Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

WARFARIN 1 MG TABLET

Facility

$192.85

Service Code	NDC 51672402701
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$77.14
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna Medicare	$96.42
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: BCBS Complete	$77.14
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Commercial	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Cofinity Medicare Advantage	$135.00
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$125.35
Rate for Payer: Priority Health SBD	$121.50

WARFARIN 1 MG TABLET

Facility

$192.85

Service Code	NDC 51672402701
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Commercial	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Cofinity Medicare Advantage	$135.00
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$125.35
Rate for Payer: Priority Health SBD	$121.50

WARFARIN 1 MG TABLET

Facility

$3.72

Service Code	NDC 00832121189
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna Medicare	$1.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: BCBS Complete	$1.49
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

WARFARIN 1 MG TABLET

Facility

$371.30

Service Code	NDC 00832121101
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$233.92
Max. Negotiated Rate	$334.17
Rate for Payer: Aetna Commercial	$315.60
Rate for Payer: Aetna New Business (MI Preferred)	$241.34
Rate for Payer: Cash Price	$297.04
Rate for Payer: Cofinity Commercial	$259.91
Rate for Payer: Cofinity Commercial	$319.32
Rate for Payer: Cofinity Medicare Advantage	$259.91
Rate for Payer: Encore Health Key Benefits Commercial	$297.04
Rate for Payer: Healthscope Commercial	$334.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.60
Rate for Payer: PHP Commercial	$315.60
Rate for Payer: Priority Health Cigna Priority Health	$241.34
Rate for Payer: Priority Health SBD	$233.92

WARFARIN 1 MG TABLET

Facility

$371.30

Service Code	NDC 00832121101
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$148.52
Max. Negotiated Rate	$334.17
Rate for Payer: Aetna Commercial	$315.60
Rate for Payer: Aetna Medicare	$185.65
Rate for Payer: Aetna New Business (MI Preferred)	$241.34
Rate for Payer: BCBS Complete	$148.52
Rate for Payer: Cash Price	$297.04
Rate for Payer: Cofinity Commercial	$259.91
Rate for Payer: Cofinity Commercial	$319.32
Rate for Payer: Cofinity Medicare Advantage	$259.91
Rate for Payer: Encore Health Key Benefits Commercial	$297.04
Rate for Payer: Healthscope Commercial	$334.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.60
Rate for Payer: PHP Commercial	$315.60
Rate for Payer: Priority Health Cigna Priority Health	$241.34
Rate for Payer: Priority Health SBD	$233.92

WARFARIN 1 MG TABLET

Facility

$3.72

Service Code	NDC 00832121189
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$3.35
Rate for Payer: Aetna Commercial	$3.16
Rate for Payer: Aetna New Business (MI Preferred)	$2.42
Rate for Payer: Cash Price	$2.98
Rate for Payer: Cofinity Commercial	$2.60
Rate for Payer: Cofinity Commercial	$3.20
Rate for Payer: Cofinity Medicare Advantage	$2.60
Rate for Payer: Encore Health Key Benefits Commercial	$2.98
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.16
Rate for Payer: PHP Commercial	$3.16
Rate for Payer: Priority Health Cigna Priority Health	$2.42
Rate for Payer: Priority Health SBD	$2.34

WARFARIN 1 MG TABLET

Facility

$211.50

Service Code	NDC 00093171201
Hospital Charge Code	11664
Hospital Revenue Code	637
Min. Negotiated Rate	$133.24
Max. Negotiated Rate	$190.35
Rate for Payer: Aetna Commercial	$179.78
Rate for Payer: Aetna New Business (MI Preferred)	$137.48
Rate for Payer: Cash Price	$169.20
Rate for Payer: Cofinity Commercial	$148.05
Rate for Payer: Cofinity Commercial	$181.89
Rate for Payer: Cofinity Medicare Advantage	$148.05
Rate for Payer: Encore Health Key Benefits Commercial	$169.20
Rate for Payer: Healthscope Commercial	$190.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.78
Rate for Payer: PHP Commercial	$179.78
Rate for Payer: Priority Health Cigna Priority Health	$137.48
Rate for Payer: Priority Health SBD	$133.24

WARFARIN 2.5 MG TABLET

Facility

$218.50

Service Code	NDC 68084002701
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$142.02
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Commercial	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Cofinity Medicare Advantage	$152.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health Cigna Priority Health	$142.02
Rate for Payer: Priority Health SBD	$137.66

