Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TRAZODONE 100 MG TABLET

Facility

$3.69

Service Code	NDC 60687045411
Hospital Charge Code	8083
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.95
Rate for Payer: Healthscope Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.32

TRAZODONE 100 MG TABLET

Facility

$368.95

Service Code	NDC 60687045401
Hospital Charge Code	8083
Hospital Revenue Code	637
Min. Negotiated Rate	$147.58
Max. Negotiated Rate	$332.06
Rate for Payer: Aetna Commercial	$313.61
Rate for Payer: Aetna Medicare	$184.47
Rate for Payer: Aetna New Business (MI Preferred)	$239.82
Rate for Payer: BCBS Complete	$147.58
Rate for Payer: Cash Price	$295.16
Rate for Payer: Cofinity Commercial	$258.26
Rate for Payer: Cofinity Commercial	$317.30
Rate for Payer: Cofinity Medicare Advantage	$258.26
Rate for Payer: Encore Health Key Benefits Commercial	$295.16
Rate for Payer: Healthscope Commercial	$332.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$313.61
Rate for Payer: PHP Commercial	$313.61
Rate for Payer: Priority Health Cigna Priority Health	$239.82
Rate for Payer: Priority Health SBD	$232.44

TRAZODONE 100 MG TABLET

Facility

$3.69

Service Code	NDC 60687045411
Hospital Charge Code	8083
Hospital Revenue Code	637
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna Medicare	$1.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: BCBS Complete	$1.48
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.95
Rate for Payer: Healthscope Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.32

TRAZODONE 100 MG TABLET

Facility

$338.40

Service Code	NDC 00904686961
Hospital Charge Code	8083
Hospital Revenue Code	637
Min. Negotiated Rate	$135.36
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Cofinity Medicare Advantage	$236.88
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health SBD	$213.19

TRAZODONE 100 MG TABLET

Facility

$338.40

Service Code	NDC 00904686961
Hospital Charge Code	8083
Hospital Revenue Code	637
Min. Negotiated Rate	$213.19
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Cofinity Medicare Advantage	$236.88
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health SBD	$213.19

TRAZODONE 150 MG TABLET

Facility

$4.42

Service Code	NDC 60687043211
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.77
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.76
Rate for Payer: Aetna Medicare	$2.21
Rate for Payer: Aetna New Business (MI Preferred)	$2.87
Rate for Payer: BCBS Complete	$1.77
Rate for Payer: Cash Price	$3.54
Rate for Payer: Cofinity Commercial	$3.09
Rate for Payer: Cofinity Commercial	$3.80
Rate for Payer: Cofinity Medicare Advantage	$3.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.54
Rate for Payer: Healthscope Commercial	$3.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.76
Rate for Payer: PHP Commercial	$3.76
Rate for Payer: Priority Health Cigna Priority Health	$2.87
Rate for Payer: Priority Health SBD	$2.78

TRAZODONE 150 MG TABLET

Facility

$357.20

Service Code	NDC 50111045001
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$225.04
Max. Negotiated Rate	$321.48
Rate for Payer: Aetna Commercial	$303.62
Rate for Payer: Aetna New Business (MI Preferred)	$232.18
Rate for Payer: Cash Price	$285.76
Rate for Payer: Cofinity Commercial	$250.04
Rate for Payer: Cofinity Commercial	$307.19
Rate for Payer: Cofinity Medicare Advantage	$250.04
Rate for Payer: Encore Health Key Benefits Commercial	$285.76
Rate for Payer: Healthscope Commercial	$321.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.62
Rate for Payer: PHP Commercial	$303.62
Rate for Payer: Priority Health Cigna Priority Health	$232.18
Rate for Payer: Priority Health SBD	$225.04

