Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR

Facility

$44.64

Service Code	NDC 00121482015
Hospital Charge Code	7820
Hospital Revenue Code	637
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.18
Rate for Payer: Aetna Commercial	$37.94
Rate for Payer: Aetna Medicare	$22.32
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: BCBS Complete	$17.86
Rate for Payer: Cash Price	$35.71
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.39
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.71
Rate for Payer: Healthscope Commercial	$40.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.94
Rate for Payer: PHP Commercial	$37.94
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.12

THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR

Facility

$44.64

Service Code	NDC 00121482015
Hospital Charge Code	7820
Hospital Revenue Code	637
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$40.18
Rate for Payer: Aetna Commercial	$37.94
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: Cash Price	$35.71
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.39
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.71
Rate for Payer: Healthscope Commercial	$40.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.94
Rate for Payer: PHP Commercial	$37.94
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.12

THEOPHYLLINE 80 MG/15 ML ORAL ELIXIR

Facility

$44.64

Service Code	NDC 00121482040
Hospital Charge Code	7820
Hospital Revenue Code	637
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.18
Rate for Payer: Aetna Commercial	$37.94
Rate for Payer: Aetna Medicare	$22.32
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: BCBS Complete	$17.86
Rate for Payer: Cash Price	$35.71
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.39
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.71
Rate for Payer: Healthscope Commercial	$40.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.94
Rate for Payer: PHP Commercial	$37.94
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.12

THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$578.88

Service Code	NDC 62332002531
Hospital Charge Code	12098
Hospital Revenue Code	637
Min. Negotiated Rate	$364.69
Max. Negotiated Rate	$520.99
Rate for Payer: Aetna Commercial	$492.05
Rate for Payer: Aetna New Business (MI Preferred)	$376.27
Rate for Payer: Cash Price	$463.10
Rate for Payer: Cofinity Commercial	$405.22
Rate for Payer: Cofinity Commercial	$497.84
Rate for Payer: Cofinity Medicare Advantage	$405.22
Rate for Payer: Encore Health Key Benefits Commercial	$463.10
Rate for Payer: Healthscope Commercial	$520.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$492.05
Rate for Payer: PHP Commercial	$492.05
Rate for Payer: Priority Health Cigna Priority Health	$376.27
Rate for Payer: Priority Health SBD	$364.69

THEOPHYLLINE ER 300 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$578.88

Service Code	NDC 62332002531
Hospital Charge Code	12098
Hospital Revenue Code	637
Min. Negotiated Rate	$231.55
Max. Negotiated Rate	$520.99
Rate for Payer: Aetna Commercial	$492.05
Rate for Payer: Aetna Medicare	$289.44
Rate for Payer: Aetna New Business (MI Preferred)	$376.27
Rate for Payer: BCBS Complete	$231.55
Rate for Payer: Cash Price	$463.10
Rate for Payer: Cofinity Commercial	$405.22
Rate for Payer: Cofinity Commercial	$497.84
Rate for Payer: Cofinity Medicare Advantage	$405.22
Rate for Payer: Encore Health Key Benefits Commercial	$463.10
Rate for Payer: Healthscope Commercial	$520.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$492.05
Rate for Payer: PHP Commercial	$492.05
Rate for Payer: Priority Health Cigna Priority Health	$376.27
Rate for Payer: Priority Health SBD	$364.69

THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$404.16

Service Code	NDC 68462038001
Hospital Charge Code	108325
Hospital Revenue Code	637
Min. Negotiated Rate	$254.62
Max. Negotiated Rate	$363.74
Rate for Payer: Aetna Commercial	$343.54
Rate for Payer: Aetna New Business (MI Preferred)	$262.70
Rate for Payer: Cash Price	$323.33
Rate for Payer: Cofinity Commercial	$282.91
Rate for Payer: Cofinity Commercial	$347.58
Rate for Payer: Cofinity Medicare Advantage	$282.91
Rate for Payer: Encore Health Key Benefits Commercial	$323.33
Rate for Payer: Healthscope Commercial	$363.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$343.54
Rate for Payer: PHP Commercial	$343.54
Rate for Payer: Priority Health Cigna Priority Health	$262.70
Rate for Payer: Priority Health SBD	$254.62

THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$404.16

Service Code	NDC 68462038001
Hospital Charge Code	108325
Hospital Revenue Code	637
Min. Negotiated Rate	$161.66
Max. Negotiated Rate	$363.74
Rate for Payer: Aetna Commercial	$343.54
Rate for Payer: Aetna Medicare	$202.08
Rate for Payer: Aetna New Business (MI Preferred)	$262.70
Rate for Payer: BCBS Complete	$161.66
Rate for Payer: Cash Price	$323.33
Rate for Payer: Cofinity Commercial	$282.91
Rate for Payer: Cofinity Commercial	$347.58
Rate for Payer: Cofinity Medicare Advantage	$282.91
Rate for Payer: Encore Health Key Benefits Commercial	$323.33
Rate for Payer: Healthscope Commercial	$363.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$343.54
Rate for Payer: PHP Commercial	$343.54
Rate for Payer: Priority Health Cigna Priority Health	$262.70
Rate for Payer: Priority Health SBD	$254.62

THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$463.68

Service Code	NDC 42858070101
Hospital Charge Code	108325
Hospital Revenue Code	637
Min. Negotiated Rate	$185.47
Max. Negotiated Rate	$417.31
Rate for Payer: Aetna Commercial	$394.13
Rate for Payer: Aetna Medicare	$231.84
Rate for Payer: Aetna New Business (MI Preferred)	$301.39
Rate for Payer: BCBS Complete	$185.47
Rate for Payer: Cash Price	$370.94
Rate for Payer: Cofinity Commercial	$324.58
Rate for Payer: Cofinity Commercial	$398.76
Rate for Payer: Cofinity Medicare Advantage	$324.58
Rate for Payer: Encore Health Key Benefits Commercial	$370.94
Rate for Payer: Healthscope Commercial	$417.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.13
Rate for Payer: PHP Commercial	$394.13
Rate for Payer: Priority Health Cigna Priority Health	$301.39
Rate for Payer: Priority Health SBD	$292.12

THEOPHYLLINE ER 400 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$463.68

Service Code	NDC 42858070101
Hospital Charge Code	108325
Hospital Revenue Code	637
Min. Negotiated Rate	$292.12
Max. Negotiated Rate	$417.31
Rate for Payer: Aetna Commercial	$394.13
Rate for Payer: Aetna New Business (MI Preferred)	$301.39
Rate for Payer: Cash Price	$370.94
Rate for Payer: Cofinity Commercial	$324.58
Rate for Payer: Cofinity Commercial	$398.76
Rate for Payer: Cofinity Medicare Advantage	$324.58
Rate for Payer: Encore Health Key Benefits Commercial	$370.94
Rate for Payer: Healthscope Commercial	$417.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.13
Rate for Payer: PHP Commercial	$394.13
Rate for Payer: Priority Health Cigna Priority Health	$301.39
Rate for Payer: Priority Health SBD	$292.12

THERMAGE

Professional

Both

$1,020.00

Service Code	HCPCS 00167
Hospital Revenue Code	960
Min. Negotiated Rate	$408.00
Max. Negotiated Rate	$663.00
Rate for Payer: Aetna Medicare	$510.00
Rate for Payer: BCBS Complete	$408.00
Rate for Payer: Cash Price	$816.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$663.00
Rate for Payer: Priority Health Cigna Priority Health	$663.00

THERMAGE ABDOMEN - ENTIRE

Professional

Both

$3,162.00

Service Code	HCPCS 00150
Hospital Revenue Code	960
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$2,055.30
Rate for Payer: Aetna Medicare	$1,581.00
Rate for Payer: BCBS Complete	$1,264.80
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,055.30
Rate for Payer: Priority Health Cigna Priority Health	$2,055.30

