Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION

Facility

$124.55

Service Code	NDC 70710146002
Hospital Charge Code	15797
Hospital Revenue Code	637
Min. Negotiated Rate	$78.47
Max. Negotiated Rate	$112.10
Rate for Payer: Aetna Commercial	$105.87
Rate for Payer: Aetna New Business (MI Preferred)	$80.96
Rate for Payer: Cash Price	$99.64
Rate for Payer: Cofinity Commercial	$107.11
Rate for Payer: Cofinity Commercial	$87.18
Rate for Payer: Cofinity Medicare Advantage	$87.18
Rate for Payer: Encore Health Key Benefits Commercial	$99.64
Rate for Payer: Healthscope Commercial	$112.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.87
Rate for Payer: PHP Commercial	$105.87
Rate for Payer: Priority Health Cigna Priority Health	$80.96
Rate for Payer: Priority Health SBD	$78.47

AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION

Facility

$124.55

Service Code	NDC 70710146002
Hospital Charge Code	15797
Hospital Revenue Code	637
Min. Negotiated Rate	$49.82
Max. Negotiated Rate	$112.10
Rate for Payer: Aetna Commercial	$105.87
Rate for Payer: Aetna Medicare	$62.28
Rate for Payer: Aetna New Business (MI Preferred)	$80.96
Rate for Payer: BCBS Complete	$49.82
Rate for Payer: Cash Price	$99.64
Rate for Payer: Cofinity Commercial	$107.11
Rate for Payer: Cofinity Commercial	$87.18
Rate for Payer: Cofinity Medicare Advantage	$87.18
Rate for Payer: Encore Health Key Benefits Commercial	$99.64
Rate for Payer: Healthscope Commercial	$112.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.87
Rate for Payer: PHP Commercial	$105.87
Rate for Payer: Priority Health Cigna Priority Health	$80.96
Rate for Payer: Priority Health SBD	$78.47

AZITHROMYCIN 250 MG TABLET

Facility

$174.24

Service Code	NDC 50268007415
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$156.82
Rate for Payer: Aetna Commercial	$148.10
Rate for Payer: Aetna Medicare	$87.12
Rate for Payer: Aetna New Business (MI Preferred)	$113.26
Rate for Payer: BCBS Complete	$69.70
Rate for Payer: Cash Price	$139.39
Rate for Payer: Cofinity Commercial	$121.97
Rate for Payer: Cofinity Commercial	$149.85
Rate for Payer: Cofinity Medicare Advantage	$121.97
Rate for Payer: Encore Health Key Benefits Commercial	$139.39
Rate for Payer: Healthscope Commercial	$156.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.10
Rate for Payer: PHP Commercial	$148.10
Rate for Payer: Priority Health Cigna Priority Health	$113.26
Rate for Payer: Priority Health SBD	$109.77

AZITHROMYCIN 250 MG TABLET

Facility

$121.41

Service Code	NDC 68094090030
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$76.49
Max. Negotiated Rate	$109.27
Rate for Payer: Aetna Commercial	$103.20
Rate for Payer: Aetna New Business (MI Preferred)	$78.92
Rate for Payer: Cash Price	$97.13
Rate for Payer: Cofinity Commercial	$104.41
Rate for Payer: Cofinity Commercial	$84.99
Rate for Payer: Cofinity Medicare Advantage	$84.99
Rate for Payer: Encore Health Key Benefits Commercial	$97.13
Rate for Payer: Healthscope Commercial	$109.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.20
Rate for Payer: PHP Commercial	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$78.92
Rate for Payer: Priority Health SBD	$76.49

AZITHROMYCIN 250 MG TABLET

Facility

$59.85

Service Code	NDC 59762219807
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$37.71
Max. Negotiated Rate	$53.86
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Commercial	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Cofinity Medicare Advantage	$41.90
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health Cigna Priority Health	$38.90
Rate for Payer: Priority Health SBD	$37.71

