Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

EZETIMIBE 10 MG TABLET

Facility

$81.80

Service Code	NDC 67877049030
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$51.53
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$69.53
Rate for Payer: Aetna New Business (MI Preferred)	$53.17
Rate for Payer: Cash Price	$65.44
Rate for Payer: Cofinity Commercial	$57.26
Rate for Payer: Cofinity Commercial	$70.35
Rate for Payer: Cofinity Medicare Advantage	$57.26
Rate for Payer: Encore Health Key Benefits Commercial	$65.44
Rate for Payer: Healthscope Commercial	$73.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.53
Rate for Payer: PHP Commercial	$69.53
Rate for Payer: Priority Health Cigna Priority Health	$53.17
Rate for Payer: Priority Health SBD	$51.53

EZETIMIBE 10 MG TABLET

Facility

$76.95

Service Code	NDC 00781569031
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$48.48
Max. Negotiated Rate	$69.26
Rate for Payer: Aetna Commercial	$65.41
Rate for Payer: Aetna New Business (MI Preferred)	$50.02
Rate for Payer: Cash Price	$61.56
Rate for Payer: Cofinity Commercial	$53.86
Rate for Payer: Cofinity Commercial	$66.18
Rate for Payer: Cofinity Medicare Advantage	$53.86
Rate for Payer: Encore Health Key Benefits Commercial	$61.56
Rate for Payer: Healthscope Commercial	$69.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.41
Rate for Payer: PHP Commercial	$65.41
Rate for Payer: Priority Health Cigna Priority Health	$50.02
Rate for Payer: Priority Health SBD	$48.48

EZETIMIBE 10 MG TABLET

Facility

$76.95

Service Code	NDC 00781569031
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$30.78
Max. Negotiated Rate	$69.26
Rate for Payer: Aetna Commercial	$65.41
Rate for Payer: Aetna Medicare	$38.48
Rate for Payer: Aetna New Business (MI Preferred)	$50.02
Rate for Payer: BCBS Complete	$30.78
Rate for Payer: Cash Price	$61.56
Rate for Payer: Cofinity Commercial	$53.86
Rate for Payer: Cofinity Commercial	$66.18
Rate for Payer: Cofinity Medicare Advantage	$53.86
Rate for Payer: Encore Health Key Benefits Commercial	$61.56
Rate for Payer: Healthscope Commercial	$69.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.41
Rate for Payer: PHP Commercial	$65.41
Rate for Payer: Priority Health Cigna Priority Health	$50.02
Rate for Payer: Priority Health SBD	$48.48

EZETIMIBE 10 MG TABLET

Facility

$22.29

Service Code	NDC 60687037311
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$20.06
Rate for Payer: Aetna Commercial	$18.95
Rate for Payer: Aetna New Business (MI Preferred)	$14.49
Rate for Payer: Cash Price	$17.83
Rate for Payer: Cofinity Commercial	$15.60
Rate for Payer: Cofinity Commercial	$19.17
Rate for Payer: Cofinity Medicare Advantage	$15.60
Rate for Payer: Encore Health Key Benefits Commercial	$17.83
Rate for Payer: Healthscope Commercial	$20.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.95
Rate for Payer: PHP Commercial	$18.95
Rate for Payer: Priority Health Cigna Priority Health	$14.49
Rate for Payer: Priority Health SBD	$14.04

FACIAL

Professional

Both

$66.00

Service Code	HCPCS 00174
Hospital Revenue Code	960
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,000.00
Rate for Payer: Priority Health Cigna Priority Health	$42.90

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$93.00

Service Code	NDC 00641602110
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$37.40

Service Code	NDC 63323073809
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$14.96
Max. Negotiated Rate	$33.66
Rate for Payer: Aetna Commercial	$31.79
Rate for Payer: Aetna Medicare	$18.70
Rate for Payer: Aetna New Business (MI Preferred)	$24.31
Rate for Payer: BCBS Complete	$14.96
Rate for Payer: Cash Price	$29.92
Rate for Payer: Cofinity Commercial	$26.18
Rate for Payer: Cofinity Commercial	$32.16
Rate for Payer: Cofinity Medicare Advantage	$26.18
Rate for Payer: Encore Health Key Benefits Commercial	$29.92
Rate for Payer: Healthscope Commercial	$33.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.79
Rate for Payer: PHP Commercial	$31.79
Rate for Payer: Priority Health Cigna Priority Health	$24.31
Rate for Payer: Priority Health SBD	$23.56

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$93.00

Service Code	NDC 00641602101
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$204.50

Service Code	NDC 67457045700
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$81.80
Max. Negotiated Rate	$184.05
Rate for Payer: Aetna Commercial	$173.82
Rate for Payer: Aetna Medicare	$102.25
Rate for Payer: Aetna New Business (MI Preferred)	$132.92
Rate for Payer: BCBS Complete	$81.80
Rate for Payer: Cash Price	$163.60
Rate for Payer: Cofinity Commercial	$143.15
Rate for Payer: Cofinity Commercial	$175.87
Rate for Payer: Cofinity Medicare Advantage	$143.15
Rate for Payer: Encore Health Key Benefits Commercial	$163.60
Rate for Payer: Healthscope Commercial	$184.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.82
Rate for Payer: PHP Commercial	$173.82
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: Priority Health SBD	$128.84

