Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GABAPENTIN 400 MG CAPSULE

Facility

$239.70

Service Code	NDC 63739-984-10
Hospital Charge Code	18307
Hospital Revenue Code	637
Min. Negotiated Rate	$151.01
Max. Negotiated Rate	$215.73
Rate for Payer: Aetna Commercial	$203.74
Rate for Payer: Aetna New Business (MI Preferred)	$155.80
Rate for Payer: Cash Price	$191.76
Rate for Payer: Cofinity Commercial	$167.79
Rate for Payer: Cofinity Commercial	$206.14
Rate for Payer: Healthscope Commercial	$215.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.74
Rate for Payer: PHP Commercial	$203.74
Rate for Payer: Priority Health Cigna Priority Health	$167.79
Rate for Payer: Priority Health SBD	$151.01

GABAPENTIN 400 MG CAPSULE

Facility

$145.70

Service Code	NDC 67877-224-01
Hospital Charge Code	18307
Hospital Revenue Code	637
Min. Negotiated Rate	$91.79
Max. Negotiated Rate	$131.13
Rate for Payer: Aetna Commercial	$123.84
Rate for Payer: Aetna New Business (MI Preferred)	$94.70
Rate for Payer: Cash Price	$116.56
Rate for Payer: Cofinity Commercial	$101.99
Rate for Payer: Cofinity Commercial	$125.30
Rate for Payer: Healthscope Commercial	$131.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$123.84
Rate for Payer: PHP Commercial	$123.84
Rate for Payer: Priority Health Cigna Priority Health	$101.99
Rate for Payer: Priority Health SBD	$91.79

GABAPENTIN 600 MG TABLET

Facility

$223.25

Service Code	NDC 0904-6823-61
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$140.65
Max. Negotiated Rate	$200.92
Rate for Payer: Aetna Commercial	$189.76
Rate for Payer: Aetna New Business (MI Preferred)	$145.11
Rate for Payer: Cash Price	$178.60
Rate for Payer: Cofinity Commercial	$156.28
Rate for Payer: Cofinity Commercial	$192.00
Rate for Payer: Healthscope Commercial	$200.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$189.76
Rate for Payer: PHP Commercial	$189.76
Rate for Payer: Priority Health Cigna Priority Health	$156.28
Rate for Payer: Priority Health SBD	$140.65

GABAPENTIN 600 MG TABLET

Facility

$3.20

Service Code	NDC 50268-351-11
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$2.02
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Commercial	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.72
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health Cigna Priority Health	$2.24
Rate for Payer: Priority Health SBD	$2.02

GABAPENTIN 600 MG TABLET

Facility

$3.43

Service Code	NDC 42292-024-01
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$3.09
Rate for Payer: Aetna Commercial	$2.92
Rate for Payer: Aetna New Business (MI Preferred)	$2.23
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$2.40
Rate for Payer: Cofinity Commercial	$2.95
Rate for Payer: Healthscope Commercial	$3.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.92
Rate for Payer: PHP Commercial	$2.92
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.16

GABAPENTIN 600 MG TABLET

Facility

$2,209.00

Service Code	NDC 68462-126-05
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$1,391.67
Max. Negotiated Rate	$1,988.10
Rate for Payer: Aetna Commercial	$1,877.65
Rate for Payer: Aetna New Business (MI Preferred)	$1,435.85
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Cofinity Commercial	$1,546.30
Rate for Payer: Cofinity Commercial	$1,899.74
Rate for Payer: Healthscope Commercial	$1,988.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,877.65
Rate for Payer: PHP Commercial	$1,877.65
Rate for Payer: Priority Health Cigna Priority Health	$1,546.30
Rate for Payer: Priority Health SBD	$1,391.67