AZITHROMYCIN 250 MG TABLET

Facility

$154.08

Service Code	NDC 00904670806
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$61.63
Max. Negotiated Rate	$138.67
Rate for Payer: Aetna Commercial	$130.97
Rate for Payer: Aetna Medicare	$77.04
Rate for Payer: Aetna New Business (MI Preferred)	$100.15
Rate for Payer: BCBS Complete	$61.63
Rate for Payer: Cash Price	$123.26
Rate for Payer: Cofinity Commercial	$107.86
Rate for Payer: Cofinity Commercial	$132.51
Rate for Payer: Cofinity Medicare Advantage	$107.86
Rate for Payer: Encore Health Key Benefits Commercial	$123.26
Rate for Payer: Healthscope Commercial	$138.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.97
Rate for Payer: PHP Commercial	$130.97
Rate for Payer: Priority Health Cigna Priority Health	$100.15
Rate for Payer: Priority Health SBD	$97.07

AZITHROMYCIN 250 MG TABLET

Facility

$775.20

Service Code	NDC 60687028201
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$310.08
Max. Negotiated Rate	$697.68
Rate for Payer: Aetna Commercial	$658.92
Rate for Payer: Aetna Medicare	$387.60
Rate for Payer: Aetna New Business (MI Preferred)	$503.88
Rate for Payer: BCBS Complete	$310.08
Rate for Payer: Cash Price	$620.16
Rate for Payer: Cofinity Commercial	$542.64
Rate for Payer: Cofinity Commercial	$666.67
Rate for Payer: Cofinity Medicare Advantage	$542.64
Rate for Payer: Encore Health Key Benefits Commercial	$620.16
Rate for Payer: Healthscope Commercial	$697.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$658.92
Rate for Payer: PHP Commercial	$658.92
Rate for Payer: Priority Health Cigna Priority Health	$503.88
Rate for Payer: Priority Health SBD	$488.38

AZITHROMYCIN 250 MG TABLET

Facility

$7.76

Service Code	NDC 60687028211
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$6.98
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna Medicare	$3.88
Rate for Payer: Aetna New Business (MI Preferred)	$5.04
Rate for Payer: BCBS Complete	$3.10
Rate for Payer: Cash Price	$6.21
Rate for Payer: Cofinity Commercial	$5.43
Rate for Payer: Cofinity Commercial	$6.67
Rate for Payer: Cofinity Medicare Advantage	$5.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.21
Rate for Payer: Healthscope Commercial	$6.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.60
Rate for Payer: PHP Commercial	$6.60
Rate for Payer: Priority Health Cigna Priority Health	$5.04
Rate for Payer: Priority Health SBD	$4.89

AZITHROMYCIN 250 MG TABLET

Facility

$593.85

Service Code	NDC 00069406189
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$237.54
Max. Negotiated Rate	$534.46
Rate for Payer: Aetna Commercial	$504.77
Rate for Payer: Aetna Medicare	$296.92
Rate for Payer: Aetna New Business (MI Preferred)	$386.00
Rate for Payer: BCBS Complete	$237.54
Rate for Payer: Cash Price	$475.08
Rate for Payer: Cofinity Commercial	$415.70
Rate for Payer: Cofinity Commercial	$510.71
Rate for Payer: Cofinity Medicare Advantage	$415.70
Rate for Payer: Encore Health Key Benefits Commercial	$475.08
Rate for Payer: Healthscope Commercial	$534.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$504.77
Rate for Payer: PHP Commercial	$504.77
Rate for Payer: Priority Health Cigna Priority Health	$386.00
Rate for Payer: Priority Health SBD	$374.13

AZITHROMYCIN 250 MG TABLET

Facility

$409.92

Service Code	NDC 00904670861
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$163.97
Max. Negotiated Rate	$368.93
Rate for Payer: Aetna Commercial	$348.43
Rate for Payer: Aetna Medicare	$204.96
Rate for Payer: Aetna New Business (MI Preferred)	$266.45
Rate for Payer: BCBS Complete	$163.97
Rate for Payer: Cash Price	$327.94
Rate for Payer: Cofinity Commercial	$286.94
Rate for Payer: Cofinity Commercial	$352.53
Rate for Payer: Cofinity Medicare Advantage	$286.94
Rate for Payer: Encore Health Key Benefits Commercial	$327.94
Rate for Payer: Healthscope Commercial	$368.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.43
Rate for Payer: PHP Commercial	$348.43
Rate for Payer: Priority Health Cigna Priority Health	$266.45
Rate for Payer: Priority Health SBD	$258.25

