Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MIRTAZAPINE 15 MG TABLET

Facility

$448.85

Service Code	NDC 68084011911
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$282.78
Max. Negotiated Rate	$403.96
Rate for Payer: Aetna Commercial	$381.52
Rate for Payer: Aetna New Business (MI Preferred)	$291.75
Rate for Payer: Cash Price	$359.08
Rate for Payer: Cofinity Commercial	$314.19
Rate for Payer: Cofinity Commercial	$386.01
Rate for Payer: Cofinity Medicare Advantage	$314.19
Rate for Payer: Encore Health Key Benefits Commercial	$359.08
Rate for Payer: Healthscope Commercial	$403.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$381.52
Rate for Payer: PHP Commercial	$381.52
Rate for Payer: Priority Health Cigna Priority Health	$291.75
Rate for Payer: Priority Health SBD	$282.78

MIRTAZAPINE 15 MG TABLET

Facility

$448.85

Service Code	NDC 68084011901
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$179.54
Max. Negotiated Rate	$403.96
Rate for Payer: Aetna Commercial	$381.52
Rate for Payer: Aetna Medicare	$224.43
Rate for Payer: Aetna New Business (MI Preferred)	$291.75
Rate for Payer: BCBS Complete	$179.54
Rate for Payer: Cash Price	$359.08
Rate for Payer: Cofinity Commercial	$314.19
Rate for Payer: Cofinity Commercial	$386.01
Rate for Payer: Cofinity Medicare Advantage	$314.19
Rate for Payer: Encore Health Key Benefits Commercial	$359.08
Rate for Payer: Healthscope Commercial	$403.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$381.52
Rate for Payer: PHP Commercial	$381.52
Rate for Payer: Priority Health Cigna Priority Health	$291.75
Rate for Payer: Priority Health SBD	$282.78

MIRTAZAPINE 15 MG TABLET

Facility

$448.85

Service Code	NDC 68084011901
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$282.78
Max. Negotiated Rate	$403.96
Rate for Payer: Aetna Commercial	$381.52
Rate for Payer: Aetna New Business (MI Preferred)	$291.75
Rate for Payer: Cash Price	$359.08
Rate for Payer: Cofinity Commercial	$314.19
Rate for Payer: Cofinity Commercial	$386.01
Rate for Payer: Cofinity Medicare Advantage	$314.19
Rate for Payer: Encore Health Key Benefits Commercial	$359.08
Rate for Payer: Healthscope Commercial	$403.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$381.52
Rate for Payer: PHP Commercial	$381.52
Rate for Payer: Priority Health Cigna Priority Health	$291.75
Rate for Payer: Priority Health SBD	$282.78

MIRTAZAPINE 15 MG TABLET

Facility

$38.07

Service Code	NDC 13107003134
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$23.98
Max. Negotiated Rate	$34.26
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna New Business (MI Preferred)	$24.75
Rate for Payer: Cash Price	$30.46
Rate for Payer: Cofinity Commercial	$26.65
Rate for Payer: Cofinity Commercial	$32.74
Rate for Payer: Cofinity Medicare Advantage	$26.65
Rate for Payer: Encore Health Key Benefits Commercial	$30.46
Rate for Payer: Healthscope Commercial	$34.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.36
Rate for Payer: PHP Commercial	$32.36
Rate for Payer: Priority Health Cigna Priority Health	$24.75
Rate for Payer: Priority Health SBD	$23.98

MIRTAZAPINE 15 MG TABLET

Facility

$38.07

Service Code	NDC 13107003134
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$15.23
Max. Negotiated Rate	$34.26
Rate for Payer: Aetna Commercial	$32.36
Rate for Payer: Aetna Medicare	$19.04
Rate for Payer: Aetna New Business (MI Preferred)	$24.75
Rate for Payer: BCBS Complete	$15.23
Rate for Payer: Cash Price	$30.46
Rate for Payer: Cofinity Commercial	$26.65
Rate for Payer: Cofinity Commercial	$32.74
Rate for Payer: Cofinity Medicare Advantage	$26.65
Rate for Payer: Encore Health Key Benefits Commercial	$30.46
Rate for Payer: Healthscope Commercial	$34.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.36
Rate for Payer: PHP Commercial	$32.36
Rate for Payer: Priority Health Cigna Priority Health	$24.75
Rate for Payer: Priority Health SBD	$23.98

