Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

METFORMIN 500 MG TABLET

Facility

$108.10

Service Code	NDC 71093013204
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health Cigna Priority Health	$70.27
Rate for Payer: Priority Health SBD	$68.10

METFORMIN 500 MG TABLET

Facility

$108.10

Service Code	NDC 71093013204
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$43.24
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna Medicare	$54.05
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: BCBS Complete	$43.24
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health Cigna Priority Health	$70.27
Rate for Payer: Priority Health SBD	$68.10

METFORMIN 500 MG TABLET

Facility

$86.95

Service Code	NDC 23155010201
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$34.78
Max. Negotiated Rate	$78.25
Rate for Payer: Aetna Commercial	$73.91
Rate for Payer: Aetna Medicare	$43.48
Rate for Payer: Aetna New Business (MI Preferred)	$56.52
Rate for Payer: BCBS Complete	$34.78
Rate for Payer: Cash Price	$69.56
Rate for Payer: Cofinity Commercial	$60.87
Rate for Payer: Cofinity Commercial	$74.78
Rate for Payer: Cofinity Medicare Advantage	$60.87
Rate for Payer: Encore Health Key Benefits Commercial	$69.56
Rate for Payer: Healthscope Commercial	$78.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$73.91
Rate for Payer: PHP Commercial	$73.91
Rate for Payer: Priority Health Cigna Priority Health	$56.52
Rate for Payer: Priority Health SBD	$54.78

METFORMIN 500 MG TABLET

Facility

$86.95

Service Code	NDC 23155010201
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$54.78
Max. Negotiated Rate	$78.25
Rate for Payer: Aetna Commercial	$73.91
Rate for Payer: Aetna New Business (MI Preferred)	$56.52
Rate for Payer: Cash Price	$69.56
Rate for Payer: Cofinity Commercial	$60.87
Rate for Payer: Cofinity Commercial	$74.78
Rate for Payer: Cofinity Medicare Advantage	$60.87
Rate for Payer: Encore Health Key Benefits Commercial	$69.56
Rate for Payer: Healthscope Commercial	$78.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$73.91
Rate for Payer: PHP Commercial	$73.91
Rate for Payer: Priority Health Cigna Priority Health	$56.52
Rate for Payer: Priority Health SBD	$54.78

METFORMIN 500 MG TABLET

Facility

$138.65

Service Code	NDC 00904716261
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$55.46
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna Medicare	$69.33
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: BCBS Complete	$55.46
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Cofinity Commercial	$97.06
Rate for Payer: Cofinity Medicare Advantage	$97.06
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$90.12
Rate for Payer: Priority Health SBD	$87.35

METFORMIN 500 MG TABLET

Facility

$246.75

Service Code	NDC 60687015501
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$155.45
Max. Negotiated Rate	$222.07
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Commercial	$172.72
Rate for Payer: Cofinity Commercial	$212.21
Rate for Payer: Cofinity Medicare Advantage	$172.72
Rate for Payer: Encore Health Key Benefits Commercial	$197.40
Rate for Payer: Healthscope Commercial	$222.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.74
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health Cigna Priority Health	$160.39
Rate for Payer: Priority Health SBD	$155.45

METFORMIN 500 MG TABLET

Facility

$42.30

Service Code	NDC 70010006301
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$38.07
Rate for Payer: Aetna Commercial	$35.95
Rate for Payer: Aetna New Business (MI Preferred)	$27.50
Rate for Payer: Cash Price	$33.84
Rate for Payer: Cofinity Commercial	$29.61
Rate for Payer: Cofinity Commercial	$36.38
Rate for Payer: Cofinity Medicare Advantage	$29.61
Rate for Payer: Encore Health Key Benefits Commercial	$33.84
Rate for Payer: Healthscope Commercial	$38.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.95
Rate for Payer: PHP Commercial	$35.95
Rate for Payer: Priority Health Cigna Priority Health	$27.50
Rate for Payer: Priority Health SBD	$26.65

METFORMIN 500 MG TABLET

Facility

$2.47

Service Code	NDC 60687015511
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna Medicare	$1.24
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: BCBS Complete	$0.99
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Medicare Advantage	$1.73
Rate for Payer: Encore Health Key Benefits Commercial	$1.98
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.61
Rate for Payer: Priority Health SBD	$1.56