THERMAGE ABDOMEN - LOWER

Professional

Both

$2,040.00

Service Code	HCPCS 00149
Hospital Revenue Code	960
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.00
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00

THERMAGE ARMS - 1 ARM

Professional

Both

$1,224.00

Service Code	HCPCS 00145
Hospital Revenue Code	960
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$612.00
Rate for Payer: BCBS Complete	$489.60
Rate for Payer: Cash Price	$979.20
Rate for Payer: Cash Price	$979.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$795.60

THERMAGE ARMS - BILATERAL

Professional

Both

$2,142.00

Service Code	HCPCS 00146
Hospital Revenue Code	960
Min. Negotiated Rate	$856.80
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna Medicare	$1,071.00
Rate for Payer: BCBS Complete	$856.80
Rate for Payer: Cash Price	$1,713.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,392.30
Rate for Payer: Priority Health Cigna Priority Health	$1,392.30

THERMAGE EYES

Professional

Both

$969.00

Service Code	HCPCS 00140
Hospital Revenue Code	960
Min. Negotiated Rate	$387.60
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$484.50
Rate for Payer: BCBS Complete	$387.60
Rate for Payer: Cash Price	$775.20
Rate for Payer: Cash Price	$775.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$629.85

THERMAGE FACE

Professional

Both

$2,040.00

Service Code	HCPCS 00139
Hospital Revenue Code	960
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.00
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00

THERMAGE FACE & EYES

Professional

Both

$2,754.00

Service Code	HCPCS 00142
Hospital Revenue Code	960
Min. Negotiated Rate	$1,101.60
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$1,377.00
Rate for Payer: BCBS Complete	$1,101.60
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$1,790.10

THERMAGE FACE & NECK

Professional

Both

$2,856.00

Service Code	HCPCS 00143
Hospital Revenue Code	960
Min. Negotiated Rate	$1,142.40
Max. Negotiated Rate	$1,856.40
Rate for Payer: Aetna Medicare	$1,428.00
Rate for Payer: BCBS Complete	$1,142.40
Rate for Payer: Cash Price	$2,284.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,856.40
Rate for Payer: Priority Health Cigna Priority Health	$1,856.40

THERMAGE FACE, NECK, & EYES

Professional

Both

$3,570.00

Service Code	HCPCS 00144
Hospital Revenue Code	960
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$1,785.00
Rate for Payer: BCBS Complete	$1,428.00
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$2,320.50

THERMAGE KNEES - BILATERAL

Professional

Both

$1,224.00

Service Code	HCPCS 00151
Hospital Revenue Code	960
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$795.60
Rate for Payer: Aetna Medicare	$612.00
Rate for Payer: BCBS Complete	$489.60
Rate for Payer: Cash Price	$979.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$795.60
Rate for Payer: Priority Health Cigna Priority Health	$795.60

THERMAGE NECK

Professional

Both

$1,224.00

Service Code	HCPCS 00141
Hospital Revenue Code	960
Min. Negotiated Rate	$489.60
Max. Negotiated Rate	$795.60
Rate for Payer: Aetna Medicare	$612.00
Rate for Payer: BCBS Complete	$489.60
Rate for Payer: Cash Price	$979.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$795.60
Rate for Payer: Priority Health Cigna Priority Health	$795.60

THERMAGE THIGH - 1 THIGH

Professional

Both

$1,938.00

Service Code	HCPCS 00147
Hospital Revenue Code	960
Min. Negotiated Rate	$775.20
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$969.00
Rate for Payer: BCBS Complete	$775.20
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70

THERMAGE THIGH - BILATERAL

Professional

Both

$3,162.00

Service Code	HCPCS 00148
Hospital Revenue Code	960
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$1,581.00
Rate for Payer: BCBS Complete	$1,264.80
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$2,055.30

THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION

Facility

$27.53

Service Code	HCPCS J3411
Hospital Charge Code	7876
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$24.78
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Commercial	$23.05
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna New Business (MI Preferred)	$18.35
Rate for Payer: Aetna New Business (MI Preferred)	$16.82
Rate for Payer: Aetna New Business (MI Preferred)	$14.85
Rate for Payer: Aetna New Business (MI Preferred)	$17.63
Rate for Payer: Aetna New Business (MI Preferred)	$17.89
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$22.58
Rate for Payer: Cash Price	$18.27
Rate for Payer: Cash Price	$21.70
Rate for Payer: Cash Price	$22.02
Rate for Payer: Cofinity Commercial	$19.27
Rate for Payer: Cofinity Commercial	$15.99
Rate for Payer: Cofinity Commercial	$19.64
Rate for Payer: Cofinity Commercial	$18.12
Rate for Payer: Cofinity Commercial	$22.26
Rate for Payer: Cofinity Commercial	$18.98
Rate for Payer: Cofinity Commercial	$23.32
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Cofinity Commercial	$19.76
Rate for Payer: Cofinity Commercial	$23.68
Rate for Payer: Cofinity Medicare Advantage	$19.76
Rate for Payer: Cofinity Medicare Advantage	$19.27
Rate for Payer: Cofinity Medicare Advantage	$18.98
Rate for Payer: Cofinity Medicare Advantage	$18.12
Rate for Payer: Cofinity Medicare Advantage	$15.99
Rate for Payer: Encore Health Key Benefits Commercial	$22.58
Rate for Payer: Encore Health Key Benefits Commercial	$22.02
Rate for Payer: Encore Health Key Benefits Commercial	$18.27
Rate for Payer: Encore Health Key Benefits Commercial	$21.70
Rate for Payer: Encore Health Key Benefits Commercial	$20.70
Rate for Payer: Healthscope Commercial	$24.41
Rate for Payer: Healthscope Commercial	$23.29
Rate for Payer: Healthscope Commercial	$20.56
Rate for Payer: Healthscope Commercial	$24.78
Rate for Payer: Healthscope Commercial	$25.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.41
Rate for Payer: PHP Commercial	$19.41
Rate for Payer: PHP Commercial	$22.00
Rate for Payer: PHP Commercial	$23.40
Rate for Payer: PHP Commercial	$24.00
Rate for Payer: PHP Commercial	$23.05
Rate for Payer: Priority Health Cigna Priority Health	$14.85
Rate for Payer: Priority Health Cigna Priority Health	$18.35
Rate for Payer: Priority Health Cigna Priority Health	$17.89
Rate for Payer: Priority Health Cigna Priority Health	$16.82
Rate for Payer: Priority Health Cigna Priority Health	$17.63
Rate for Payer: Priority Health SBD	$17.09
Rate for Payer: Priority Health SBD	$17.34
Rate for Payer: Priority Health SBD	$17.78
Rate for Payer: Priority Health SBD	$14.39
Rate for Payer: Priority Health SBD	$16.30

THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION

Facility

$27.12

Service Code	HCPCS J3411
Hospital Charge Code	7876
Hospital Revenue Code	636
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$24.41
Rate for Payer: Aetna Commercial	$23.05
Rate for Payer: Aetna Commercial	$24.00
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Commercial	$23.40
Rate for Payer: Aetna Commercial	$22.00
Rate for Payer: Aetna Medicare	$13.76
Rate for Payer: Aetna Medicare	$13.56
Rate for Payer: Aetna Medicare	$11.42
Rate for Payer: Aetna Medicare	$12.94
Rate for Payer: Aetna Medicare	$14.12
Rate for Payer: Aetna New Business (MI Preferred)	$14.85
Rate for Payer: Aetna New Business (MI Preferred)	$16.82
Rate for Payer: Aetna New Business (MI Preferred)	$17.89
Rate for Payer: Aetna New Business (MI Preferred)	$18.35
Rate for Payer: Aetna New Business (MI Preferred)	$17.63
Rate for Payer: BCBS Complete	$9.14
Rate for Payer: BCBS Complete	$11.29
Rate for Payer: BCBS Complete	$10.85
Rate for Payer: BCBS Complete	$11.01
Rate for Payer: BCBS Complete	$10.35
Rate for Payer: BCBS Trust/PPO	$5.02
Rate for Payer: BCBS Trust/PPO	$5.02
Rate for Payer: BCBS Trust/PPO	$5.02
Rate for Payer: BCBS Trust/PPO	$5.02
Rate for Payer: BCBS Trust/PPO	$5.02
Rate for Payer: BCN Commercial	$5.02
Rate for Payer: BCN Commercial	$5.02
Rate for Payer: BCN Commercial	$5.02
Rate for Payer: BCN Commercial	$5.02
Rate for Payer: BCN Commercial	$5.02
Rate for Payer: Cash Price	$22.02
Rate for Payer: Cash Price	$18.27
Rate for Payer: Cash Price	$22.58
Rate for Payer: Cash Price	$21.70
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$22.58
Rate for Payer: Cash Price	$20.70
Rate for Payer: Cash Price	$21.70
Rate for Payer: Cash Price	$18.27
Rate for Payer: Cash Price	$22.02
Rate for Payer: Cofinity Commercial	$24.28
Rate for Payer: Cofinity Commercial	$19.76
Rate for Payer: Cofinity Commercial	$15.99
Rate for Payer: Cofinity Commercial	$19.64
Rate for Payer: Cofinity Commercial	$18.12
Rate for Payer: Cofinity Commercial	$22.26
Rate for Payer: Cofinity Commercial	$18.98
Rate for Payer: Cofinity Commercial	$23.32
Rate for Payer: Cofinity Commercial	$19.27
Rate for Payer: Cofinity Commercial	$23.68
Rate for Payer: Cofinity Medicare Advantage	$15.99
Rate for Payer: Cofinity Medicare Advantage	$18.98
Rate for Payer: Cofinity Medicare Advantage	$19.27
Rate for Payer: Cofinity Medicare Advantage	$18.12
Rate for Payer: Cofinity Medicare Advantage	$19.76
Rate for Payer: Encore Health Key Benefits Commercial	$21.70
Rate for Payer: Encore Health Key Benefits Commercial	$20.70
Rate for Payer: Encore Health Key Benefits Commercial	$22.58
Rate for Payer: Encore Health Key Benefits Commercial	$18.27
Rate for Payer: Encore Health Key Benefits Commercial	$22.02
Rate for Payer: Healthscope Commercial	$24.41
Rate for Payer: Healthscope Commercial	$25.41
Rate for Payer: Healthscope Commercial	$23.29
Rate for Payer: Healthscope Commercial	$24.78
Rate for Payer: Healthscope Commercial	$20.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: PHP Commercial	$24.00
Rate for Payer: PHP Commercial	$19.41
Rate for Payer: PHP Commercial	$23.05
Rate for Payer: PHP Commercial	$22.00
Rate for Payer: PHP Commercial	$23.40
Rate for Payer: Priority Health Cigna Priority Health	$16.82
Rate for Payer: Priority Health Cigna Priority Health	$17.63
Rate for Payer: Priority Health Cigna Priority Health	$17.89
Rate for Payer: Priority Health Cigna Priority Health	$18.35
Rate for Payer: Priority Health Cigna Priority Health	$14.85
Rate for Payer: Priority Health SBD	$16.30
Rate for Payer: Priority Health SBD	$17.09
Rate for Payer: Priority Health SBD	$14.39
Rate for Payer: Priority Health SBD	$17.78
Rate for Payer: Priority Health SBD	$17.34

Know your out-of-pocket cost for care.

All Charges