GABAPENTIN 600 MG TABLET

Facility

$342.95

Service Code	NDC 42292-024-20
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$216.06
Max. Negotiated Rate	$308.66
Rate for Payer: Aetna Commercial	$291.51
Rate for Payer: Aetna New Business (MI Preferred)	$222.92
Rate for Payer: Cash Price	$274.36
Rate for Payer: Cofinity Commercial	$240.06
Rate for Payer: Cofinity Commercial	$294.94
Rate for Payer: Healthscope Commercial	$308.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$291.51
Rate for Payer: PHP Commercial	$291.51
Rate for Payer: Priority Health Cigna Priority Health	$240.06
Rate for Payer: Priority Health SBD	$216.06

GABAPENTIN 600 MG TABLET

Facility

$159.84

Service Code	NDC 50268-351-15
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$100.70
Max. Negotiated Rate	$143.86
Rate for Payer: Aetna Commercial	$135.86
Rate for Payer: Aetna New Business (MI Preferred)	$103.90
Rate for Payer: Cash Price	$127.87
Rate for Payer: Cofinity Commercial	$111.89
Rate for Payer: Cofinity Commercial	$137.46
Rate for Payer: Healthscope Commercial	$143.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$135.86
Rate for Payer: PHP Commercial	$135.86
Rate for Payer: Priority Health Cigna Priority Health	$111.89
Rate for Payer: Priority Health SBD	$100.70

GABAPENTIN 600 MG TABLET

Facility

$441.80

Service Code	NDC 68462-126-01
Hospital Charge Code	25855
Hospital Revenue Code	637
Min. Negotiated Rate	$278.33
Max. Negotiated Rate	$397.62
Rate for Payer: Aetna Commercial	$375.53
Rate for Payer: Aetna New Business (MI Preferred)	$287.17
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$309.26
Rate for Payer: Cofinity Commercial	$379.95
Rate for Payer: Healthscope Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$375.53
Rate for Payer: PHP Commercial	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$309.26
Rate for Payer: Priority Health SBD	$278.33

GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$28.50

Service Code	HCPCS A9585
Hospital Charge Code	152500
Hospital Revenue Code	636
Min. Negotiated Rate	$17.96
Max. Negotiated Rate	$25.65
Rate for Payer: Aetna Commercial	$24.22
Rate for Payer: Aetna New Business (MI Preferred)	$18.52
Rate for Payer: Cash Price	$22.80
Rate for Payer: Cofinity Commercial	$19.95
Rate for Payer: Cofinity Commercial	$24.51
Rate for Payer: Healthscope Commercial	$25.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.22
Rate for Payer: PHP Commercial	$24.22
Rate for Payer: Priority Health Cigna Priority Health	$19.95
Rate for Payer: Priority Health SBD	$17.96

GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) INTRAVENOUS SOLUTION

Facility

$21.37

Service Code	HCPCS A9585
Hospital Charge Code	152499
Hospital Revenue Code	636
Min. Negotiated Rate	$13.46
Max. Negotiated Rate	$19.23
Rate for Payer: Aetna Commercial	$18.16
Rate for Payer: Aetna New Business (MI Preferred)	$13.89
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cofinity Commercial	$14.96
Rate for Payer: Cofinity Commercial	$18.38
Rate for Payer: Healthscope Commercial	$19.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.16
Rate for Payer: PHP Commercial	$18.16
Rate for Payer: Priority Health Cigna Priority Health	$14.96
Rate for Payer: Priority Health SBD	$13.46

GADOPENTETATE DIMEGLUMINE 10 MMOL/20 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$77.62

Service Code	HCPCS A9579
Hospital Charge Code	118272
Hospital Revenue Code	636
Min. Negotiated Rate	$48.90
Max. Negotiated Rate	$69.86
Rate for Payer: Aetna Commercial	$65.98
Rate for Payer: Aetna New Business (MI Preferred)	$50.45
Rate for Payer: Cash Price	$62.10
Rate for Payer: Cofinity Commercial	$54.33
Rate for Payer: Cofinity Commercial	$66.75
Rate for Payer: Healthscope Commercial	$69.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.98
Rate for Payer: PHP Commercial	$65.98
Rate for Payer: Priority Health Cigna Priority Health	$54.33
Rate for Payer: Priority Health SBD	$48.90