METFORMIN 500 MG TABLET

Facility

$138.65

Service Code	NDC 00904716261
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Cofinity Commercial	$97.06
Rate for Payer: Cofinity Medicare Advantage	$97.06
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health Cigna Priority Health	$90.12
Rate for Payer: Priority Health SBD	$87.35

METFORMIN 500 MG TABLET

Facility

$282.00

Service Code	NDC 70010006310
Hospital Charge Code	10544
Hospital Revenue Code	637
Min. Negotiated Rate	$112.80
Max. Negotiated Rate	$253.80
Rate for Payer: Aetna Commercial	$239.70
Rate for Payer: Aetna Medicare	$141.00
Rate for Payer: Aetna New Business (MI Preferred)	$183.30
Rate for Payer: BCBS Complete	$112.80
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cofinity Commercial	$197.40
Rate for Payer: Cofinity Commercial	$242.52
Rate for Payer: Cofinity Medicare Advantage	$197.40
Rate for Payer: Encore Health Key Benefits Commercial	$225.60
Rate for Payer: Healthscope Commercial	$253.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.70
Rate for Payer: PHP Commercial	$239.70
Rate for Payer: Priority Health Cigna Priority Health	$183.30
Rate for Payer: Priority Health SBD	$177.66

METFORMIN 850 MG TABLET

Facility

$434.75

Service Code	NDC 60687014301
Hospital Charge Code	14719
Hospital Revenue Code	637
Min. Negotiated Rate	$273.89
Max. Negotiated Rate	$391.27
Rate for Payer: Aetna Commercial	$369.54
Rate for Payer: Aetna New Business (MI Preferred)	$282.59
Rate for Payer: Cash Price	$347.80
Rate for Payer: Cofinity Commercial	$304.32
Rate for Payer: Cofinity Commercial	$373.88
Rate for Payer: Cofinity Medicare Advantage	$304.32
Rate for Payer: Encore Health Key Benefits Commercial	$347.80
Rate for Payer: Healthscope Commercial	$391.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.54
Rate for Payer: PHP Commercial	$369.54
Rate for Payer: Priority Health Cigna Priority Health	$282.59
Rate for Payer: Priority Health SBD	$273.89

METFORMIN 850 MG TABLET

Facility

$434.75

Service Code	NDC 60687014301
Hospital Charge Code	14719
Hospital Revenue Code	637
Min. Negotiated Rate	$173.90
Max. Negotiated Rate	$391.27
Rate for Payer: Aetna Commercial	$369.54
Rate for Payer: Aetna Medicare	$217.38
Rate for Payer: Aetna New Business (MI Preferred)	$282.59
Rate for Payer: BCBS Complete	$173.90
Rate for Payer: Cash Price	$347.80
Rate for Payer: Cofinity Commercial	$304.32
Rate for Payer: Cofinity Commercial	$373.88
Rate for Payer: Cofinity Medicare Advantage	$304.32
Rate for Payer: Encore Health Key Benefits Commercial	$347.80
Rate for Payer: Healthscope Commercial	$391.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$369.54
Rate for Payer: PHP Commercial	$369.54
Rate for Payer: Priority Health Cigna Priority Health	$282.59
Rate for Payer: Priority Health SBD	$273.89

METFORMIN 850 MG TABLET

Facility

$4.35

Service Code	NDC 60687014311
Hospital Charge Code	14719
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Cofinity Medicare Advantage	$3.04
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health SBD	$2.74

METFORMIN 850 MG TABLET

Facility

$4.35

Service Code	NDC 60687014311
Hospital Charge Code	14719
Hospital Revenue Code	637
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Cofinity Medicare Advantage	$3.04
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health Cigna Priority Health	$2.83
Rate for Payer: Priority Health SBD	$2.74

METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION

Facility

$170.20

Service Code	HCPCS J7674
Hospital Charge Code	180308
Hospital Revenue Code	636
Min. Negotiated Rate	$107.23
Max. Negotiated Rate	$153.18
Rate for Payer: Aetna Commercial	$144.67
Rate for Payer: Aetna New Business (MI Preferred)	$110.63
Rate for Payer: Cash Price	$136.16
Rate for Payer: Cofinity Commercial	$119.14
Rate for Payer: Cofinity Commercial	$146.37
Rate for Payer: Cofinity Medicare Advantage	$119.14
Rate for Payer: Encore Health Key Benefits Commercial	$136.16
Rate for Payer: Healthscope Commercial	$153.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$144.67
Rate for Payer: PHP Commercial	$144.67
Rate for Payer: Priority Health Cigna Priority Health	$110.63
Rate for Payer: Priority Health SBD	$107.23

