Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

OXYBUTYNIN CHLORIDE 5 MG TABLET

Facility

$325.85

Service Code	NDC 00904282161
Hospital Charge Code	5938
Hospital Revenue Code	637
Min. Negotiated Rate	$205.29
Max. Negotiated Rate	$293.26
Rate for Payer: Aetna Commercial	$276.97
Rate for Payer: Aetna New Business (MI Preferred)	$211.80
Rate for Payer: Cash Price	$260.68
Rate for Payer: Cofinity Commercial	$228.09
Rate for Payer: Cofinity Commercial	$280.23
Rate for Payer: Cofinity Medicare Advantage	$228.09
Rate for Payer: Encore Health Key Benefits Commercial	$260.68
Rate for Payer: Healthscope Commercial	$293.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$276.97
Rate for Payer: PHP Commercial	$276.97
Rate for Payer: Priority Health Cigna Priority Health	$211.80
Rate for Payer: Priority Health SBD	$205.29

OXYBUTYNIN CHLORIDE 5 MG TABLET

Facility

$355.30

Service Code	NDC 68084040011
Hospital Charge Code	5938
Hospital Revenue Code	637
Min. Negotiated Rate	$142.12
Max. Negotiated Rate	$319.77
Rate for Payer: Aetna Commercial	$302.00
Rate for Payer: Aetna Medicare	$177.65
Rate for Payer: Aetna New Business (MI Preferred)	$230.94
Rate for Payer: BCBS Complete	$142.12
Rate for Payer: Cash Price	$284.24
Rate for Payer: Cofinity Commercial	$248.71
Rate for Payer: Cofinity Commercial	$305.56
Rate for Payer: Cofinity Medicare Advantage	$248.71
Rate for Payer: Encore Health Key Benefits Commercial	$284.24
Rate for Payer: Healthscope Commercial	$319.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$302.00
Rate for Payer: PHP Commercial	$302.00
Rate for Payer: Priority Health Cigna Priority Health	$230.94
Rate for Payer: Priority Health SBD	$223.84

OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$8.43

Service Code	NDC 50268062811
Hospital Charge Code	24471
Hospital Revenue Code	637
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Cofinity Medicare Advantage	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health Cigna Priority Health	$5.48
Rate for Payer: Priority Health SBD	$5.31

OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$421.25

Service Code	NDC 50268062815
Hospital Charge Code	24471
Hospital Revenue Code	637
Min. Negotiated Rate	$168.50
Max. Negotiated Rate	$379.12
Rate for Payer: Aetna Commercial	$358.06
Rate for Payer: Aetna Medicare	$210.62
Rate for Payer: Aetna New Business (MI Preferred)	$273.81
Rate for Payer: BCBS Complete	$168.50
Rate for Payer: Cash Price	$337.00
Rate for Payer: Cofinity Commercial	$294.88
Rate for Payer: Cofinity Commercial	$362.27
Rate for Payer: Cofinity Medicare Advantage	$294.88
Rate for Payer: Encore Health Key Benefits Commercial	$337.00
Rate for Payer: Healthscope Commercial	$379.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.06
Rate for Payer: PHP Commercial	$358.06
Rate for Payer: Priority Health Cigna Priority Health	$273.81
Rate for Payer: Priority Health SBD	$265.39

OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$8.43

Service Code	NDC 50268062811
Hospital Charge Code	24471
Hospital Revenue Code	637
Min. Negotiated Rate	$3.37
Max. Negotiated Rate	$7.59
Rate for Payer: Aetna Commercial	$7.17
Rate for Payer: Aetna Medicare	$4.21
Rate for Payer: Aetna New Business (MI Preferred)	$5.48
Rate for Payer: BCBS Complete	$3.37
Rate for Payer: Cash Price	$6.74
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Cofinity Medicare Advantage	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$6.74
Rate for Payer: Healthscope Commercial	$7.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.17
Rate for Payer: PHP Commercial	$7.17
Rate for Payer: Priority Health Cigna Priority Health	$5.48
Rate for Payer: Priority Health SBD	$5.31

OXYBUTYNIN CHLORIDE ER 10 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$421.25

Service Code	NDC 50268062815
Hospital Charge Code	24471
Hospital Revenue Code	637
Min. Negotiated Rate	$265.39
Max. Negotiated Rate	$379.12
Rate for Payer: Aetna Commercial	$358.06
Rate for Payer: Aetna New Business (MI Preferred)	$273.81
Rate for Payer: Cash Price	$337.00
Rate for Payer: Cofinity Commercial	$294.88
Rate for Payer: Cofinity Commercial	$362.27
Rate for Payer: Cofinity Medicare Advantage	$294.88
Rate for Payer: Encore Health Key Benefits Commercial	$337.00
Rate for Payer: Healthscope Commercial	$379.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.06
Rate for Payer: PHP Commercial	$358.06
Rate for Payer: Priority Health Cigna Priority Health	$273.81
Rate for Payer: Priority Health SBD	$265.39