MIRTAZAPINE 15 MG TABLET

Facility

$366.60

Service Code	NDC 51079008620
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$230.96
Max. Negotiated Rate	$329.94
Rate for Payer: Aetna Commercial	$311.61
Rate for Payer: Aetna New Business (MI Preferred)	$238.29
Rate for Payer: Cash Price	$293.28
Rate for Payer: Cofinity Commercial	$256.62
Rate for Payer: Cofinity Commercial	$315.28
Rate for Payer: Cofinity Medicare Advantage	$256.62
Rate for Payer: Encore Health Key Benefits Commercial	$293.28
Rate for Payer: Healthscope Commercial	$329.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$311.61
Rate for Payer: PHP Commercial	$311.61
Rate for Payer: Priority Health Cigna Priority Health	$238.29
Rate for Payer: Priority Health SBD	$230.96

MIRTAZAPINE 30 MG TABLET

Facility

$354.85

Service Code	NDC 63739009910
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$223.56
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Cofinity Medicare Advantage	$248.40
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: Priority Health SBD	$223.56

MIRTAZAPINE 30 MG TABLET

Facility

$455.90

Service Code	NDC 68084012011
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$182.36
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$387.51
Rate for Payer: Aetna Medicare	$227.95
Rate for Payer: Aetna New Business (MI Preferred)	$296.33
Rate for Payer: BCBS Complete	$182.36
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$319.13
Rate for Payer: Cofinity Commercial	$392.07
Rate for Payer: Cofinity Medicare Advantage	$319.13
Rate for Payer: Encore Health Key Benefits Commercial	$364.72
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$387.51
Rate for Payer: PHP Commercial	$387.51
Rate for Payer: Priority Health Cigna Priority Health	$296.33
Rate for Payer: Priority Health SBD	$287.22

MIRTAZAPINE 30 MG TABLET

Facility

$248.90

Service Code	NDC 00378353001
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$99.56
Max. Negotiated Rate	$224.01
Rate for Payer: Aetna Commercial	$211.56
Rate for Payer: Aetna Medicare	$124.45
Rate for Payer: Aetna New Business (MI Preferred)	$161.78
Rate for Payer: BCBS Complete	$99.56
Rate for Payer: Cash Price	$199.12
Rate for Payer: Cofinity Commercial	$174.23
Rate for Payer: Cofinity Commercial	$214.05
Rate for Payer: Cofinity Medicare Advantage	$174.23
Rate for Payer: Encore Health Key Benefits Commercial	$199.12
Rate for Payer: Healthscope Commercial	$224.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.56
Rate for Payer: PHP Commercial	$211.56
Rate for Payer: Priority Health Cigna Priority Health	$161.78
Rate for Payer: Priority Health SBD	$156.81

MIRTAZAPINE 30 MG TABLET

Facility

$354.85

Service Code	NDC 63739009910
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$141.94
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna Medicare	$177.43
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Commercial	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Cofinity Medicare Advantage	$248.40
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health Cigna Priority Health	$230.65
Rate for Payer: Priority Health SBD	$223.56

MIRTAZAPINE 30 MG TABLET

Facility

$248.90

Service Code	NDC 00378353001
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$156.81
Max. Negotiated Rate	$224.01
Rate for Payer: Aetna Commercial	$211.56
Rate for Payer: Aetna New Business (MI Preferred)	$161.78
Rate for Payer: Cash Price	$199.12
Rate for Payer: Cofinity Commercial	$174.23
Rate for Payer: Cofinity Commercial	$214.05
Rate for Payer: Cofinity Medicare Advantage	$174.23
Rate for Payer: Encore Health Key Benefits Commercial	$199.12
Rate for Payer: Healthscope Commercial	$224.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.56
Rate for Payer: PHP Commercial	$211.56
Rate for Payer: Priority Health Cigna Priority Health	$161.78
Rate for Payer: Priority Health SBD	$156.81