METHACHOLINE 0.0625 MG/ML (VIAL E) SOLUTION FOR INHALATION

Facility

$170.20

Service Code	HCPCS J7674
Hospital Charge Code	180308
Hospital Revenue Code	636
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$153.18
Rate for Payer: Aetna Commercial	$144.67
Rate for Payer: Aetna Medicare	$85.10
Rate for Payer: Aetna New Business (MI Preferred)	$110.63
Rate for Payer: BCBS Complete	$68.08
Rate for Payer: Cash Price	$136.16
Rate for Payer: Cofinity Commercial	$119.14
Rate for Payer: Cofinity Commercial	$146.37
Rate for Payer: Cofinity Medicare Advantage	$119.14
Rate for Payer: Encore Health Key Benefits Commercial	$136.16
Rate for Payer: Healthscope Commercial	$153.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$144.67
Rate for Payer: PHP Commercial	$144.67
Rate for Payer: Priority Health Cigna Priority Health	$110.63
Rate for Payer: Priority Health SBD	$107.23

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION

Facility

$285.61

Service Code	HCPCS J7674
Hospital Charge Code	27032
Hospital Revenue Code	636
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$257.05
Rate for Payer: Aetna Commercial	$242.77
Rate for Payer: Aetna Medicare	$142.81
Rate for Payer: Aetna New Business (MI Preferred)	$185.65
Rate for Payer: BCBS Complete	$114.24
Rate for Payer: Cash Price	$228.49
Rate for Payer: Cofinity Commercial	$199.93
Rate for Payer: Cofinity Commercial	$245.62
Rate for Payer: Cofinity Medicare Advantage	$199.93
Rate for Payer: Encore Health Key Benefits Commercial	$228.49
Rate for Payer: Healthscope Commercial	$257.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.77
Rate for Payer: PHP Commercial	$242.77
Rate for Payer: Priority Health Cigna Priority Health	$185.65
Rate for Payer: Priority Health SBD	$179.93

METHACHOLINE CHLORIDE 100 MG SOLUTION FOR INHALATION

Facility

$285.61

Service Code	HCPCS J7674
Hospital Charge Code	27032
Hospital Revenue Code	636
Min. Negotiated Rate	$179.93
Max. Negotiated Rate	$257.05
Rate for Payer: Aetna Commercial	$242.77
Rate for Payer: Aetna New Business (MI Preferred)	$185.65
Rate for Payer: Cash Price	$228.49
Rate for Payer: Cofinity Commercial	$199.93
Rate for Payer: Cofinity Commercial	$245.62
Rate for Payer: Cofinity Medicare Advantage	$199.93
Rate for Payer: Encore Health Key Benefits Commercial	$228.49
Rate for Payer: Healthscope Commercial	$257.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$242.77
Rate for Payer: PHP Commercial	$242.77
Rate for Payer: Priority Health Cigna Priority Health	$185.65
Rate for Payer: Priority Health SBD	$179.93

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00054355344
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$118.88
Rate for Payer: Aetna Commercial	$112.28
Rate for Payer: Aetna New Business (MI Preferred)	$85.86
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$113.60
Rate for Payer: Cofinity Commercial	$92.46
Rate for Payer: Cofinity Medicare Advantage	$92.46
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: PHP Commercial	$112.28
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: Priority Health SBD	$83.22

METHADONE 10 MG/ML ORAL CONCENTRATE

Facility

$132.09

Service Code	NDC 00054355344
Hospital Charge Code	15996
Hospital Revenue Code	637
Min. Negotiated Rate	$52.84
Max. Negotiated Rate	$118.88
Rate for Payer: Aetna Commercial	$112.28
Rate for Payer: Aetna Medicare	$66.05
Rate for Payer: Aetna New Business (MI Preferred)	$85.86
Rate for Payer: BCBS Complete	$52.84
Rate for Payer: Cash Price	$105.67
Rate for Payer: Cofinity Commercial	$113.60
Rate for Payer: Cofinity Commercial	$92.46
Rate for Payer: Cofinity Medicare Advantage	$92.46
Rate for Payer: Encore Health Key Benefits Commercial	$105.67
Rate for Payer: Healthscope Commercial	$118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.28
Rate for Payer: PHP Commercial	$112.28
Rate for Payer: Priority Health Cigna Priority Health	$85.86
Rate for Payer: Priority Health SBD	$83.22