AZITHROMYCIN 250 MG TABLET

Facility

$59.85

Service Code	NDC 59762219807
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$23.94
Max. Negotiated Rate	$53.86
Rate for Payer: Aetna Commercial	$50.87
Rate for Payer: Aetna Medicare	$29.92
Rate for Payer: Aetna New Business (MI Preferred)	$38.90
Rate for Payer: BCBS Complete	$23.94
Rate for Payer: Cash Price	$47.88
Rate for Payer: Cofinity Commercial	$41.90
Rate for Payer: Cofinity Commercial	$51.47
Rate for Payer: Cofinity Medicare Advantage	$41.90
Rate for Payer: Encore Health Key Benefits Commercial	$47.88
Rate for Payer: Healthscope Commercial	$53.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.87
Rate for Payer: PHP Commercial	$50.87
Rate for Payer: Priority Health Cigna Priority Health	$38.90
Rate for Payer: Priority Health SBD	$37.71

AZITHROMYCIN 250 MG TABLET

Facility

$775.20

Service Code	NDC 60687028201
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$488.38
Max. Negotiated Rate	$697.68
Rate for Payer: Aetna Commercial	$658.92
Rate for Payer: Aetna New Business (MI Preferred)	$503.88
Rate for Payer: Cash Price	$620.16
Rate for Payer: Cofinity Commercial	$542.64
Rate for Payer: Cofinity Commercial	$666.67
Rate for Payer: Cofinity Medicare Advantage	$542.64
Rate for Payer: Encore Health Key Benefits Commercial	$620.16
Rate for Payer: Healthscope Commercial	$697.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$658.92
Rate for Payer: PHP Commercial	$658.92
Rate for Payer: Priority Health Cigna Priority Health	$503.88
Rate for Payer: Priority Health SBD	$488.38

AZITHROMYCIN 250 MG TABLET

Facility

$384.80

Service Code	NDC 59762306003
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$242.42
Max. Negotiated Rate	$346.32
Rate for Payer: Aetna Commercial	$327.08
Rate for Payer: Aetna New Business (MI Preferred)	$250.12
Rate for Payer: Cash Price	$307.84
Rate for Payer: Cofinity Commercial	$269.36
Rate for Payer: Cofinity Commercial	$330.93
Rate for Payer: Cofinity Medicare Advantage	$269.36
Rate for Payer: Encore Health Key Benefits Commercial	$307.84
Rate for Payer: Healthscope Commercial	$346.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.08
Rate for Payer: PHP Commercial	$327.08
Rate for Payer: Priority Health Cigna Priority Health	$250.12
Rate for Payer: Priority Health SBD	$242.42

AZITHROMYCIN 250 MG TABLET

Facility

$281.96

Service Code	NDC 64679096101
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$112.78
Max. Negotiated Rate	$253.76
Rate for Payer: Aetna Commercial	$239.67
Rate for Payer: Aetna Medicare	$140.98
Rate for Payer: Aetna New Business (MI Preferred)	$183.27
Rate for Payer: BCBS Complete	$112.78
Rate for Payer: Cash Price	$225.57
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Commercial	$242.49
Rate for Payer: Cofinity Medicare Advantage	$197.37
Rate for Payer: Encore Health Key Benefits Commercial	$225.57
Rate for Payer: Healthscope Commercial	$253.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.67
Rate for Payer: PHP Commercial	$239.67
Rate for Payer: Priority Health Cigna Priority Health	$183.27
Rate for Payer: Priority Health SBD	$177.63

AZITHROMYCIN 250 MG TABLET

Facility

$409.92

Service Code	NDC 00904670861
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$258.25
Max. Negotiated Rate	$368.93
Rate for Payer: Aetna Commercial	$348.43
Rate for Payer: Aetna New Business (MI Preferred)	$266.45
Rate for Payer: Cash Price	$327.94
Rate for Payer: Cofinity Commercial	$286.94
Rate for Payer: Cofinity Commercial	$352.53
Rate for Payer: Cofinity Medicare Advantage	$286.94
Rate for Payer: Encore Health Key Benefits Commercial	$327.94
Rate for Payer: Healthscope Commercial	$368.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.43
Rate for Payer: PHP Commercial	$348.43
Rate for Payer: Priority Health Cigna Priority Health	$266.45
Rate for Payer: Priority Health SBD	$258.25