MIRTAZAPINE 30 MG TABLET

Facility

$455.90

Service Code	NDC 68084012011
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$287.22
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$387.51
Rate for Payer: Aetna New Business (MI Preferred)	$296.33
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$319.13
Rate for Payer: Cofinity Commercial	$392.07
Rate for Payer: Cofinity Medicare Advantage	$319.13
Rate for Payer: Encore Health Key Benefits Commercial	$364.72
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$387.51
Rate for Payer: PHP Commercial	$387.51
Rate for Payer: Priority Health Cigna Priority Health	$296.33
Rate for Payer: Priority Health SBD	$287.22

MISOPROSTOL 100 MCG TABLET

Facility

$177.41

Service Code	NDC 59762500701
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$70.96
Max. Negotiated Rate	$159.67
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna Medicare	$88.70
Rate for Payer: Aetna New Business (MI Preferred)	$115.32
Rate for Payer: BCBS Complete	$70.96
Rate for Payer: Cash Price	$141.93
Rate for Payer: Cofinity Commercial	$124.19
Rate for Payer: Cofinity Commercial	$152.57
Rate for Payer: Cofinity Medicare Advantage	$124.19
Rate for Payer: Encore Health Key Benefits Commercial	$141.93
Rate for Payer: Healthscope Commercial	$159.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.80
Rate for Payer: PHP Commercial	$150.80
Rate for Payer: Priority Health Cigna Priority Health	$115.32
Rate for Payer: Priority Health SBD	$111.77

MISOPROSTOL 100 MCG TABLET

Facility

$355.40

Service Code	NDC 59762500702
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$223.90
Max. Negotiated Rate	$319.86
Rate for Payer: Aetna Commercial	$302.09
Rate for Payer: Aetna New Business (MI Preferred)	$231.01
Rate for Payer: Cash Price	$284.32
Rate for Payer: Cofinity Commercial	$248.78
Rate for Payer: Cofinity Commercial	$305.64
Rate for Payer: Cofinity Medicare Advantage	$248.78
Rate for Payer: Encore Health Key Benefits Commercial	$284.32
Rate for Payer: Healthscope Commercial	$319.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.09
Rate for Payer: PHP Commercial	$302.09
Rate for Payer: Priority Health Cigna Priority Health	$231.01
Rate for Payer: Priority Health SBD	$223.90

MISOPROSTOL 100 MCG TABLET

Facility

$355.40

Service Code	NDC 59762500702
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$142.16
Max. Negotiated Rate	$319.86
Rate for Payer: Aetna Commercial	$302.09
Rate for Payer: Aetna Medicare	$177.70
Rate for Payer: Aetna New Business (MI Preferred)	$231.01
Rate for Payer: BCBS Complete	$142.16
Rate for Payer: Cash Price	$284.32
Rate for Payer: Cofinity Commercial	$248.78
Rate for Payer: Cofinity Commercial	$305.64
Rate for Payer: Cofinity Medicare Advantage	$248.78
Rate for Payer: Encore Health Key Benefits Commercial	$284.32
Rate for Payer: Healthscope Commercial	$319.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.09
Rate for Payer: PHP Commercial	$302.09
Rate for Payer: Priority Health Cigna Priority Health	$231.01
Rate for Payer: Priority Health SBD	$223.90