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$204.50

Service Code	NDC 67457045720
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$128.84
Max. Negotiated Rate	$184.05
Rate for Payer: Aetna Commercial	$173.82
Rate for Payer: Aetna New Business (MI Preferred)	$132.92
Rate for Payer: Cash Price	$163.60
Rate for Payer: Cofinity Commercial	$143.15
Rate for Payer: Cofinity Commercial	$175.87
Rate for Payer: Cofinity Medicare Advantage	$143.15
Rate for Payer: Encore Health Key Benefits Commercial	$163.60
Rate for Payer: Healthscope Commercial	$184.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.82
Rate for Payer: PHP Commercial	$173.82
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: Priority Health SBD	$128.84

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$204.50

Service Code	NDC 67457045720
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$81.80
Max. Negotiated Rate	$184.05
Rate for Payer: Aetna Commercial	$173.82
Rate for Payer: Aetna Medicare	$102.25
Rate for Payer: Aetna New Business (MI Preferred)	$132.92
Rate for Payer: BCBS Complete	$81.80
Rate for Payer: Cash Price	$163.60
Rate for Payer: Cofinity Commercial	$143.15
Rate for Payer: Cofinity Commercial	$175.87
Rate for Payer: Cofinity Medicare Advantage	$143.15
Rate for Payer: Encore Health Key Benefits Commercial	$163.60
Rate for Payer: Healthscope Commercial	$184.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.82
Rate for Payer: PHP Commercial	$173.82
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: Priority Health SBD	$128.84

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$204.50

Service Code	NDC 67457045700
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$128.84
Max. Negotiated Rate	$184.05
Rate for Payer: Aetna Commercial	$173.82
Rate for Payer: Aetna New Business (MI Preferred)	$132.92
Rate for Payer: Cash Price	$163.60
Rate for Payer: Cofinity Commercial	$143.15
Rate for Payer: Cofinity Commercial	$175.87
Rate for Payer: Cofinity Medicare Advantage	$143.15
Rate for Payer: Encore Health Key Benefits Commercial	$163.60
Rate for Payer: Healthscope Commercial	$184.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.82
Rate for Payer: PHP Commercial	$173.82
Rate for Payer: Priority Health Cigna Priority Health	$132.92
Rate for Payer: Priority Health SBD	$128.84

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$93.00

Service Code	NDC 00641602110
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$93.00

Service Code	NDC 00641602101
Hospital Charge Code	10009
Hospital Revenue Code	250
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 10 MG/ML IV (CODE)

Facility

$93.00

Service Code	NDC 00641602101
Hospital Charge Code	163732
Hospital Revenue Code	250
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 10 MG/ML IV (CODE)

Facility

$93.00

Service Code	NDC 00641602101
Hospital Charge Code	163732
Hospital Revenue Code	250
Min. Negotiated Rate	$37.20
Max. Negotiated Rate	$83.70
Rate for Payer: Aetna Commercial	$79.05
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: Aetna New Business (MI Preferred)	$60.45
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cofinity Commercial	$65.10
Rate for Payer: Cofinity Commercial	$79.98
Rate for Payer: Cofinity Medicare Advantage	$65.10
Rate for Payer: Encore Health Key Benefits Commercial	$74.40
Rate for Payer: Healthscope Commercial	$83.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.05
Rate for Payer: PHP Commercial	$79.05
Rate for Payer: Priority Health Cigna Priority Health	$60.45
Rate for Payer: Priority Health SBD	$58.59

FAMOTIDINE 20 MG TABLET

Facility

$1.49

Service Code	NDC 51079096601
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.34
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare	$0.75
Rate for Payer: Aetna New Business (MI Preferred)	$0.97
Rate for Payer: BCBS Complete	$0.60
Rate for Payer: Cash Price	$1.19
Rate for Payer: Cofinity Commercial	$1.04
Rate for Payer: Cofinity Commercial	$1.28
Rate for Payer: Cofinity Medicare Advantage	$1.04
Rate for Payer: Encore Health Key Benefits Commercial	$1.19
Rate for Payer: Healthscope Commercial	$1.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.27
Rate for Payer: PHP Commercial	$1.27
Rate for Payer: Priority Health Cigna Priority Health	$0.97
Rate for Payer: Priority Health SBD	$0.94

FAMOTIDINE 20 MG TABLET

Facility

$265.55

Service Code	NDC 72606050902
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Commercial	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Cofinity Medicare Advantage	$185.88
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health Cigna Priority Health	$172.61
Rate for Payer: Priority Health SBD	$167.30