AZITHROMYCIN 250 MG TABLET

Facility

$140.51

Service Code	NDC 00781808931
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$56.20
Max. Negotiated Rate	$126.46
Rate for Payer: Aetna Commercial	$119.43
Rate for Payer: Aetna Medicare	$70.26
Rate for Payer: Aetna New Business (MI Preferred)	$91.33
Rate for Payer: BCBS Complete	$56.20
Rate for Payer: Cash Price	$112.41
Rate for Payer: Cofinity Commercial	$120.84
Rate for Payer: Cofinity Commercial	$98.36
Rate for Payer: Cofinity Medicare Advantage	$98.36
Rate for Payer: Encore Health Key Benefits Commercial	$112.41
Rate for Payer: Healthscope Commercial	$126.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.43
Rate for Payer: PHP Commercial	$119.43
Rate for Payer: Priority Health Cigna Priority Health	$91.33
Rate for Payer: Priority Health SBD	$88.52

AZITHROMYCIN 250 MG TABLET

Facility

$281.96

Service Code	NDC 64679096101
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$177.63
Max. Negotiated Rate	$253.76
Rate for Payer: Aetna Commercial	$239.67
Rate for Payer: Aetna New Business (MI Preferred)	$183.27
Rate for Payer: Cash Price	$225.57
Rate for Payer: Cofinity Commercial	$197.37
Rate for Payer: Cofinity Commercial	$242.49
Rate for Payer: Cofinity Medicare Advantage	$197.37
Rate for Payer: Encore Health Key Benefits Commercial	$225.57
Rate for Payer: Healthscope Commercial	$253.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.67
Rate for Payer: PHP Commercial	$239.67
Rate for Payer: Priority Health Cigna Priority Health	$183.27
Rate for Payer: Priority Health SBD	$177.63

AZITHROMYCIN 250 MG TABLET

Facility

$3.12

Service Code	NDC 50268009811
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.65
Rate for Payer: Aetna New Business (MI Preferred)	$2.03
Rate for Payer: Cash Price	$2.50
Rate for Payer: Cofinity Commercial	$2.18
Rate for Payer: Cofinity Commercial	$2.68
Rate for Payer: Cofinity Medicare Advantage	$2.18
Rate for Payer: Encore Health Key Benefits Commercial	$2.50
Rate for Payer: Healthscope Commercial	$2.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.65
Rate for Payer: PHP Commercial	$2.65
Rate for Payer: Priority Health Cigna Priority Health	$2.03
Rate for Payer: Priority Health SBD	$1.97

AZITHROMYCIN 250 MG TABLET

Facility

$158.40

Service Code	NDC 00904735006
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$63.36
Max. Negotiated Rate	$142.56
Rate for Payer: Aetna Commercial	$134.64
Rate for Payer: Aetna Medicare	$79.20
Rate for Payer: Aetna New Business (MI Preferred)	$102.96
Rate for Payer: BCBS Complete	$63.36
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cofinity Commercial	$110.88
Rate for Payer: Cofinity Commercial	$136.22
Rate for Payer: Cofinity Medicare Advantage	$110.88
Rate for Payer: Encore Health Key Benefits Commercial	$126.72
Rate for Payer: Healthscope Commercial	$142.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.64
Rate for Payer: PHP Commercial	$134.64
Rate for Payer: Priority Health Cigna Priority Health	$102.96
Rate for Payer: Priority Health SBD	$99.79

AZITHROMYCIN 250 MG TABLET

Facility

$513.60

Service Code	NDC 00904735061
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$323.57
Max. Negotiated Rate	$462.24
Rate for Payer: Aetna Commercial	$436.56
Rate for Payer: Aetna New Business (MI Preferred)	$333.84
Rate for Payer: Cash Price	$410.88
Rate for Payer: Cofinity Commercial	$359.52
Rate for Payer: Cofinity Commercial	$441.70
Rate for Payer: Cofinity Medicare Advantage	$359.52
Rate for Payer: Encore Health Key Benefits Commercial	$410.88
Rate for Payer: Healthscope Commercial	$462.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$436.56
Rate for Payer: PHP Commercial	$436.56
Rate for Payer: Priority Health Cigna Priority Health	$333.84
Rate for Payer: Priority Health SBD	$323.57