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$339.60

Service Code	NDC 00904657006
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$135.84
Max. Negotiated Rate	$305.64
Rate for Payer: Aetna Commercial	$288.66
Rate for Payer: Aetna Medicare	$169.80
Rate for Payer: Aetna New Business (MI Preferred)	$220.74
Rate for Payer: BCBS Complete	$135.84
Rate for Payer: Cash Price	$271.68
Rate for Payer: Cofinity Commercial	$237.72
Rate for Payer: Cofinity Commercial	$292.06
Rate for Payer: Cofinity Medicare Advantage	$237.72
Rate for Payer: Encore Health Key Benefits Commercial	$271.68
Rate for Payer: Healthscope Commercial	$305.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.66
Rate for Payer: PHP Commercial	$288.66
Rate for Payer: Priority Health Cigna Priority Health	$220.74
Rate for Payer: Priority Health SBD	$213.95

OXYBUTYNIN CHLORIDE ER 5 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$339.60

Service Code	NDC 00904657006
Hospital Charge Code	24470
Hospital Revenue Code	637
Min. Negotiated Rate	$213.95
Max. Negotiated Rate	$305.64
Rate for Payer: Aetna Commercial	$288.66
Rate for Payer: Aetna New Business (MI Preferred)	$220.74
Rate for Payer: Cash Price	$271.68
Rate for Payer: Cofinity Commercial	$237.72
Rate for Payer: Cofinity Commercial	$292.06
Rate for Payer: Cofinity Medicare Advantage	$237.72
Rate for Payer: Encore Health Key Benefits Commercial	$271.68
Rate for Payer: Healthscope Commercial	$305.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.66
Rate for Payer: PHP Commercial	$288.66
Rate for Payer: Priority Health Cigna Priority Health	$220.74
Rate for Payer: Priority Health SBD	$213.95

OXYCODONE 10 MG TABLET

Facility

$267.75

Service Code	NDC 10702005601
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$107.10
Max. Negotiated Rate	$240.97
Rate for Payer: Aetna Commercial	$227.59
Rate for Payer: Aetna Medicare	$133.88
Rate for Payer: Aetna New Business (MI Preferred)	$174.04
Rate for Payer: BCBS Complete	$107.10
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cofinity Commercial	$187.43
Rate for Payer: Cofinity Commercial	$230.26
Rate for Payer: Cofinity Medicare Advantage	$187.43
Rate for Payer: Encore Health Key Benefits Commercial	$214.20
Rate for Payer: Healthscope Commercial	$240.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.59
Rate for Payer: PHP Commercial	$227.59
Rate for Payer: Priority Health Cigna Priority Health	$174.04
Rate for Payer: Priority Health SBD	$168.68

OXYCODONE 10 MG TABLET

Facility

$4.67

Service Code	NDC 68084096811
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$4.20
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.97
Rate for Payer: PHP Commercial	$3.97
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.94

OXYCODONE 10 MG TABLET

Facility

$267.75

Service Code	NDC 10702005601
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$168.68
Max. Negotiated Rate	$240.97
Rate for Payer: Aetna Commercial	$227.59
Rate for Payer: Aetna New Business (MI Preferred)	$174.04
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cofinity Commercial	$187.43
Rate for Payer: Cofinity Commercial	$230.26
Rate for Payer: Cofinity Medicare Advantage	$187.43
Rate for Payer: Encore Health Key Benefits Commercial	$214.20
Rate for Payer: Healthscope Commercial	$240.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.59
Rate for Payer: PHP Commercial	$227.59
Rate for Payer: Priority Health Cigna Priority Health	$174.04
Rate for Payer: Priority Health SBD	$168.68

OXYCODONE 10 MG TABLET

Facility

$466.20

Service Code	NDC 68084096801
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$293.71
Max. Negotiated Rate	$419.58
Rate for Payer: Aetna Commercial	$396.27
Rate for Payer: Aetna New Business (MI Preferred)	$303.03
Rate for Payer: Cash Price	$372.96
Rate for Payer: Cofinity Commercial	$326.34
Rate for Payer: Cofinity Commercial	$400.93
Rate for Payer: Cofinity Medicare Advantage	$326.34
Rate for Payer: Encore Health Key Benefits Commercial	$372.96
Rate for Payer: Healthscope Commercial	$419.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$396.27
Rate for Payer: PHP Commercial	$396.27
Rate for Payer: Priority Health Cigna Priority Health	$303.03
Rate for Payer: Priority Health SBD	$293.71