GADOPENTETATE DIMEGLUMINE 2.5 MMOL/5 ML(469.01 MG/ML) INTRAVENOUS SOLN

Facility

$21.62

Service Code	HCPCS A9579
Hospital Charge Code	118269
Hospital Revenue Code	636
Min. Negotiated Rate	$13.62
Max. Negotiated Rate	$19.46
Rate for Payer: Aetna Commercial	$18.38
Rate for Payer: Aetna New Business (MI Preferred)	$14.05
Rate for Payer: Cash Price	$17.30
Rate for Payer: Cofinity Commercial	$15.13
Rate for Payer: Cofinity Commercial	$18.59
Rate for Payer: Healthscope Commercial	$19.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.38
Rate for Payer: PHP Commercial	$18.38
Rate for Payer: Priority Health Cigna Priority Health	$15.13
Rate for Payer: Priority Health SBD	$13.62

GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION

Facility

$631.68

Service Code	HCPCS A9581
Hospital Charge Code	93574
Hospital Revenue Code	636
Min. Negotiated Rate	$397.96
Max. Negotiated Rate	$568.51
Rate for Payer: Aetna Commercial	$536.93
Rate for Payer: Aetna New Business (MI Preferred)	$410.59
Rate for Payer: Cash Price	$505.34
Rate for Payer: Cofinity Commercial	$442.18
Rate for Payer: Cofinity Commercial	$543.24
Rate for Payer: Healthscope Commercial	$568.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$536.93
Rate for Payer: PHP Commercial	$536.93
Rate for Payer: Priority Health Cigna Priority Health	$442.18
Rate for Payer: Priority Health SBD	$397.96

GALANTAMINE 4 MG TABLET

Facility

$238.83

Service Code	NDC 70436-004-06
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$150.46
Max. Negotiated Rate	$214.95
Rate for Payer: Aetna Commercial	$203.01
Rate for Payer: Aetna New Business (MI Preferred)	$155.24
Rate for Payer: Cash Price	$191.06
Rate for Payer: Cofinity Commercial	$167.18
Rate for Payer: Cofinity Commercial	$205.39
Rate for Payer: Healthscope Commercial	$214.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$203.01
Rate for Payer: PHP Commercial	$203.01
Rate for Payer: Priority Health Cigna Priority Health	$167.18
Rate for Payer: Priority Health SBD	$150.46

GALANTAMINE 4 MG TABLET

Facility

$361.20

Service Code	NDC 68084-729-21
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$227.56
Max. Negotiated Rate	$325.08
Rate for Payer: Aetna Commercial	$307.02
Rate for Payer: Aetna New Business (MI Preferred)	$234.78
Rate for Payer: Cash Price	$288.96
Rate for Payer: Cofinity Commercial	$252.84
Rate for Payer: Cofinity Commercial	$310.63
Rate for Payer: Healthscope Commercial	$325.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$307.02
Rate for Payer: PHP Commercial	$307.02
Rate for Payer: Priority Health Cigna Priority Health	$252.84
Rate for Payer: Priority Health SBD	$227.56

GALANTAMINE 4 MG TABLET

Facility

$12.04

Service Code	NDC 68084-729-11
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$7.59
Max. Negotiated Rate	$10.84
Rate for Payer: Aetna Commercial	$10.23
Rate for Payer: Aetna New Business (MI Preferred)	$7.83
Rate for Payer: Cash Price	$9.63
Rate for Payer: Cofinity Commercial	$10.35
Rate for Payer: Cofinity Commercial	$8.43
Rate for Payer: Healthscope Commercial	$10.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.23
Rate for Payer: PHP Commercial	$10.23
Rate for Payer: Priority Health Cigna Priority Health	$8.43
Rate for Payer: Priority Health SBD	$7.59

GALANTAMINE 4 MG TABLET

Facility

$9.21

Service Code	NDC 51079-852-01
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$5.80
Max. Negotiated Rate	$8.29
Rate for Payer: Aetna Commercial	$7.83
Rate for Payer: Aetna New Business (MI Preferred)	$5.99
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cofinity Commercial	$6.45
Rate for Payer: Cofinity Commercial	$7.92
Rate for Payer: Healthscope Commercial	$8.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.83
Rate for Payer: PHP Commercial	$7.83
Rate for Payer: Priority Health Cigna Priority Health	$6.45
Rate for Payer: Priority Health SBD	$5.80