MISOPROSTOL 100 MCG TABLET

Facility

$7.00

Service Code	NDC 68084004011
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$4.41
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna New Business (MI Preferred)	$4.55
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cofinity Commercial	$4.90
Rate for Payer: Cofinity Commercial	$6.02
Rate for Payer: Cofinity Medicare Advantage	$4.90
Rate for Payer: Encore Health Key Benefits Commercial	$5.60
Rate for Payer: Healthscope Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.95
Rate for Payer: PHP Commercial	$5.95
Rate for Payer: Priority Health Cigna Priority Health	$4.55
Rate for Payer: Priority Health SBD	$4.41

MISOPROSTOL 100 MCG TABLET

Facility

$177.41

Service Code	NDC 59762500701
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$111.77
Max. Negotiated Rate	$159.67
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna New Business (MI Preferred)	$115.32
Rate for Payer: Cash Price	$141.93
Rate for Payer: Cofinity Commercial	$124.19
Rate for Payer: Cofinity Commercial	$152.57
Rate for Payer: Cofinity Medicare Advantage	$124.19
Rate for Payer: Encore Health Key Benefits Commercial	$141.93
Rate for Payer: Healthscope Commercial	$159.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.80
Rate for Payer: PHP Commercial	$150.80
Rate for Payer: Priority Health Cigna Priority Health	$115.32
Rate for Payer: Priority Health SBD	$111.77

MISOPROSTOL 100 MCG TABLET

Facility

$7.00

Service Code	NDC 68084004011
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.30
Rate for Payer: Aetna Commercial	$5.95
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: Aetna New Business (MI Preferred)	$4.55
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cofinity Commercial	$4.90
Rate for Payer: Cofinity Commercial	$6.02
Rate for Payer: Cofinity Medicare Advantage	$4.90
Rate for Payer: Encore Health Key Benefits Commercial	$5.60
Rate for Payer: Healthscope Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.95
Rate for Payer: PHP Commercial	$5.95
Rate for Payer: Priority Health Cigna Priority Health	$4.55
Rate for Payer: Priority Health SBD	$4.41

MISOPROSTOL 100 MCG TABLET

Facility

$177.12

Service Code	NDC 43386016006
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$159.41
Rate for Payer: Aetna Commercial	$150.55
Rate for Payer: Aetna Medicare	$88.56
Rate for Payer: Aetna New Business (MI Preferred)	$115.13
Rate for Payer: BCBS Complete	$70.85
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Cofinity Commercial	$152.32
Rate for Payer: Cofinity Medicare Advantage	$123.98
Rate for Payer: Encore Health Key Benefits Commercial	$141.70
Rate for Payer: Healthscope Commercial	$159.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.55
Rate for Payer: PHP Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$115.13
Rate for Payer: Priority Health SBD	$111.59

MISOPROSTOL 100 MCG TABLET

Facility

$699.84

Service Code	NDC 68084004001
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$440.90
Max. Negotiated Rate	$629.86
Rate for Payer: Aetna Commercial	$594.86
Rate for Payer: Aetna New Business (MI Preferred)	$454.90
Rate for Payer: Cash Price	$559.87
Rate for Payer: Cofinity Commercial	$489.89
Rate for Payer: Cofinity Commercial	$601.86
Rate for Payer: Cofinity Medicare Advantage	$489.89
Rate for Payer: Encore Health Key Benefits Commercial	$559.87
Rate for Payer: Healthscope Commercial	$629.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$594.86
Rate for Payer: PHP Commercial	$594.86
Rate for Payer: Priority Health Cigna Priority Health	$454.90
Rate for Payer: Priority Health SBD	$440.90

MISOPROSTOL 100 MCG TABLET

Facility

$699.84

Service Code	NDC 68084004001
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$279.94
Max. Negotiated Rate	$629.86
Rate for Payer: Aetna Commercial	$594.86
Rate for Payer: Aetna Medicare	$349.92
Rate for Payer: Aetna New Business (MI Preferred)	$454.90
Rate for Payer: BCBS Complete	$279.94
Rate for Payer: Cash Price	$559.87
Rate for Payer: Cofinity Commercial	$489.89
Rate for Payer: Cofinity Commercial	$601.86
Rate for Payer: Cofinity Medicare Advantage	$489.89
Rate for Payer: Encore Health Key Benefits Commercial	$559.87
Rate for Payer: Healthscope Commercial	$629.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$594.86
Rate for Payer: PHP Commercial	$594.86
Rate for Payer: Priority Health Cigna Priority Health	$454.90
Rate for Payer: Priority Health SBD	$440.90

