Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ISOSOURCE HN CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 4390018480
Hospital Charge Code	168942
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN CYCLIC FEED

Facility

$9.60

Service Code	NDC 4390018480
Hospital Charge Code	200075
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSOURCE HN INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 4390018480
Hospital Charge Code	200074
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.72
Rate for Payer: Priority Health SBD	$6.05

ISOSULFAN BLUE 1 % SUBCUTANEOUS SOLUTION

Facility

$3,157.22

Service Code	HCPCS Q9968
Hospital Charge Code	10358
Hospital Revenue Code	636
Min. Negotiated Rate	$1,989.05
Max. Negotiated Rate	$2,841.50
Rate for Payer: Aetna Commercial	$2,683.64
Rate for Payer: Aetna Commercial	$1,039.58
Rate for Payer: Aetna Commercial	$2,656.79
Rate for Payer: Aetna New Business (MI Preferred)	$2,031.67
Rate for Payer: Aetna New Business (MI Preferred)	$2,052.19
Rate for Payer: Aetna New Business (MI Preferred)	$794.97
Rate for Payer: Cash Price	$978.42
Rate for Payer: Cash Price	$2,525.78
Rate for Payer: Cash Price	$2,500.51
Rate for Payer: Cofinity Commercial	$1,051.81
Rate for Payer: Cofinity Commercial	$856.12
Rate for Payer: Cofinity Commercial	$2,187.95
Rate for Payer: Cofinity Commercial	$2,688.05
Rate for Payer: Cofinity Commercial	$2,210.05
Rate for Payer: Cofinity Commercial	$2,715.21
Rate for Payer: Healthscope Commercial	$2,841.50
Rate for Payer: Healthscope Commercial	$2,813.08
Rate for Payer: Healthscope Commercial	$1,100.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,683.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,656.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,039.58
Rate for Payer: PHP Commercial	$2,683.64
Rate for Payer: PHP Commercial	$2,656.79
Rate for Payer: PHP Commercial	$1,039.58
Rate for Payer: Priority Health Cigna Priority Health	$2,210.05
Rate for Payer: Priority Health Cigna Priority Health	$2,187.95
Rate for Payer: Priority Health Cigna Priority Health	$856.12
Rate for Payer: Priority Health SBD	$770.51
Rate for Payer: Priority Health SBD	$1,969.15
Rate for Payer: Priority Health SBD	$1,989.05

ITRACONAZOLE 100 MG CAPSULE

Facility

$140.26

Service Code	NDC 67877-454-30
Hospital Charge Code	10364
Hospital Revenue Code	637
Min. Negotiated Rate	$88.36
Max. Negotiated Rate	$126.23
Rate for Payer: Aetna Commercial	$119.22
Rate for Payer: Aetna New Business (MI Preferred)	$91.17
Rate for Payer: Cash Price	$112.21
Rate for Payer: Cofinity Commercial	$120.62
Rate for Payer: Cofinity Commercial	$98.18
Rate for Payer: Healthscope Commercial	$126.23
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$119.22
Rate for Payer: PHP Commercial	$119.22
Rate for Payer: Priority Health Cigna Priority Health	$98.18
Rate for Payer: Priority Health SBD	$88.36

ITRACONAZOLE 10 MG/ML ORAL SOLUTION

Facility

$1,179.38

Service Code	NDC 50458-295-15
Hospital Charge Code	19928
Hospital Revenue Code	637
Min. Negotiated Rate	$743.01
Max. Negotiated Rate	$1,061.44
Rate for Payer: Aetna Commercial	$1,002.47
Rate for Payer: Aetna New Business (MI Preferred)	$766.60
Rate for Payer: Cash Price	$943.50
Rate for Payer: Cofinity Commercial	$1,014.27
Rate for Payer: Cofinity Commercial	$825.57
Rate for Payer: Healthscope Commercial	$1,061.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,002.47
Rate for Payer: PHP Commercial	$1,002.47
Rate for Payer: Priority Health Cigna Priority Health	$825.57
Rate for Payer: Priority Health SBD	$743.01