GALANTAMINE 4 MG TABLET

Facility

$276.06

Service Code	NDC 51079-852-03
Hospital Charge Code	29806
Hospital Revenue Code	637
Min. Negotiated Rate	$173.92
Max. Negotiated Rate	$248.45
Rate for Payer: Aetna Commercial	$234.65
Rate for Payer: Aetna New Business (MI Preferred)	$179.44
Rate for Payer: Cash Price	$220.85
Rate for Payer: Cofinity Commercial	$193.24
Rate for Payer: Cofinity Commercial	$237.41
Rate for Payer: Healthscope Commercial	$248.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$234.65
Rate for Payer: PHP Commercial	$234.65
Rate for Payer: Priority Health Cigna Priority Health	$193.24
Rate for Payer: Priority Health SBD	$173.92

GALANTAMINE ER 8 MG 24 HR CAPSULE,EXTENDED RELEASE

Facility

$126.87

Service Code	NDC 47335-835-83
Hospital Charge Code	41138
Hospital Revenue Code	637
Min. Negotiated Rate	$79.93
Max. Negotiated Rate	$114.18
Rate for Payer: Aetna Commercial	$107.84
Rate for Payer: Aetna New Business (MI Preferred)	$82.47
Rate for Payer: Cash Price	$101.50
Rate for Payer: Cofinity Commercial	$88.81
Rate for Payer: Cofinity Commercial	$109.11
Rate for Payer: Healthscope Commercial	$114.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$107.84
Rate for Payer: PHP Commercial	$107.84
Rate for Payer: Priority Health Cigna Priority Health	$88.81
Rate for Payer: Priority Health SBD	$79.93

GAMUNEX-C 10 GRAM/100 ML (10 %) INJECTION SOLUTION

Facility

$4,114.19

Service Code	HCPCS J1561
Hospital Charge Code	107780
Hospital Revenue Code	636
Min. Negotiated Rate	$2,591.94
Max. Negotiated Rate	$3,702.77
Rate for Payer: Aetna Commercial	$3,497.06
Rate for Payer: Aetna New Business (MI Preferred)	$2,674.22
Rate for Payer: Cash Price	$3,291.35
Rate for Payer: Cofinity Commercial	$2,879.93
Rate for Payer: Cofinity Commercial	$3,538.20
Rate for Payer: Healthscope Commercial	$3,702.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,497.06
Rate for Payer: PHP Commercial	$3,497.06
Rate for Payer: Priority Health Cigna Priority Health	$2,879.93
Rate for Payer: Priority Health SBD	$2,591.94

GANCICLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION

Facility

$199.73

Service Code	HCPCS J1570
Hospital Charge Code	10101
Hospital Revenue Code	636
Min. Negotiated Rate	$125.83
Max. Negotiated Rate	$179.76
Rate for Payer: Aetna Commercial	$169.77
Rate for Payer: Aetna New Business (MI Preferred)	$129.82
Rate for Payer: Cash Price	$159.78
Rate for Payer: Cofinity Commercial	$139.81
Rate for Payer: Cofinity Commercial	$171.77
Rate for Payer: Healthscope Commercial	$179.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.77
Rate for Payer: PHP Commercial	$169.77
Rate for Payer: Priority Health Cigna Priority Health	$139.81
Rate for Payer: Priority Health SBD	$125.83