TRAZODONE 150 MG TABLET

Facility

$441.75

Service Code	NDC 60687043201
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$278.30
Max. Negotiated Rate	$397.57
Rate for Payer: Aetna Commercial	$375.49
Rate for Payer: Aetna New Business (MI Preferred)	$287.14
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cofinity Commercial	$309.23
Rate for Payer: Cofinity Commercial	$379.90
Rate for Payer: Cofinity Medicare Advantage	$309.23
Rate for Payer: Encore Health Key Benefits Commercial	$353.40
Rate for Payer: Healthscope Commercial	$397.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.49
Rate for Payer: PHP Commercial	$375.49
Rate for Payer: Priority Health Cigna Priority Health	$287.14
Rate for Payer: Priority Health SBD	$278.30

TRAZODONE 150 MG TABLET

Facility

$4.42

Service Code	NDC 60687043211
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$3.98
Rate for Payer: Aetna Commercial	$3.76
Rate for Payer: Aetna New Business (MI Preferred)	$2.87
Rate for Payer: Cash Price	$3.54
Rate for Payer: Cofinity Commercial	$3.09
Rate for Payer: Cofinity Commercial	$3.80
Rate for Payer: Cofinity Medicare Advantage	$3.09
Rate for Payer: Encore Health Key Benefits Commercial	$3.54
Rate for Payer: Healthscope Commercial	$3.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.76
Rate for Payer: PHP Commercial	$3.76
Rate for Payer: Priority Health Cigna Priority Health	$2.87
Rate for Payer: Priority Health SBD	$2.78

TRAZODONE 150 MG TABLET

Facility

$3.55

Service Code	NDC 68084060811
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Cofinity Medicare Advantage	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.84
Rate for Payer: Healthscope Commercial	$3.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.02
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health Cigna Priority Health	$2.31
Rate for Payer: Priority Health SBD	$2.24

TRAZODONE 150 MG TABLET

Facility

$354.35

Service Code	NDC 68084060801
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$141.74
Max. Negotiated Rate	$318.92
Rate for Payer: Aetna Commercial	$301.20
Rate for Payer: Aetna Medicare	$177.18
Rate for Payer: Aetna New Business (MI Preferred)	$230.33
Rate for Payer: BCBS Complete	$141.74
Rate for Payer: Cash Price	$283.48
Rate for Payer: Cofinity Commercial	$248.04
Rate for Payer: Cofinity Commercial	$304.74
Rate for Payer: Cofinity Medicare Advantage	$248.04
Rate for Payer: Encore Health Key Benefits Commercial	$283.48
Rate for Payer: Healthscope Commercial	$318.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.20
Rate for Payer: PHP Commercial	$301.20
Rate for Payer: Priority Health Cigna Priority Health	$230.33
Rate for Payer: Priority Health SBD	$223.24

TRAZODONE 150 MG TABLET

Facility

$3.55

Service Code	NDC 68084060811
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.42
Max. Negotiated Rate	$3.19
Rate for Payer: Aetna Commercial	$3.02
Rate for Payer: Aetna Medicare	$1.77
Rate for Payer: Aetna New Business (MI Preferred)	$2.31
Rate for Payer: BCBS Complete	$1.42
Rate for Payer: Cash Price	$2.84
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Cofinity Commercial	$3.05
Rate for Payer: Cofinity Medicare Advantage	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.84
Rate for Payer: Healthscope Commercial	$3.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.02
Rate for Payer: PHP Commercial	$3.02
Rate for Payer: Priority Health Cigna Priority Health	$2.31
Rate for Payer: Priority Health SBD	$2.24

TRAZODONE 150 MG TABLET

Facility

$357.20

Service Code	NDC 50111045001
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$142.88
Max. Negotiated Rate	$321.48
Rate for Payer: Aetna Commercial	$303.62
Rate for Payer: Aetna Medicare	$178.60
Rate for Payer: Aetna New Business (MI Preferred)	$232.18
Rate for Payer: BCBS Complete	$142.88
Rate for Payer: Cash Price	$285.76
Rate for Payer: Cofinity Commercial	$250.04
Rate for Payer: Cofinity Commercial	$307.19
Rate for Payer: Cofinity Medicare Advantage	$250.04
Rate for Payer: Encore Health Key Benefits Commercial	$285.76
Rate for Payer: Healthscope Commercial	$321.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.62
Rate for Payer: PHP Commercial	$303.62
Rate for Payer: Priority Health Cigna Priority Health	$232.18
Rate for Payer: Priority Health SBD	$225.04