FAMOTIDINE 20 MG TABLET

Facility

$99.88

Service Code	NDC 00904578017
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$62.92
Max. Negotiated Rate	$89.89
Rate for Payer: Aetna Commercial	$84.90
Rate for Payer: Aetna New Business (MI Preferred)	$64.92
Rate for Payer: Cash Price	$79.90
Rate for Payer: Cofinity Commercial	$69.92
Rate for Payer: Cofinity Commercial	$85.90
Rate for Payer: Cofinity Medicare Advantage	$69.92
Rate for Payer: Encore Health Key Benefits Commercial	$79.90
Rate for Payer: Healthscope Commercial	$89.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.90
Rate for Payer: PHP Commercial	$84.90
Rate for Payer: Priority Health Cigna Priority Health	$64.92
Rate for Payer: Priority Health SBD	$62.92

FAMOTIDINE 20 MG TABLET

Facility

$218.55

Service Code	NDC 65862085901
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$87.42
Max. Negotiated Rate	$196.70
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Commercial	$152.98
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Cofinity Medicare Advantage	$152.98
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health Cigna Priority Health	$142.06
Rate for Payer: Priority Health SBD	$137.69

FAMOTIDINE 20 MG TABLET

Facility

$110.45

Service Code	NDC 50268030315
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$44.18
Max. Negotiated Rate	$99.40
Rate for Payer: Aetna Commercial	$93.88
Rate for Payer: Aetna Medicare	$55.22
Rate for Payer: Aetna New Business (MI Preferred)	$71.79
Rate for Payer: BCBS Complete	$44.18
Rate for Payer: Cash Price	$88.36
Rate for Payer: Cofinity Commercial	$77.32
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Cofinity Medicare Advantage	$77.32
Rate for Payer: Encore Health Key Benefits Commercial	$88.36
Rate for Payer: Healthscope Commercial	$99.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.88
Rate for Payer: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$71.79
Rate for Payer: Priority Health SBD	$69.58

FAMOTIDINE 20 MG TABLET

Facility

$110.45

Service Code	NDC 50268030315
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$69.58
Max. Negotiated Rate	$99.40
Rate for Payer: Aetna Commercial	$93.88
Rate for Payer: Aetna New Business (MI Preferred)	$71.79
Rate for Payer: Cash Price	$88.36
Rate for Payer: Cofinity Commercial	$77.32
Rate for Payer: Cofinity Commercial	$94.99
Rate for Payer: Cofinity Medicare Advantage	$77.32
Rate for Payer: Encore Health Key Benefits Commercial	$88.36
Rate for Payer: Healthscope Commercial	$99.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$93.88
Rate for Payer: PHP Commercial	$93.88
Rate for Payer: Priority Health Cigna Priority Health	$71.79
Rate for Payer: Priority Health SBD	$69.58

FAMOTIDINE 20 MG TABLET

Facility

$111.63

Service Code	NDC 00904719306
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$44.65
Max. Negotiated Rate	$100.47
Rate for Payer: Aetna Commercial	$94.89
Rate for Payer: Aetna Medicare	$55.82
Rate for Payer: Aetna New Business (MI Preferred)	$72.56
Rate for Payer: BCBS Complete	$44.65
Rate for Payer: Cash Price	$89.30
Rate for Payer: Cofinity Commercial	$78.14
Rate for Payer: Cofinity Commercial	$96.00
Rate for Payer: Cofinity Medicare Advantage	$78.14
Rate for Payer: Encore Health Key Benefits Commercial	$89.30
Rate for Payer: Healthscope Commercial	$100.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.89
Rate for Payer: PHP Commercial	$94.89
Rate for Payer: Priority Health Cigna Priority Health	$72.56
Rate for Payer: Priority Health SBD	$70.33

FAMOTIDINE 20 MG TABLET

Facility

$4,550.26

Service Code	NDC 00187442010
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$2,866.66
Max. Negotiated Rate	$4,095.23
Rate for Payer: Aetna Commercial	$3,867.72
Rate for Payer: Aetna New Business (MI Preferred)	$2,957.67
Rate for Payer: Cash Price	$3,640.21
Rate for Payer: Cofinity Commercial	$3,185.18
Rate for Payer: Cofinity Commercial	$3,913.22
Rate for Payer: Cofinity Medicare Advantage	$3,185.18
Rate for Payer: Encore Health Key Benefits Commercial	$3,640.21
Rate for Payer: Healthscope Commercial	$4,095.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,867.72
Rate for Payer: PHP Commercial	$3,867.72
Rate for Payer: Priority Health Cigna Priority Health	$2,957.67
Rate for Payer: Priority Health SBD	$2,866.66

FAMOTIDINE 20 MG TABLET

Facility

$399.50

Service Code	NDC 00172572870
Hospital Charge Code	10011
Hospital Revenue Code	637
Min. Negotiated Rate	$251.68
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.58
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.58
Rate for Payer: PHP Commercial	$339.58
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.68

Know your out-of-pocket cost for care.

All Charges