GASTROINTESTINAL HEMORRHAGE WITH CC

Facility

$17,455.21

Service Code	MS-DRG 378
Min. Negotiated Rate	$7,198.96
Max. Negotiated Rate	$17,455.21
Rate for Payer: Aetna Medicare	$7,880.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,472.31
Rate for Payer: Amish Plain Church Group Commercial	$9,472.31
Rate for Payer: BCBS MAPPO	$7,577.85
Rate for Payer: BCBS Trust/PPO	$17,455.21
Rate for Payer: BCN Medicare Advantage	$7,577.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,577.85
Rate for Payer: Mclaren Medicare	$7,577.85
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,956.74
Rate for Payer: MI Amish Medical Board Commercial	$8,714.53
Rate for Payer: PACE Medicare	$7,198.96
Rate for Payer: PACE SWMI	$7,577.85
Rate for Payer: PHP Medicare Advantage	$7,577.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,117.45
Rate for Payer: Priority Health Medicare	$7,577.85
Rate for Payer: Priority Health Narrow Network	$11,293.96
Rate for Payer: Railroad Medicare Medicare	$7,577.85
Rate for Payer: UHC All Payor (Choice/PPO)	$15,006.89
Rate for Payer: UHC Core	$9,208.37
Rate for Payer: UHC Dual Complete DSNP	$7,577.85
Rate for Payer: UHC Exchange	$9,862.60
Rate for Payer: UHC Medicare Advantage	$7,805.19
Rate for Payer: VA VA	$7,577.85

GASTROINTESTINAL HEMORRHAGE WITH MCC

Facility

$27,309.24

Service Code	MS-DRG 377
Min. Negotiated Rate	$12,716.80
Max. Negotiated Rate	$27,309.24
Rate for Payer: Aetna Medicare	$13,921.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,732.62
Rate for Payer: Amish Plain Church Group Commercial	$16,732.62
Rate for Payer: BCBS MAPPO	$13,386.10
Rate for Payer: BCBS Trust/PPO	$26,634.07
Rate for Payer: BCN Medicare Advantage	$13,386.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,386.10
Rate for Payer: Mclaren Medicare	$13,386.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,055.40
Rate for Payer: MI Amish Medical Board Commercial	$15,394.02
Rate for Payer: PACE Medicare	$12,716.80
Rate for Payer: PACE SWMI	$13,386.10
Rate for Payer: PHP Medicare Advantage	$13,386.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25,690.66
Rate for Payer: Priority Health Medicare	$13,386.10
Rate for Payer: Priority Health Narrow Network	$20,552.53
Rate for Payer: Railroad Medicare Medicare	$13,386.10
Rate for Payer: UHC All Payor (Choice/PPO)	$27,309.24
Rate for Payer: UHC Core	$16,757.21
Rate for Payer: UHC Dual Complete DSNP	$13,386.10
Rate for Payer: UHC Exchange	$17,947.76
Rate for Payer: UHC Medicare Advantage	$13,787.68
Rate for Payer: VA VA	$13,386.10

GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC

Facility

$12,870.17

Service Code	MS-DRG 379
Min. Negotiated Rate	$4,800.26
Max. Negotiated Rate	$12,870.17
Rate for Payer: Aetna Medicare	$5,255.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,316.12
Rate for Payer: Amish Plain Church Group Commercial	$6,316.12
Rate for Payer: BCBS MAPPO	$5,052.90
Rate for Payer: BCBS Trust/PPO	$12,870.17
Rate for Payer: BCN Medicare Advantage	$5,052.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,052.90
Rate for Payer: Mclaren Medicare	$5,052.90
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,305.54
Rate for Payer: MI Amish Medical Board Commercial	$5,810.84
Rate for Payer: PACE Medicare	$4,800.26
Rate for Payer: PACE SWMI	$5,052.90
Rate for Payer: PHP Medicare Advantage	$5,052.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,086.37
Rate for Payer: Priority Health Medicare	$5,052.90
Rate for Payer: Priority Health Narrow Network	$7,269.10
Rate for Payer: Railroad Medicare Medicare	$5,052.90
Rate for Payer: UHC All Payor (Choice/PPO)	$9,658.83
Rate for Payer: UHC Core	$5,926.75
Rate for Payer: UHC Dual Complete DSNP	$5,052.90
Rate for Payer: UHC Exchange	$6,347.83
Rate for Payer: UHC Medicare Advantage	$5,204.49
Rate for Payer: VA VA	$5,052.90

Know your out-of-pocket cost for care.

All Charges