Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUVOXAMINE 100 MG TABLET

Facility

$4.15

Service Code	NDC 51079099301
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: BCBS Complete	$1.66
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Medicare Advantage	$2.90
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health Cigna Priority Health	$2.70
Rate for Payer: Priority Health SBD	$2.61

FLUVOXAMINE 100 MG TABLET

Facility

$414.20

Service Code	NDC 51079099320
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$372.78
Rate for Payer: Aetna Commercial	$352.07
Rate for Payer: Aetna New Business (MI Preferred)	$269.23
Rate for Payer: Cash Price	$331.36
Rate for Payer: Cofinity Commercial	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Cofinity Medicare Advantage	$289.94
Rate for Payer: Encore Health Key Benefits Commercial	$331.36
Rate for Payer: Healthscope Commercial	$372.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$352.07
Rate for Payer: PHP Commercial	$352.07
Rate for Payer: Priority Health Cigna Priority Health	$269.23
Rate for Payer: Priority Health SBD	$260.95

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079099201
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

FLUVOXAMINE 50 MG TABLET

Facility

$378.35

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$238.36
Max. Negotiated Rate	$340.51
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Commercial	$264.85
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Cofinity Medicare Advantage	$264.85
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health Cigna Priority Health	$245.93
Rate for Payer: Priority Health SBD	$238.36

FLUVOXAMINE 50 MG TABLET

Facility

$378.35

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$151.34
Max. Negotiated Rate	$340.51
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna Medicare	$189.18
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: BCBS Complete	$151.34
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Commercial	$264.85
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Cofinity Medicare Advantage	$264.85
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health Cigna Priority Health	$245.93
Rate for Payer: Priority Health SBD	$238.36

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079099220
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Cofinity Medicare Advantage	$262.01
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health Cigna Priority Health	$243.29
Rate for Payer: Priority Health SBD	$235.81

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079099220
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$149.72
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna Medicare	$187.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: BCBS Complete	$149.72
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Cofinity Medicare Advantage	$262.01
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health Cigna Priority Health	$243.29
Rate for Payer: Priority Health SBD	$235.81

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079099201
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

FOLIC ACID 1 MG TABLET

Facility

$149.60

Service Code	NDC 62584089701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$94.25
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$127.16
Rate for Payer: Aetna New Business (MI Preferred)	$97.24
Rate for Payer: Cash Price	$119.68
Rate for Payer: Cofinity Commercial	$104.72
Rate for Payer: Cofinity Commercial	$128.66
Rate for Payer: Cofinity Medicare Advantage	$104.72
Rate for Payer: Encore Health Key Benefits Commercial	$119.68
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.16
Rate for Payer: PHP Commercial	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$97.24
Rate for Payer: Priority Health SBD	$94.25

FOLIC ACID 1 MG TABLET

Facility

$1.50

Service Code	NDC 62584089711
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna Medicare	$0.75
Rate for Payer: Aetna New Business (MI Preferred)	$0.98
Rate for Payer: BCBS Complete	$0.60
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cofinity Commercial	$1.05
Rate for Payer: Cofinity Commercial	$1.29
Rate for Payer: Cofinity Medicare Advantage	$1.05
Rate for Payer: Encore Health Key Benefits Commercial	$1.20
Rate for Payer: Healthscope Commercial	$1.35
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	$0.98
Rate for Payer: Priority Health SBD	$0.95

FOLIC ACID 1 MG TABLET

Facility

$164.00

Service Code	NDC 69315012701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$103.32
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna Commercial	$139.40
Rate for Payer: Aetna New Business (MI Preferred)	$106.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cofinity Commercial	$114.80
Rate for Payer: Cofinity Commercial	$141.04
Rate for Payer: Cofinity Medicare Advantage	$114.80
Rate for Payer: Encore Health Key Benefits Commercial	$131.20
Rate for Payer: Healthscope Commercial	$147.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.40
Rate for Payer: PHP Commercial	$139.40
Rate for Payer: Priority Health Cigna Priority Health	$106.60
Rate for Payer: Priority Health SBD	$103.32

FOLIC ACID 1 MG TABLET

Facility

$224.00

Service Code	NDC 11534016501
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$141.12
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$190.40
Rate for Payer: Aetna New Business (MI Preferred)	$145.60
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cofinity Commercial	$156.80
Rate for Payer: Cofinity Commercial	$192.64
Rate for Payer: Cofinity Medicare Advantage	$156.80
Rate for Payer: Encore Health Key Benefits Commercial	$179.20
Rate for Payer: Healthscope Commercial	$201.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.40
Rate for Payer: PHP Commercial	$190.40
Rate for Payer: Priority Health Cigna Priority Health	$145.60
Rate for Payer: Priority Health SBD	$141.12