WARFARIN 2.5 MG TABLET

Facility

$368.95

Service Code	NDC 00832121301
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$232.44
Max. Negotiated Rate	$332.06
Rate for Payer: Aetna Commercial	$313.61
Rate for Payer: Aetna New Business (MI Preferred)	$239.82
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

WARFARIN 2.5 MG TABLET

Facility

$218.50

Service Code	NDC 68084002711
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$87.40
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna Medicare	$109.25
Rate for Payer: Aetna New Business (MI Preferred)	$142.02
Rate for Payer: BCBS Complete	$87.40
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Commercial	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Cofinity Medicare Advantage	$152.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health Cigna Priority Health	$142.02
Rate for Payer: Priority Health SBD	$137.66

WARFARIN 2.5 MG TABLET

Facility

$218.50

Service Code	NDC 68084002711
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$142.02
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Commercial	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Cofinity Medicare Advantage	$152.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health Cigna Priority Health	$142.02
Rate for Payer: Priority Health SBD	$137.66

WARFARIN 2.5 MG TABLET

Facility

$368.95

Service Code	NDC 00832121301
Hospital Charge Code	8750
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	$184.48
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

WARFARIN 2.5 MG TABLET

Facility

$3.69

Service Code	NDC 00832121389
Hospital Charge Code	8750
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

WARFARIN 2.5 MG TABLET

Facility

$3.69

Service Code	NDC 00832121389
Hospital Charge Code	8750
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

WARFARIN 2.5 MG TABLET

Facility

$218.50

Service Code	NDC 68084002701
Hospital Charge Code	8750
Hospital Revenue Code	637
Min. Negotiated Rate	$87.40
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna Medicare	$109.25
Rate for Payer: Aetna New Business (MI Preferred)	$142.02
Rate for Payer: BCBS Complete	$87.40
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Commercial	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Cofinity Medicare Advantage	$152.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health Cigna Priority Health	$142.02
Rate for Payer: Priority Health SBD	$137.66

WARFARIN 2 MG TABLET

Facility

$230.30

Service Code	NDC 00093171301
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$92.12
Max. Negotiated Rate	$207.27
Rate for Payer: Aetna Commercial	$195.76
Rate for Payer: Aetna Medicare	$115.15
Rate for Payer: Aetna New Business (MI Preferred)	$149.70
Rate for Payer: BCBS Complete	$92.12
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Commercial	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Cofinity Medicare Advantage	$161.21
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.76
Rate for Payer: PHP Commercial	$195.76
Rate for Payer: Priority Health Cigna Priority Health	$149.70
Rate for Payer: Priority Health SBD	$145.09

WARFARIN 2 MG TABLET

Facility

$230.30

Service Code	NDC 00093171301
Hospital Charge Code	8749
Hospital Revenue Code	637
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$207.27
Rate for Payer: Aetna Commercial	$195.76
Rate for Payer: Aetna New Business (MI Preferred)	$149.70
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Commercial	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Cofinity Medicare Advantage	$161.21
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.76
Rate for Payer: PHP Commercial	$195.76
Rate for Payer: Priority Health Cigna Priority Health	$149.70
Rate for Payer: Priority Health SBD	$145.09

WARFARIN 5 MG TABLET

Facility

$4.23

Service Code	NDC 00832121689
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna Medicare	$2.12
Rate for Payer: Aetna New Business (MI Preferred)	$2.75
Rate for Payer: BCBS Complete	$1.69
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cofinity Commercial	$2.96
Rate for Payer: Cofinity Commercial	$3.64
Rate for Payer: Cofinity Medicare Advantage	$2.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.38
Rate for Payer: Healthscope Commercial	$3.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.60
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health Cigna Priority Health	$2.75
Rate for Payer: Priority Health SBD	$2.66

WARFARIN 5 MG TABLET

Facility

$228.00

Service Code	NDC 62584099401
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$143.64
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna New Business (MI Preferred)	$148.20
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$159.60
Rate for Payer: Cofinity Commercial	$196.08
Rate for Payer: Cofinity Medicare Advantage	$159.60
Rate for Payer: Encore Health Key Benefits Commercial	$182.40
Rate for Payer: Healthscope Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.80
Rate for Payer: PHP Commercial	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$148.20
Rate for Payer: Priority Health SBD	$143.64