OXYCODONE 10 MG TABLET

Facility

$4.67

Service Code	NDC 68084096811
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.20
Rate for Payer: Aetna Commercial	$3.97
Rate for Payer: Aetna Medicare	$2.33
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: BCBS Complete	$1.87
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.97
Rate for Payer: PHP Commercial	$3.97
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.94

OXYCODONE 10 MG TABLET

Facility

$466.20

Service Code	NDC 68084096801
Hospital Charge Code	87795
Hospital Revenue Code	637
Min. Negotiated Rate	$186.48
Max. Negotiated Rate	$419.58
Rate for Payer: Aetna Commercial	$396.27
Rate for Payer: Aetna Medicare	$233.10
Rate for Payer: Aetna New Business (MI Preferred)	$303.03
Rate for Payer: BCBS Complete	$186.48
Rate for Payer: Cash Price	$372.96
Rate for Payer: Cofinity Commercial	$326.34
Rate for Payer: Cofinity Commercial	$400.93
Rate for Payer: Cofinity Medicare Advantage	$326.34
Rate for Payer: Encore Health Key Benefits Commercial	$372.96
Rate for Payer: Healthscope Commercial	$419.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$396.27
Rate for Payer: PHP Commercial	$396.27
Rate for Payer: Priority Health Cigna Priority Health	$303.03
Rate for Payer: Priority Health SBD	$293.71

OXYCODONE 15 MG TABLET

Facility

$513.80

Service Code	NDC 00406851562
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$323.69
Max. Negotiated Rate	$462.42
Rate for Payer: Aetna Commercial	$436.73
Rate for Payer: Aetna New Business (MI Preferred)	$333.97
Rate for Payer: Cash Price	$411.04
Rate for Payer: Cofinity Commercial	$359.66
Rate for Payer: Cofinity Commercial	$441.87
Rate for Payer: Cofinity Medicare Advantage	$359.66
Rate for Payer: Encore Health Key Benefits Commercial	$411.04
Rate for Payer: Healthscope Commercial	$462.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.73
Rate for Payer: PHP Commercial	$436.73
Rate for Payer: Priority Health Cigna Priority Health	$333.97
Rate for Payer: Priority Health SBD	$323.69

OXYCODONE 15 MG TABLET

Facility

$513.80

Service Code	NDC 00406851562
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$205.52
Max. Negotiated Rate	$462.42
Rate for Payer: Aetna Commercial	$436.73
Rate for Payer: Aetna Medicare	$256.90
Rate for Payer: Aetna New Business (MI Preferred)	$333.97
Rate for Payer: BCBS Complete	$205.52
Rate for Payer: Cash Price	$411.04
Rate for Payer: Cofinity Commercial	$359.66
Rate for Payer: Cofinity Commercial	$441.87
Rate for Payer: Cofinity Medicare Advantage	$359.66
Rate for Payer: Encore Health Key Benefits Commercial	$411.04
Rate for Payer: Healthscope Commercial	$462.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.73
Rate for Payer: PHP Commercial	$436.73
Rate for Payer: Priority Health Cigna Priority Health	$333.97
Rate for Payer: Priority Health SBD	$323.69

OXYCODONE 15 MG TABLET

Facility

$5.14

Service Code	NDC 00406851523
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$4.63
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna New Business (MI Preferred)	$3.34
Rate for Payer: Cash Price	$4.11
Rate for Payer: Cofinity Commercial	$3.60
Rate for Payer: Cofinity Commercial	$4.42
Rate for Payer: Cofinity Medicare Advantage	$3.60
Rate for Payer: Encore Health Key Benefits Commercial	$4.11
Rate for Payer: Healthscope Commercial	$4.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.37
Rate for Payer: PHP Commercial	$4.37
Rate for Payer: Priority Health Cigna Priority Health	$3.34
Rate for Payer: Priority Health SBD	$3.24

OXYCODONE 15 MG TABLET

Facility

$5.14

Service Code	NDC 00406851523
Hospital Charge Code	28899
Hospital Revenue Code	637
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$4.63
Rate for Payer: Aetna Commercial	$4.37
Rate for Payer: Aetna Medicare	$2.57
Rate for Payer: Aetna New Business (MI Preferred)	$3.34
Rate for Payer: BCBS Complete	$2.06
Rate for Payer: Cash Price	$4.11
Rate for Payer: Cofinity Commercial	$3.60
Rate for Payer: Cofinity Commercial	$4.42
Rate for Payer: Cofinity Medicare Advantage	$3.60
Rate for Payer: Encore Health Key Benefits Commercial	$4.11
Rate for Payer: Healthscope Commercial	$4.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.37
Rate for Payer: PHP Commercial	$4.37
Rate for Payer: Priority Health Cigna Priority Health	$3.34
Rate for Payer: Priority Health SBD	$3.24