FOLIC ACID 1 MG TABLET

Facility

$149.60

Service Code	NDC 62584089701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$59.84
Max. Negotiated Rate	$134.64
Rate for Payer: Aetna Commercial	$127.16
Rate for Payer: Aetna Medicare	$74.80
Rate for Payer: Aetna New Business (MI Preferred)	$97.24
Rate for Payer: BCBS Complete	$59.84
Rate for Payer: Cash Price	$119.68
Rate for Payer: Cofinity Commercial	$104.72
Rate for Payer: Cofinity Commercial	$128.66
Rate for Payer: Cofinity Medicare Advantage	$104.72
Rate for Payer: Encore Health Key Benefits Commercial	$119.68
Rate for Payer: Healthscope Commercial	$134.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.16
Rate for Payer: PHP Commercial	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$97.24
Rate for Payer: Priority Health SBD	$94.25

FOLIC ACID 1 MG TABLET

Facility

$161.70

Service Code	NDC 60687068101
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$101.87
Max. Negotiated Rate	$145.53
Rate for Payer: Aetna Commercial	$137.44
Rate for Payer: Aetna New Business (MI Preferred)	$105.11
Rate for Payer: Cash Price	$129.36
Rate for Payer: Cofinity Commercial	$113.19
Rate for Payer: Cofinity Commercial	$139.06
Rate for Payer: Cofinity Medicare Advantage	$113.19
Rate for Payer: Encore Health Key Benefits Commercial	$129.36
Rate for Payer: Healthscope Commercial	$145.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.44
Rate for Payer: PHP Commercial	$137.44
Rate for Payer: Priority Health Cigna Priority Health	$105.11
Rate for Payer: Priority Health SBD	$101.87

FOLIC ACID 1 MG TABLET

Facility

$147.40

Service Code	NDC 00904722461
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$58.96
Max. Negotiated Rate	$132.66
Rate for Payer: Aetna Commercial	$125.29
Rate for Payer: Aetna Medicare	$73.70
Rate for Payer: Aetna New Business (MI Preferred)	$95.81
Rate for Payer: BCBS Complete	$58.96
Rate for Payer: Cash Price	$117.92
Rate for Payer: Cofinity Commercial	$103.18
Rate for Payer: Cofinity Commercial	$126.76
Rate for Payer: Cofinity Medicare Advantage	$103.18
Rate for Payer: Encore Health Key Benefits Commercial	$117.92
Rate for Payer: Healthscope Commercial	$132.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.29
Rate for Payer: PHP Commercial	$125.29
Rate for Payer: Priority Health Cigna Priority Health	$95.81
Rate for Payer: Priority Health SBD	$92.86

FOLIC ACID 1 MG TABLET

Facility

$188.00

Service Code	NDC 65162036110
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Cofinity Medicare Advantage	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health Cigna Priority Health	$122.20
Rate for Payer: Priority Health SBD	$118.44

FOLIC ACID 1 MG TABLET

Facility

$147.40

Service Code	NDC 00904722461
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$92.86
Max. Negotiated Rate	$132.66
Rate for Payer: Aetna Commercial	$125.29
Rate for Payer: Aetna New Business (MI Preferred)	$95.81
Rate for Payer: Cash Price	$117.92
Rate for Payer: Cofinity Commercial	$103.18
Rate for Payer: Cofinity Commercial	$126.76
Rate for Payer: Cofinity Medicare Advantage	$103.18
Rate for Payer: Encore Health Key Benefits Commercial	$117.92
Rate for Payer: Healthscope Commercial	$132.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$125.29
Rate for Payer: PHP Commercial	$125.29
Rate for Payer: Priority Health Cigna Priority Health	$95.81
Rate for Payer: Priority Health SBD	$92.86

FOLIC ACID 1 MG TABLET

Facility

$1.62

Service Code	NDC 60687068111
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.46
Rate for Payer: Aetna Commercial	$1.38
Rate for Payer: Aetna New Business (MI Preferred)	$1.05
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cofinity Commercial	$1.13
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Medicare Advantage	$1.13
Rate for Payer: Encore Health Key Benefits Commercial	$1.30
Rate for Payer: Healthscope Commercial	$1.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.38
Rate for Payer: PHP Commercial	$1.38
Rate for Payer: Priority Health Cigna Priority Health	$1.05
Rate for Payer: Priority Health SBD	$1.02

FOLIC ACID 1 MG TABLET

Facility

$188.00

Service Code	NDC 65162036110
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Cofinity Medicare Advantage	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health Cigna Priority Health	$122.20
Rate for Payer: Priority Health SBD	$118.44