TRAZODONE 150 MG TABLET

Facility

$441.75

Service Code	NDC 60687043201
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$176.70
Max. Negotiated Rate	$397.57
Rate for Payer: Aetna Commercial	$375.49
Rate for Payer: Aetna Medicare	$220.88
Rate for Payer: Aetna New Business (MI Preferred)	$287.14
Rate for Payer: BCBS Complete	$176.70
Rate for Payer: Cash Price	$353.40
Rate for Payer: Cofinity Commercial	$309.23
Rate for Payer: Cofinity Commercial	$379.90
Rate for Payer: Cofinity Medicare Advantage	$309.23
Rate for Payer: Encore Health Key Benefits Commercial	$353.40
Rate for Payer: Healthscope Commercial	$397.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.49
Rate for Payer: PHP Commercial	$375.49
Rate for Payer: Priority Health Cigna Priority Health	$287.14
Rate for Payer: Priority Health SBD	$278.30

TRAZODONE 150 MG TABLET

Facility

$354.35

Service Code	NDC 68084060801
Hospital Charge Code	8084
Hospital Revenue Code	637
Min. Negotiated Rate	$223.24
Max. Negotiated Rate	$318.92
Rate for Payer: Aetna Commercial	$301.20
Rate for Payer: Aetna New Business (MI Preferred)	$230.33
Rate for Payer: Cash Price	$283.48
Rate for Payer: Cofinity Commercial	$248.04
Rate for Payer: Cofinity Commercial	$304.74
Rate for Payer: Cofinity Medicare Advantage	$248.04
Rate for Payer: Encore Health Key Benefits Commercial	$283.48
Rate for Payer: Healthscope Commercial	$318.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.20
Rate for Payer: PHP Commercial	$301.20
Rate for Payer: Priority Health Cigna Priority Health	$230.33
Rate for Payer: Priority Health SBD	$223.24

TRAZODONE 50 MG TABLET

Facility

$244.40

Service Code	NDC 00904686861
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$97.76
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna Medicare	$122.20
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: BCBS Complete	$97.76
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Cofinity Medicare Advantage	$171.08
Rate for Payer: Encore Health Key Benefits Commercial	$195.52
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.74
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health Cigna Priority Health	$158.86
Rate for Payer: Priority Health SBD	$153.97

TRAZODONE 50 MG TABLET

Facility

$244.40

Service Code	NDC 00904686861
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Cofinity Medicare Advantage	$171.08
Rate for Payer: Encore Health Key Benefits Commercial	$195.52
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$207.74
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health Cigna Priority Health	$158.86
Rate for Payer: Priority Health SBD	$153.97

TRAZODONE 50 MG TABLET

Facility

$2.71

Service Code	NDC 60687044311
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.44
Rate for Payer: Aetna Commercial	$2.30
Rate for Payer: Aetna Medicare	$1.35
Rate for Payer: Aetna New Business (MI Preferred)	$1.76
Rate for Payer: BCBS Complete	$1.08
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$1.90
Rate for Payer: Cofinity Commercial	$2.33
Rate for Payer: Cofinity Medicare Advantage	$1.90
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.30
Rate for Payer: PHP Commercial	$2.30
Rate for Payer: Priority Health Cigna Priority Health	$1.76
Rate for Payer: Priority Health SBD	$1.71

TRAZODONE 50 MG TABLET

Facility

$270.25

Service Code	NDC 60687044301
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$108.10
Max. Negotiated Rate	$243.22
Rate for Payer: Aetna Commercial	$229.71
Rate for Payer: Aetna Medicare	$135.12
Rate for Payer: Aetna New Business (MI Preferred)	$175.66
Rate for Payer: BCBS Complete	$108.10
Rate for Payer: Cash Price	$216.20
Rate for Payer: Cofinity Commercial	$189.18
Rate for Payer: Cofinity Commercial	$232.41
Rate for Payer: Cofinity Medicare Advantage	$189.18
Rate for Payer: Encore Health Key Benefits Commercial	$216.20
Rate for Payer: Healthscope Commercial	$243.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.71
Rate for Payer: PHP Commercial	$229.71
Rate for Payer: Priority Health Cigna Priority Health	$175.66
Rate for Payer: Priority Health SBD	$170.26