OXYCODONE 5 MG TABLET

Facility

$201.25

Service Code	NDC 65162004710
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$126.79
Max. Negotiated Rate	$181.12
Rate for Payer: Aetna Commercial	$171.06
Rate for Payer: Aetna New Business (MI Preferred)	$130.81
Rate for Payer: Cash Price	$161.00
Rate for Payer: Cofinity Commercial	$140.88
Rate for Payer: Cofinity Commercial	$173.07
Rate for Payer: Cofinity Medicare Advantage	$140.88
Rate for Payer: Encore Health Key Benefits Commercial	$161.00
Rate for Payer: Healthscope Commercial	$181.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$171.06
Rate for Payer: PHP Commercial	$171.06
Rate for Payer: Priority Health Cigna Priority Health	$130.81
Rate for Payer: Priority Health SBD	$126.79

OXYCODONE 5 MG TABLET

Facility

$238.00

Service Code	NDC 57664022388
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$149.94
Max. Negotiated Rate	$214.20
Rate for Payer: Aetna Commercial	$202.30
Rate for Payer: Aetna New Business (MI Preferred)	$154.70
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cofinity Commercial	$166.60
Rate for Payer: Cofinity Commercial	$204.68
Rate for Payer: Cofinity Medicare Advantage	$166.60
Rate for Payer: Encore Health Key Benefits Commercial	$190.40
Rate for Payer: Healthscope Commercial	$214.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$202.30
Rate for Payer: PHP Commercial	$202.30
Rate for Payer: Priority Health Cigna Priority Health	$154.70
Rate for Payer: Priority Health SBD	$149.94

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035411
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$412.33
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

OXYCODONE 5 MG TABLET

Facility

$736.75

Service Code	NDC 42858000110
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$464.15
Max. Negotiated Rate	$663.08
Rate for Payer: Aetna Commercial	$626.24
Rate for Payer: Aetna New Business (MI Preferred)	$478.89
Rate for Payer: Cash Price	$589.40
Rate for Payer: Cofinity Commercial	$515.73
Rate for Payer: Cofinity Commercial	$633.61
Rate for Payer: Cofinity Medicare Advantage	$515.73
Rate for Payer: Encore Health Key Benefits Commercial	$589.40
Rate for Payer: Healthscope Commercial	$663.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.24
Rate for Payer: PHP Commercial	$626.24
Rate for Payer: Priority Health Cigna Priority Health	$478.89
Rate for Payer: Priority Health SBD	$464.15

OXYCODONE 5 MG TABLET

Facility

$5.95

Service Code	NDC 00406055223
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$5.36
Rate for Payer: Aetna Commercial	$5.06
Rate for Payer: Aetna New Business (MI Preferred)	$3.87
Rate for Payer: Cash Price	$4.76
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Cofinity Commercial	$5.12
Rate for Payer: Cofinity Medicare Advantage	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$4.76
Rate for Payer: Healthscope Commercial	$5.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.06
Rate for Payer: PHP Commercial	$5.06
Rate for Payer: Priority Health Cigna Priority Health	$3.87
Rate for Payer: Priority Health SBD	$3.75

OXYCODONE 5 MG TABLET

Facility

$654.50

Service Code	NDC 68084035401
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$412.33
Max. Negotiated Rate	$589.05
Rate for Payer: Aetna Commercial	$556.33
Rate for Payer: Aetna New Business (MI Preferred)	$425.43
Rate for Payer: Cash Price	$523.60
Rate for Payer: Cofinity Commercial	$458.15
Rate for Payer: Cofinity Commercial	$562.87
Rate for Payer: Cofinity Medicare Advantage	$458.15
Rate for Payer: Encore Health Key Benefits Commercial	$523.60
Rate for Payer: Healthscope Commercial	$589.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$556.33
Rate for Payer: PHP Commercial	$556.33
Rate for Payer: Priority Health Cigna Priority Health	$425.43
Rate for Payer: Priority Health SBD	$412.33

OXYCODONE 5 MG TABLET

Facility

$204.75

Service Code	NDC 42858000101
Hospital Charge Code	10814
Hospital Revenue Code	637
Min. Negotiated Rate	$81.90
Max. Negotiated Rate	$184.28
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare	$102.38
Rate for Payer: Aetna New Business (MI Preferred)	$133.09
Rate for Payer: BCBS Complete	$81.90
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cofinity Commercial	$143.32
Rate for Payer: Cofinity Commercial	$176.09
Rate for Payer: Cofinity Medicare Advantage	$143.32
Rate for Payer: Encore Health Key Benefits Commercial	$163.80
Rate for Payer: Healthscope Commercial	$184.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.04
Rate for Payer: PHP Commercial	$174.04
Rate for Payer: Priority Health Cigna Priority Health	$133.09
Rate for Payer: Priority Health SBD	$128.99

Know your out-of-pocket cost for care.

All Charges