$251.45

Service Code	NDC 00904720061
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.01
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.01
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

LISINOPRIL 40 MG TABLET

Facility

$267.90

Service Code	NDC 43547035610
Hospital Charge Code	10450
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

LISINOPRIL 5 MG TABLET

Facility

$37.60

Service Code	NDC 68180051301
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$15.04
Max. Negotiated Rate	$33.84
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna Medicare	$18.80
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: BCBS Complete	$15.04
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Cofinity Medicare Advantage	$26.32
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: Priority Health SBD	$23.69

LISINOPRIL 5 MG TABLET

Facility

$291.40

Service Code	NDC 60687066701
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$183.58
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Commercial	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Cofinity Medicare Advantage	$203.98
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health Cigna Priority Health	$189.41
Rate for Payer: Priority Health SBD	$183.58

LISINOPRIL 5 MG TABLET

Facility

$2.92

Service Code	NDC 60687066711
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Medicare Advantage	$2.04
Rate for Payer: Encore Health Key Benefits Commercial	$2.34
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$1.90
Rate for Payer: Priority Health SBD	$1.84

LISINOPRIL 5 MG TABLET

Facility

$37.60

Service Code	NDC 68180051301
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$33.84
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Cofinity Medicare Advantage	$26.32
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: Priority Health SBD	$23.69

LISINOPRIL 5 MG TABLET

Facility

$141.00

Service Code	NDC 00904679761
Hospital Charge Code	10451
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

LISINOPRIL 5 MG TABLET

Facility

$291.40

Service Code	NDC 60687066701
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$116.56
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna Medicare	$145.70
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: BCBS Complete	$116.56
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Commercial	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Cofinity Medicare Advantage	$203.98
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health Cigna Priority Health	$189.41
Rate for Payer: Priority Health SBD	$183.58

LISINOPRIL 5 MG TABLET

Facility

$2.92

Service Code	NDC 60687066711
Hospital Charge Code	10451
Hospital Revenue Code	637
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.63
Rate for Payer: Aetna Commercial	$2.48
Rate for Payer: Aetna Medicare	$1.46
Rate for Payer: Aetna New Business (MI Preferred)	$1.90
Rate for Payer: BCBS Complete	$1.17
Rate for Payer: Cash Price	$2.34
Rate for Payer: Cofinity Commercial	$2.04
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Medicare Advantage	$2.04
Rate for Payer: Encore Health Key Benefits Commercial	$2.34
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.48
Rate for Payer: PHP Commercial	$2.48
Rate for Payer: Priority Health Cigna Priority Health	$1.90
Rate for Payer: Priority Health SBD	$1.84

LISINOPRIL 5 MG TABLET

Facility

$141.00

Service Code	NDC 00904679761
Hospital Charge Code	10451
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

Know your out-of-pocket cost for care.

All Charges