WARFARIN 5 MG TABLET

Facility

$2.28

Service Code	NDC 62584099411
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$2.05
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna New Business (MI Preferred)	$1.48
Rate for Payer: Cash Price	$1.82
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Cofinity Commercial	$1.96
Rate for Payer: Cofinity Medicare Advantage	$1.60
Rate for Payer: Encore Health Key Benefits Commercial	$1.82
Rate for Payer: Healthscope Commercial	$2.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.94
Rate for Payer: PHP Commercial	$1.94
Rate for Payer: Priority Health Cigna Priority Health	$1.48
Rate for Payer: Priority Health SBD	$1.44

WARFARIN 5 MG TABLET

Facility

$423.00

Service Code	NDC 00832121601
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$169.20
Max. Negotiated Rate	$380.70
Rate for Payer: Aetna Commercial	$359.55
Rate for Payer: Aetna Medicare	$211.50
Rate for Payer: Aetna New Business (MI Preferred)	$274.95
Rate for Payer: BCBS Complete	$169.20
Rate for Payer: Cash Price	$338.40
Rate for Payer: Cofinity Commercial	$296.10
Rate for Payer: Cofinity Commercial	$363.78
Rate for Payer: Cofinity Medicare Advantage	$296.10
Rate for Payer: Encore Health Key Benefits Commercial	$338.40
Rate for Payer: Healthscope Commercial	$380.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.55
Rate for Payer: PHP Commercial	$359.55
Rate for Payer: Priority Health Cigna Priority Health	$274.95
Rate for Payer: Priority Health SBD	$266.49

WARFARIN 5 MG TABLET

Facility

$4.23

Service Code	NDC 00832121689
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$3.81
Rate for Payer: Aetna Commercial	$3.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.75
Rate for Payer: Cash Price	$3.38
Rate for Payer: Cofinity Commercial	$2.96
Rate for Payer: Cofinity Commercial	$3.64
Rate for Payer: Cofinity Medicare Advantage	$2.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.38
Rate for Payer: Healthscope Commercial	$3.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.60
Rate for Payer: PHP Commercial	$3.60
Rate for Payer: Priority Health Cigna Priority Health	$2.75
Rate for Payer: Priority Health SBD	$2.66

WARFARIN 5 MG TABLET

Facility

$2.28

Service Code	NDC 62584099411
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.05
Rate for Payer: Aetna Commercial	$1.94
Rate for Payer: Aetna Medicare	$1.14
Rate for Payer: Aetna New Business (MI Preferred)	$1.48
Rate for Payer: BCBS Complete	$0.91
Rate for Payer: Cash Price	$1.82
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Cofinity Commercial	$1.96
Rate for Payer: Cofinity Medicare Advantage	$1.60
Rate for Payer: Encore Health Key Benefits Commercial	$1.82
Rate for Payer: Healthscope Commercial	$2.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.94
Rate for Payer: PHP Commercial	$1.94
Rate for Payer: Priority Health Cigna Priority Health	$1.48
Rate for Payer: Priority Health SBD	$1.44

WARFARIN 5 MG TABLET

Facility

$228.00

Service Code	NDC 62584099401
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$91.20
Max. Negotiated Rate	$205.20
Rate for Payer: Aetna Commercial	$193.80
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: Aetna New Business (MI Preferred)	$148.20
Rate for Payer: BCBS Complete	$91.20
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cofinity Commercial	$159.60
Rate for Payer: Cofinity Commercial	$196.08
Rate for Payer: Cofinity Medicare Advantage	$159.60
Rate for Payer: Encore Health Key Benefits Commercial	$182.40
Rate for Payer: Healthscope Commercial	$205.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.80
Rate for Payer: PHP Commercial	$193.80
Rate for Payer: Priority Health Cigna Priority Health	$148.20
Rate for Payer: Priority Health SBD	$143.64

WARFARIN 5 MG TABLET

Facility

$423.00

Service Code	NDC 00832121601
Hospital Charge Code	8751
Hospital Revenue Code	637
Min. Negotiated Rate	$266.49
Max. Negotiated Rate	$380.70
Rate for Payer: Aetna Commercial	$359.55
Rate for Payer: Aetna New Business (MI Preferred)	$274.95
Rate for Payer: Cash Price	$338.40
Rate for Payer: Cofinity Commercial	$296.10
Rate for Payer: Cofinity Commercial	$363.78
Rate for Payer: Cofinity Medicare Advantage	$296.10
Rate for Payer: Encore Health Key Benefits Commercial	$338.40
Rate for Payer: Healthscope Commercial	$380.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$359.55
Rate for Payer: PHP Commercial	$359.55
Rate for Payer: Priority Health Cigna Priority Health	$274.95
Rate for Payer: Priority Health SBD	$266.49

Know your out-of-pocket cost for care.

All Charges