IXABEPILONE 15 MG INTRAVENOUS SOLUTION

Facility

$8,694.13

Service Code	HCPCS J9207
Hospital Charge Code	88652
Hospital Revenue Code	636
Min. Negotiated Rate	$5,477.30
Max. Negotiated Rate	$7,824.72
Rate for Payer: Aetna Commercial	$7,390.01
Rate for Payer: Aetna New Business (MI Preferred)	$5,651.18
Rate for Payer: Cash Price	$6,955.30
Rate for Payer: Cofinity Commercial	$6,085.89
Rate for Payer: Cofinity Commercial	$7,476.95
Rate for Payer: Healthscope Commercial	$7,824.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,390.01
Rate for Payer: PHP Commercial	$7,390.01
Rate for Payer: Priority Health Cigna Priority Health	$6,085.89
Rate for Payer: Priority Health SBD	$5,477.30

IXABEPILONE 15 MG INTRAVENOUS SOLUTION

Facility

$8,694.13

Service Code	HCPCS J9207
Hospital Charge Code	88652
Hospital Revenue Code	636
Min. Negotiated Rate	$70.06
Max. Negotiated Rate	$7,824.72
Rate for Payer: Aetna Commercial	$7,390.01
Rate for Payer: Aetna Medicare	$133.20
Rate for Payer: Aetna New Business (MI Preferred)	$5,651.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$160.09
Rate for Payer: Amish Plain Church Group Commercial	$160.09
Rate for Payer: BCBS Complete	$73.57
Rate for Payer: BCBS MAPPO	$128.07
Rate for Payer: BCBS Trust/PPO	$379.16
Rate for Payer: BCN Medicare Advantage	$128.07
Rate for Payer: Cash Price	$6,955.30
Rate for Payer: Cash Price	$6,955.30
Rate for Payer: Cofinity Commercial	$7,476.95
Rate for Payer: Cofinity Commercial	$6,085.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$128.07
Rate for Payer: Healthscope Commercial	$7,824.72
Rate for Payer: Mclaren Medicaid	$70.06
Rate for Payer: Mclaren Medicare	$128.07
Rate for Payer: Meridian Medicaid	$73.57
Rate for Payer: Meridian Wellcare - Medicare Advantage	$134.48
Rate for Payer: MI Amish Medical Board Commercial	$147.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,390.01
Rate for Payer: PACE Medicare	$121.67
Rate for Payer: PACE SWMI	$128.07
Rate for Payer: PHP Commercial	$7,390.01
Rate for Payer: PHP Medicare Advantage	$128.07
Rate for Payer: Priority Health Choice Medicaid	$70.06
Rate for Payer: Priority Health Cigna Priority Health	$6,085.89
Rate for Payer: Priority Health Medicare	$128.07
Rate for Payer: Priority Health SBD	$5,477.30
Rate for Payer: Railroad Medicare Medicare	$128.07
Rate for Payer: UHC Dual Complete DSNP	$128.07
Rate for Payer: UHC Medicare Advantage	$131.92
Rate for Payer: VA VA	$128.07

J-TIP NEEDLE FREE INJECTOR 0.25 ML

Facility

$3.99

Service Code	NDC 9900-0004-00
Hospital Charge Code	163515
Hospital Revenue Code	250
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.59
Rate for Payer: Aetna Commercial	$3.39
Rate for Payer: Aetna New Business (MI Preferred)	$2.59
Rate for Payer: Cash Price	$3.19
Rate for Payer: Cofinity Commercial	$2.79
Rate for Payer: Cofinity Commercial	$3.43
Rate for Payer: Healthscope Commercial	$3.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.39
Rate for Payer: PHP Commercial	$3.39
Rate for Payer: Priority Health Cigna Priority Health	$2.79
Rate for Payer: Priority Health SBD	$2.51