TRAZODONE 50 MG TABLET

Facility

$2.71

Service Code	NDC 60687044311
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$2.44
Rate for Payer: Aetna Commercial	$2.30
Rate for Payer: Aetna New Business (MI Preferred)	$1.76
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$1.90
Rate for Payer: Cofinity Commercial	$2.33
Rate for Payer: Cofinity Medicare Advantage	$1.90
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.30
Rate for Payer: PHP Commercial	$2.30
Rate for Payer: Priority Health Cigna Priority Health	$1.76
Rate for Payer: Priority Health SBD	$1.71

TRAZODONE 50 MG TABLET

Facility

$270.25

Service Code	NDC 60687044301
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$170.26
Max. Negotiated Rate	$243.22
Rate for Payer: Aetna Commercial	$229.71
Rate for Payer: Aetna New Business (MI Preferred)	$175.66
Rate for Payer: Cash Price	$216.20
Rate for Payer: Cofinity Commercial	$189.18
Rate for Payer: Cofinity Commercial	$232.41
Rate for Payer: Cofinity Medicare Advantage	$189.18
Rate for Payer: Encore Health Key Benefits Commercial	$216.20
Rate for Payer: Healthscope Commercial	$243.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.71
Rate for Payer: PHP Commercial	$229.71
Rate for Payer: Priority Health Cigna Priority Health	$175.66
Rate for Payer: Priority Health SBD	$170.26

TRAZODONE 50 MG TABLET

Facility

$145.70

Service Code	NDC 60505265301
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$131.13
Rate for Payer: Aetna Commercial	$123.84
Rate for Payer: Aetna Medicare	$72.85
Rate for Payer: Aetna New Business (MI Preferred)	$94.70
Rate for Payer: BCBS Complete	$58.28
Rate for Payer: Cash Price	$116.56
Rate for Payer: Cofinity Commercial	$101.99
Rate for Payer: Cofinity Commercial	$125.30
Rate for Payer: Cofinity Medicare Advantage	$101.99
Rate for Payer: Encore Health Key Benefits Commercial	$116.56
Rate for Payer: Healthscope Commercial	$131.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.84
Rate for Payer: PHP Commercial	$123.84
Rate for Payer: Priority Health Cigna Priority Health	$94.70
Rate for Payer: Priority Health SBD	$91.79

TRAZODONE 50 MG TABLET

Facility

$108.10

Service Code	NDC 68382080501
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health Cigna Priority Health	$70.27
Rate for Payer: Priority Health SBD	$68.10

TRAZODONE 50 MG TABLET

Facility

$108.10

Service Code	NDC 68382080501
Hospital Charge Code	8085
Hospital Revenue Code	637
Min. Negotiated Rate	$43.24
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.89
Rate for Payer: Aetna Medicare	$54.05
Rate for Payer: Aetna New Business (MI Preferred)	$70.27
Rate for Payer: BCBS Complete	$43.24
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Cofinity Medicare Advantage	$75.67
Rate for Payer: Encore Health Key Benefits Commercial	$86.48
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.89
Rate for Payer: PHP Commercial	$91.89
Rate for Payer: Priority Health Cigna Priority Health	$70.27
Rate for Payer: Priority Health SBD	$68.10

TRAZODONE 50 MG TABLET

Facility

$145.70

Service Code	NDC 60505265301
Hospital Charge Code	8085
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: Cofinity Medicare Advantage	$101.99
Rate for Payer: Encore Health Key Benefits Commercial	$116.56
Rate for Payer: Healthscope Commercial	$131.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.84
Rate for Payer: PHP Commercial	$123.84
Rate for Payer: Priority Health Cigna Priority Health	$94.70
Rate for Payer: Priority Health SBD	$91.79

Know your out-of-pocket cost for care.

All Charges