AZITHROMYCIN 250 MG TABLET

Facility

$121.41

Service Code	NDC 68094090030
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$109.27
Rate for Payer: Aetna Commercial	$103.20
Rate for Payer: Aetna Medicare	$60.70
Rate for Payer: Aetna New Business (MI Preferred)	$78.92
Rate for Payer: BCBS Complete	$48.56
Rate for Payer: Cash Price	$97.13
Rate for Payer: Cofinity Commercial	$104.41
Rate for Payer: Cofinity Commercial	$84.99
Rate for Payer: Cofinity Medicare Advantage	$84.99
Rate for Payer: Encore Health Key Benefits Commercial	$97.13
Rate for Payer: Healthscope Commercial	$109.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.20
Rate for Payer: PHP Commercial	$103.20
Rate for Payer: Priority Health Cigna Priority Health	$78.92
Rate for Payer: Priority Health SBD	$76.49

AZITHROMYCIN 250 MG TABLET

Facility

$158.40

Service Code	NDC 00904735006
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$99.79
Max. Negotiated Rate	$142.56
Rate for Payer: Aetna Commercial	$134.64
Rate for Payer: Aetna New Business (MI Preferred)	$102.96
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cofinity Commercial	$110.88
Rate for Payer: Cofinity Commercial	$136.22
Rate for Payer: Cofinity Medicare Advantage	$110.88
Rate for Payer: Encore Health Key Benefits Commercial	$126.72
Rate for Payer: Healthscope Commercial	$142.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.64
Rate for Payer: PHP Commercial	$134.64
Rate for Payer: Priority Health Cigna Priority Health	$102.96
Rate for Payer: Priority Health SBD	$99.79

AZITHROMYCIN 250 MG TABLET

Facility

$7.76

Service Code	NDC 60687028211
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$6.98
Rate for Payer: Aetna Commercial	$6.60
Rate for Payer: Aetna New Business (MI Preferred)	$5.04
Rate for Payer: Cash Price	$6.21
Rate for Payer: Cofinity Commercial	$5.43
Rate for Payer: Cofinity Commercial	$6.67
Rate for Payer: Cofinity Medicare Advantage	$5.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.21
Rate for Payer: Healthscope Commercial	$6.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.60
Rate for Payer: PHP Commercial	$6.60
Rate for Payer: Priority Health Cigna Priority Health	$5.04
Rate for Payer: Priority Health SBD	$4.89

AZITHROMYCIN 250 MG TABLET

Facility

$3.49

Service Code	NDC 50268007411
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.14
Rate for Payer: Aetna Commercial	$2.97
Rate for Payer: Aetna New Business (MI Preferred)	$2.27
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Commercial	$3.00
Rate for Payer: Cofinity Medicare Advantage	$2.44
Rate for Payer: Encore Health Key Benefits Commercial	$2.79
Rate for Payer: Healthscope Commercial	$3.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.97
Rate for Payer: PHP Commercial	$2.97
Rate for Payer: Priority Health Cigna Priority Health	$2.27
Rate for Payer: Priority Health SBD	$2.20

AZITHROMYCIN 250 MG TABLET

Facility

$140.51

Service Code	NDC 00781808931
Hospital Charge Code	20943
Hospital Revenue Code	637
Min. Negotiated Rate	$88.52
Max. Negotiated Rate	$126.46
Rate for Payer: Aetna Commercial	$119.43
Rate for Payer: Aetna New Business (MI Preferred)	$91.33
Rate for Payer: Cash Price	$112.41
Rate for Payer: Cofinity Commercial	$120.84
Rate for Payer: Cofinity Commercial	$98.36
Rate for Payer: Cofinity Medicare Advantage	$98.36
Rate for Payer: Encore Health Key Benefits Commercial	$112.41
Rate for Payer: Healthscope Commercial	$126.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.43
Rate for Payer: PHP Commercial	$119.43
Rate for Payer: Priority Health Cigna Priority Health	$91.33
Rate for Payer: Priority Health SBD	$88.52

Know your out-of-pocket cost for care.

All Charges