MISOPROSTOL 100 MCG TABLET

Facility

$177.12

Service Code	NDC 43386016006
Hospital Charge Code	10628
Hospital Revenue Code	637
Min. Negotiated Rate	$111.59
Max. Negotiated Rate	$159.41
Rate for Payer: Aetna Commercial	$150.55
Rate for Payer: Aetna New Business (MI Preferred)	$115.13
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Cofinity Commercial	$152.32
Rate for Payer: Cofinity Medicare Advantage	$123.98
Rate for Payer: Encore Health Key Benefits Commercial	$141.70
Rate for Payer: Healthscope Commercial	$159.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.55
Rate for Payer: PHP Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$115.13
Rate for Payer: Priority Health SBD	$111.59

MISOPROSTOL 200 MCG TABLET

Facility

$794.88

Service Code	NDC 68084004101
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$317.95
Max. Negotiated Rate	$715.39
Rate for Payer: Aetna Commercial	$675.65
Rate for Payer: Aetna Medicare	$397.44
Rate for Payer: Aetna New Business (MI Preferred)	$516.67
Rate for Payer: BCBS Complete	$317.95
Rate for Payer: Cash Price	$635.90
Rate for Payer: Cofinity Commercial	$556.42
Rate for Payer: Cofinity Commercial	$683.60
Rate for Payer: Cofinity Medicare Advantage	$556.42
Rate for Payer: Encore Health Key Benefits Commercial	$635.90
Rate for Payer: Healthscope Commercial	$715.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.65
Rate for Payer: PHP Commercial	$675.65
Rate for Payer: Priority Health Cigna Priority Health	$516.67
Rate for Payer: Priority Health SBD	$500.77

MISOPROSTOL 200 MCG TABLET

Facility

$2,022.79

Service Code	NDC 00025146131
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$1,274.36
Max. Negotiated Rate	$1,820.51
Rate for Payer: Aetna Commercial	$1,719.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,314.81
Rate for Payer: Cash Price	$1,618.23
Rate for Payer: Cofinity Commercial	$1,415.95
Rate for Payer: Cofinity Commercial	$1,739.60
Rate for Payer: Cofinity Medicare Advantage	$1,415.95
Rate for Payer: Encore Health Key Benefits Commercial	$1,618.23
Rate for Payer: Healthscope Commercial	$1,820.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,719.37
Rate for Payer: PHP Commercial	$1,719.37
Rate for Payer: Priority Health Cigna Priority Health	$1,314.81
Rate for Payer: Priority Health SBD	$1,274.36

MISOPROSTOL 200 MCG TABLET

Facility

$2,022.79

Service Code	NDC 00025146131
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$809.12
Max. Negotiated Rate	$1,820.51
Rate for Payer: Aetna Commercial	$1,719.37
Rate for Payer: Aetna Medicare	$1,011.39
Rate for Payer: Aetna New Business (MI Preferred)	$1,314.81
Rate for Payer: BCBS Complete	$809.12
Rate for Payer: Cash Price	$1,618.23
Rate for Payer: Cofinity Commercial	$1,415.95
Rate for Payer: Cofinity Commercial	$1,739.60
Rate for Payer: Cofinity Medicare Advantage	$1,415.95
Rate for Payer: Encore Health Key Benefits Commercial	$1,618.23
Rate for Payer: Healthscope Commercial	$1,820.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,719.37
Rate for Payer: PHP Commercial	$1,719.37
Rate for Payer: Priority Health Cigna Priority Health	$1,314.81
Rate for Payer: Priority Health SBD	$1,274.36

Know your out-of-pocket cost for care.

All Charges