KATE FARMS ADULT PEPTIDE 1.5 CONTINUOUS FEED PLAIN

Facility

$13.23

Service Code	NDC 1111203042
Hospital Charge Code	301627
Hospital Revenue Code	637
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$11.91
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Aetna New Business (MI Preferred)	$8.60
Rate for Payer: Cash Price	$10.58
Rate for Payer: Cofinity Commercial	$11.38
Rate for Payer: Cofinity Commercial	$9.26
Rate for Payer: Healthscope Commercial	$11.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.25
Rate for Payer: PHP Commercial	$11.25
Rate for Payer: Priority Health Cigna Priority Health	$9.26
Rate for Payer: Priority Health SBD	$8.33

KATE FARMS ADULT PEPTIDE 1.5 CYCLIC FEED PLAIN

Facility

$13.23

Service Code	NDC 1111203042
Hospital Charge Code	301628
Hospital Revenue Code	637
Min. Negotiated Rate	$8.33
Max. Negotiated Rate	$11.91
Rate for Payer: Aetna Commercial	$11.25
Rate for Payer: Aetna New Business (MI Preferred)	$8.60
Rate for Payer: Cash Price	$10.58
Rate for Payer: Cofinity Commercial	$11.38
Rate for Payer: Cofinity Commercial	$9.26
Rate for Payer: Healthscope Commercial	$11.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.25
Rate for Payer: PHP Commercial	$11.25
Rate for Payer: Priority Health Cigna Priority Health	$9.26
Rate for Payer: Priority Health SBD	$8.33

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$32.55

Service Code	NDC 0409-2051-05
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$22.78
Rate for Payer: Priority Health SBD	$20.51

KETAMINE 100 MG/ML INJECTION IM (CODE)

Facility

$32.55

Service Code	NDC 0409-0040-10
Hospital Charge Code	163728
Hospital Revenue Code	250
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$22.78
Rate for Payer: Priority Health SBD	$20.51

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$32.55

Service Code	NDC 0409-2051-15
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$22.78
Rate for Payer: Priority Health SBD	$20.51

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$32.55

Service Code	NDC 0409-2051-05
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$20.51
Max. Negotiated Rate	$29.30
Rate for Payer: Aetna Commercial	$27.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.16
Rate for Payer: Cash Price	$26.04
Rate for Payer: Cofinity Commercial	$22.78
Rate for Payer: Cofinity Commercial	$27.99
Rate for Payer: Healthscope Commercial	$29.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.67
Rate for Payer: PHP Commercial	$27.67
Rate for Payer: Priority Health Cigna Priority Health	$22.78
Rate for Payer: Priority Health SBD	$20.51

KETAMINE 100 MG/ML INJECTION SOLUTION

Facility

$62.03

Service Code	NDC 42023-115-10
Hospital Charge Code	4237
Hospital Revenue Code	250
Min. Negotiated Rate	$39.08
Max. Negotiated Rate	$55.83
Rate for Payer: Aetna Commercial	$52.73
Rate for Payer: Aetna New Business (MI Preferred)	$40.32
Rate for Payer: Cash Price	$49.62
Rate for Payer: Cofinity Commercial	$43.42
Rate for Payer: Cofinity Commercial	$53.35
Rate for Payer: Healthscope Commercial	$55.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.73
Rate for Payer: PHP Commercial	$52.73
Rate for Payer: Priority Health Cigna Priority Health	$43.42
Rate for Payer: Priority Health SBD	$39.08

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$68.00

Service Code	NDC 67457-181-20
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$42.84
Max. Negotiated Rate	$61.20
Rate for Payer: Aetna Commercial	$57.80
Rate for Payer: Aetna New Business (MI Preferred)	$44.20
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cofinity Commercial	$47.60
Rate for Payer: Cofinity Commercial	$58.48
Rate for Payer: Healthscope Commercial	$61.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.80
Rate for Payer: PHP Commercial	$57.80
Rate for Payer: Priority Health Cigna Priority Health	$47.60
Rate for Payer: Priority Health SBD	$42.84

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$96.00

Service Code	NDC 9900-0008-69
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$86.40
Rate for Payer: Aetna Commercial	$81.60
Rate for Payer: Aetna New Business (MI Preferred)	$62.40
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cofinity Commercial	$67.20
Rate for Payer: Cofinity Commercial	$82.56
Rate for Payer: Healthscope Commercial	$86.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.60
Rate for Payer: PHP Commercial	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$67.20
Rate for Payer: Priority Health SBD	$60.48