METHADONE 10 MG TABLET

Facility

$432.25

Service Code	NDC 00406577162
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$172.90
Max. Negotiated Rate	$389.02
Rate for Payer: Aetna Commercial	$367.41
Rate for Payer: Aetna Medicare	$216.12
Rate for Payer: Aetna New Business (MI Preferred)	$280.96
Rate for Payer: BCBS Complete	$172.90
Rate for Payer: Cash Price	$345.80
Rate for Payer: Cofinity Commercial	$302.57
Rate for Payer: Cofinity Commercial	$371.74
Rate for Payer: Cofinity Medicare Advantage	$302.57
Rate for Payer: Encore Health Key Benefits Commercial	$345.80
Rate for Payer: Healthscope Commercial	$389.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.41
Rate for Payer: PHP Commercial	$367.41
Rate for Payer: Priority Health Cigna Priority Health	$280.96
Rate for Payer: Priority Health SBD	$272.32

METHADONE 10 MG TABLET

Facility

$432.25

Service Code	NDC 00406577162
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$272.32
Max. Negotiated Rate	$389.02
Rate for Payer: Aetna Commercial	$367.41
Rate for Payer: Aetna New Business (MI Preferred)	$280.96
Rate for Payer: Cash Price	$345.80
Rate for Payer: Cofinity Commercial	$302.57
Rate for Payer: Cofinity Commercial	$371.74
Rate for Payer: Cofinity Medicare Advantage	$302.57
Rate for Payer: Encore Health Key Benefits Commercial	$345.80
Rate for Payer: Healthscope Commercial	$389.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.41
Rate for Payer: PHP Commercial	$367.41
Rate for Payer: Priority Health Cigna Priority Health	$280.96
Rate for Payer: Priority Health SBD	$272.32

METHADONE 10 MG TABLET

Facility

$4.33

Service Code	NDC 00406577123
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$2.73
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Commercial	$3.68
Rate for Payer: Aetna New Business (MI Preferred)	$2.81
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cofinity Commercial	$3.03
Rate for Payer: Cofinity Commercial	$3.72
Rate for Payer: Cofinity Medicare Advantage	$3.03
Rate for Payer: Encore Health Key Benefits Commercial	$3.46
Rate for Payer: Healthscope Commercial	$3.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.68
Rate for Payer: PHP Commercial	$3.68
Rate for Payer: Priority Health Cigna Priority Health	$2.81
Rate for Payer: Priority Health SBD	$2.73

METHADONE 10 MG TABLET

Facility

$4.33

Service Code	NDC 00406577123
Hospital Charge Code	4953
Hospital Revenue Code	637
Min. Negotiated Rate	$1.73
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Commercial	$3.68
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.81
Rate for Payer: BCBS Complete	$1.73
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cofinity Commercial	$3.03
Rate for Payer: Cofinity Commercial	$3.72
Rate for Payer: Cofinity Medicare Advantage	$3.03
Rate for Payer: Encore Health Key Benefits Commercial	$3.46
Rate for Payer: Healthscope Commercial	$3.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.68
Rate for Payer: PHP Commercial	$3.68
Rate for Payer: Priority Health Cigna Priority Health	$2.81
Rate for Payer: Priority Health SBD	$2.73

METHADONE 5 MG TABLET

Facility

$441.00

Service Code	NDC 00406575562
Hospital Charge Code	4954
Hospital Revenue Code	637
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna Commercial	$374.85
Rate for Payer: Aetna Medicare	$220.50
Rate for Payer: Aetna New Business (MI Preferred)	$286.65
Rate for Payer: BCBS Complete	$176.40
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cofinity Commercial	$308.70
Rate for Payer: Cofinity Commercial	$379.26
Rate for Payer: Cofinity Medicare Advantage	$308.70
Rate for Payer: Encore Health Key Benefits Commercial	$352.80
Rate for Payer: Healthscope Commercial	$396.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.85
Rate for Payer: PHP Commercial	$374.85
Rate for Payer: Priority Health Cigna Priority Health	$286.65
Rate for Payer: Priority Health SBD	$277.83

Know your out-of-pocket cost for care.

All Charges