FOLIC ACID 1 MG TABLET

Facility

$1.50

Service Code	NDC 62584089711
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna Commercial	$1.27
Rate for Payer: Aetna New Business (MI Preferred)	$0.98
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cofinity Commercial	$1.05
Rate for Payer: Cofinity Commercial	$1.29
Rate for Payer: Cofinity Medicare Advantage	$1.05
Rate for Payer: Encore Health Key Benefits Commercial	$1.20
Rate for Payer: Healthscope Commercial	$1.35
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	$0.98
Rate for Payer: Priority Health SBD	$0.95

FOLIC ACID 1 MG TABLET

Facility

$164.00

Service Code	NDC 69315012701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna Commercial	$139.40
Rate for Payer: Aetna Medicare	$82.00
Rate for Payer: Aetna New Business (MI Preferred)	$106.60
Rate for Payer: BCBS Complete	$65.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cofinity Commercial	$114.80
Rate for Payer: Cofinity Commercial	$141.04
Rate for Payer: Cofinity Medicare Advantage	$114.80
Rate for Payer: Encore Health Key Benefits Commercial	$131.20
Rate for Payer: Healthscope Commercial	$147.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.40
Rate for Payer: PHP Commercial	$139.40
Rate for Payer: Priority Health Cigna Priority Health	$106.60
Rate for Payer: Priority Health SBD	$103.32

FOLIC ACID 1 MG TABLET

Facility

$1.62

Service Code	NDC 60687068111
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.46
Rate for Payer: Aetna Commercial	$1.38
Rate for Payer: Aetna Medicare	$0.81
Rate for Payer: Aetna New Business (MI Preferred)	$1.05
Rate for Payer: BCBS Complete	$0.65
Rate for Payer: Cash Price	$1.30
Rate for Payer: Cofinity Commercial	$1.13
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Medicare Advantage	$1.13
Rate for Payer: Encore Health Key Benefits Commercial	$1.30
Rate for Payer: Healthscope Commercial	$1.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.38
Rate for Payer: PHP Commercial	$1.38
Rate for Payer: Priority Health Cigna Priority Health	$1.05
Rate for Payer: Priority Health SBD	$1.02

FOLIC ACID 1 MG TABLET

Facility

$161.70

Service Code	NDC 60687068101
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$64.68
Max. Negotiated Rate	$145.53
Rate for Payer: Aetna Commercial	$137.44
Rate for Payer: Aetna Medicare	$80.85
Rate for Payer: Aetna New Business (MI Preferred)	$105.11
Rate for Payer: BCBS Complete	$64.68
Rate for Payer: Cash Price	$129.36
Rate for Payer: Cofinity Commercial	$113.19
Rate for Payer: Cofinity Commercial	$139.06
Rate for Payer: Cofinity Medicare Advantage	$113.19
Rate for Payer: Encore Health Key Benefits Commercial	$129.36
Rate for Payer: Healthscope Commercial	$145.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.44
Rate for Payer: PHP Commercial	$137.44
Rate for Payer: Priority Health Cigna Priority Health	$105.11
Rate for Payer: Priority Health SBD	$101.87

FOLIC ACID 1 MG TABLET

Facility

$224.00

Service Code	NDC 11534016501
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$89.60
Max. Negotiated Rate	$201.60
Rate for Payer: Aetna Commercial	$190.40
Rate for Payer: Aetna Medicare	$112.00
Rate for Payer: Aetna New Business (MI Preferred)	$145.60
Rate for Payer: BCBS Complete	$89.60
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cofinity Commercial	$156.80
Rate for Payer: Cofinity Commercial	$192.64
Rate for Payer: Cofinity Medicare Advantage	$156.80
Rate for Payer: Encore Health Key Benefits Commercial	$179.20
Rate for Payer: Healthscope Commercial	$201.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$190.40
Rate for Payer: PHP Commercial	$190.40
Rate for Payer: Priority Health Cigna Priority Health	$145.60
Rate for Payer: Priority Health SBD	$141.12

FOLIC ACID 5 MG/ML INJECTION SOLUTION

Facility

$158.59

Service Code	NDC 63323018410
Hospital Charge Code	3232
Hospital Revenue Code	250
Min. Negotiated Rate	$99.91
Max. Negotiated Rate	$142.73
Rate for Payer: Aetna Commercial	$134.80
Rate for Payer: Aetna New Business (MI Preferred)	$103.08
Rate for Payer: Cash Price	$126.87
Rate for Payer: Cofinity Commercial	$111.01
Rate for Payer: Cofinity Commercial	$136.39
Rate for Payer: Cofinity Medicare Advantage	$111.01
Rate for Payer: Encore Health Key Benefits Commercial	$126.87
Rate for Payer: Healthscope Commercial	$142.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.80
Rate for Payer: PHP Commercial	$134.80
Rate for Payer: Priority Health Cigna Priority Health	$103.08
Rate for Payer: Priority Health SBD	$99.91

Know your out-of-pocket cost for care.

All Charges