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374-982-55
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health SBD	$22.05

KETAMINE 10 MG/ML INJECTION SOLUTION

Facility

$35.00

Service Code	NDC 69374-308-05
Hospital Charge Code	4236
Hospital Revenue Code	250
Min. Negotiated Rate	$22.05
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Commercial	$29.75
Rate for Payer: Aetna New Business (MI Preferred)	$22.75
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cofinity Commercial	$24.50
Rate for Payer: Cofinity Commercial	$30.10
Rate for Payer: Healthscope Commercial	$31.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.75
Rate for Payer: PHP Commercial	$29.75
Rate for Payer: Priority Health Cigna Priority Health	$24.50
Rate for Payer: Priority Health SBD	$22.05

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.65

Service Code	NDC 42023-114-10
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.57
Max. Negotiated Rate	$29.38
Rate for Payer: Aetna Commercial	$27.75
Rate for Payer: Aetna New Business (MI Preferred)	$21.22
Rate for Payer: Cash Price	$26.12
Rate for Payer: Cofinity Commercial	$22.86
Rate for Payer: Cofinity Commercial	$28.08
Rate for Payer: Healthscope Commercial	$29.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.75
Rate for Payer: PHP Commercial	$27.75
Rate for Payer: Priority Health Cigna Priority Health	$22.86
Rate for Payer: Priority Health SBD	$20.57

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457-001-10
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$29.56
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Healthscope Commercial	$29.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$23.00
Rate for Payer: Priority Health SBD	$20.70

KETAMINE 50 MG/ML INJECTION SOLUTION

Facility

$32.85

Service Code	NDC 67457-001-00
Hospital Charge Code	4238
Hospital Revenue Code	250
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$29.56
Rate for Payer: Aetna Commercial	$27.92
Rate for Payer: Aetna New Business (MI Preferred)	$21.35
Rate for Payer: Cash Price	$26.28
Rate for Payer: Cofinity Commercial	$23.00
Rate for Payer: Cofinity Commercial	$28.25
Rate for Payer: Healthscope Commercial	$29.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.92
Rate for Payer: PHP Commercial	$27.92
Rate for Payer: Priority Health Cigna Priority Health	$23.00
Rate for Payer: Priority Health SBD	$20.70

KETOCONAZOLE 2 % SHAMPOO

Facility

$33.60

Service Code	NDC 45802-465-64
Hospital Charge Code	14132
Hospital Revenue Code	637
Min. Negotiated Rate	$21.17
Max. Negotiated Rate	$30.24
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: Aetna New Business (MI Preferred)	$21.84
Rate for Payer: Cash Price	$26.88
Rate for Payer: Cofinity Commercial	$23.52
Rate for Payer: Cofinity Commercial	$28.90
Rate for Payer: Healthscope Commercial	$30.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$28.56
Rate for Payer: PHP Commercial	$28.56
Rate for Payer: Priority Health Cigna Priority Health	$23.52
Rate for Payer: Priority Health SBD	$21.17

KETOCONAZOLE 2 % TOPICAL CREAM

Facility

$123.80

Service Code	NDC 51672-1298-2
Hospital Charge Code	10368
Hospital Revenue Code	637
Min. Negotiated Rate	$77.99
Max. Negotiated Rate	$111.42
Rate for Payer: Aetna Commercial	$105.23
Rate for Payer: Aetna New Business (MI Preferred)	$80.47
Rate for Payer: Cash Price	$99.04
Rate for Payer: Cofinity Commercial	$86.66
Rate for Payer: Cofinity Commercial	$106.47
Rate for Payer: Healthscope Commercial	$111.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$105.23
Rate for Payer: PHP Commercial	$105.23
Rate for Payer: Priority Health Cigna Priority Health	$86.66
Rate for Payer: Priority Health SBD	$77.99

Know your out-of-pocket cost for care.

All Charges