Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LACTOBACILLUS RHAMNOSUS GG 10 BILLION CELL CAPSULE

Facility

$627.36

Service Code	NDC 4910040007
Hospital Charge Code	27974
Hospital Revenue Code	637
Min. Negotiated Rate	$395.24
Max. Negotiated Rate	$564.62
Rate for Payer: Aetna Commercial	$533.26
Rate for Payer: Aetna New Business (MI Preferred)	$407.78
Rate for Payer: Cash Price	$501.89
Rate for Payer: Cofinity Commercial	$439.15
Rate for Payer: Cofinity Commercial	$539.53
Rate for Payer: Healthscope Commercial	$564.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$533.26
Rate for Payer: PHP Commercial	$533.26
Rate for Payer: Priority Health Cigna Priority Health	$439.15
Rate for Payer: Priority Health SBD	$395.24

LACTULOSE 10 GRAM/15 ML ORAL SOLUTION

Facility

$21.01

Service Code	NDC 0121-0873-16
Hospital Charge Code	38245
Hospital Revenue Code	637
Min. Negotiated Rate	$13.24
Max. Negotiated Rate	$18.91
Rate for Payer: Aetna Commercial	$17.86
Rate for Payer: Aetna New Business (MI Preferred)	$13.66
Rate for Payer: Cash Price	$16.81
Rate for Payer: Cofinity Commercial	$14.71
Rate for Payer: Cofinity Commercial	$18.07
Rate for Payer: Healthscope Commercial	$18.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.86
Rate for Payer: PHP Commercial	$17.86
Rate for Payer: Priority Health Cigna Priority Health	$14.71
Rate for Payer: Priority Health SBD	$13.24

LACTULOSE 10 GRAM/15 ML ORAL SOLUTION

Facility

$38.51

Service Code	NDC 50383-779-32
Hospital Charge Code	38245
Hospital Revenue Code	637
Min. Negotiated Rate	$24.26
Max. Negotiated Rate	$34.66
Rate for Payer: Aetna Commercial	$32.73
Rate for Payer: Aetna New Business (MI Preferred)	$25.03
Rate for Payer: Cash Price	$30.81
Rate for Payer: Cofinity Commercial	$26.96
Rate for Payer: Cofinity Commercial	$33.12
Rate for Payer: Healthscope Commercial	$34.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.73
Rate for Payer: PHP Commercial	$32.73
Rate for Payer: Priority Health Cigna Priority Health	$26.96
Rate for Payer: Priority Health SBD	$24.26

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$7.20

Service Code	NDC 0121-1154-40
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$6.48
Rate for Payer: Aetna Commercial	$6.12
Rate for Payer: Aetna New Business (MI Preferred)	$4.68
Rate for Payer: Cash Price	$5.76
Rate for Payer: Cofinity Commercial	$5.04
Rate for Payer: Cofinity Commercial	$6.19
Rate for Payer: Healthscope Commercial	$6.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.12
Rate for Payer: PHP Commercial	$6.12
Rate for Payer: Priority Health Cigna Priority Health	$5.04
Rate for Payer: Priority Health SBD	$4.54

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$3.42

Service Code	NDC 50383-779-30
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna Commercial	$2.91
Rate for Payer: Aetna New Business (MI Preferred)	$2.22
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$2.94
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Healthscope Commercial	$3.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.91
Rate for Payer: PHP Commercial	$2.91
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.15

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$3.42

Service Code	NDC 50383-779-31
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$3.08
Rate for Payer: Aetna Commercial	$2.91
Rate for Payer: Aetna New Business (MI Preferred)	$2.22
Rate for Payer: Cash Price	$2.74
Rate for Payer: Cofinity Commercial	$2.39
Rate for Payer: Cofinity Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.91
Rate for Payer: PHP Commercial	$2.91
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.15

LACTULOSE 20 GRAM/30 ML ORAL SOLUTION

Facility

$6.48

Service Code	NDC 0121-1154-30
Hospital Charge Code	150919
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna New Business (MI Preferred)	$4.21
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Commercial	$5.57
Rate for Payer: Healthscope Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.51
Rate for Payer: PHP Commercial	$5.51
Rate for Payer: Priority Health Cigna Priority Health	$4.54
Rate for Payer: Priority Health SBD	$4.08

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL VERTEBRAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$5,298.97

Service Code	CPT 63048
Hospital Revenue Code	360
Min. Negotiated Rate	$206.29
Max. Negotiated Rate	$5,298.97
Rate for Payer: BCBS Trust/PPO	$5,298.97
Rate for Payer: UHC All Payor (Choice/PPO)	$226.92
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$206.29

Facility

$7,957.04

Service Code	CPT 63047
Hospital Revenue Code	360
Min. Negotiated Rate	$1,100.53
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$4,937.19
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1,210.58
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$1,100.53
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL

Facility

$24,330.89

Service Code	CPT 63655
Hospital Revenue Code	360
Min. Negotiated Rate	$838.25
Max. Negotiated Rate	$24,330.89
Rate for Payer: Aetna Medicare	$20,243.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,330.89
Rate for Payer: Amish Plain Church Group Commercial	$24,330.89
Rate for Payer: BCBS Complete	$11,180.53
Rate for Payer: BCBS MAPPO	$19,464.71
Rate for Payer: BCBS Trust/PPO	$12,611.00
Rate for Payer: BCN Medicare Advantage	$19,464.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,464.71
Rate for Payer: Mclaren Medicaid	$10,647.20
Rate for Payer: Mclaren Medicare	$19,464.71
Rate for Payer: Meridian Medicaid	$11,180.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$20,437.95
Rate for Payer: MI Amish Medical Board Commercial	$22,384.42
Rate for Payer: PACE Medicare	$18,491.47
Rate for Payer: PACE SWMI	$19,464.71
Rate for Payer: PHP Medicare Advantage	$19,464.71
Rate for Payer: Priority Health Choice Medicaid	$10,647.20
Rate for Payer: Priority Health Medicare	$19,464.71
Rate for Payer: Railroad Medicare Medicare	$19,464.71
Rate for Payer: UHC All Payor (Choice/PPO)	$922.08
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$19,464.71
Rate for Payer: UHC Exchange	$838.25
Rate for Payer: UHC Medicare Advantage	$20,048.65
Rate for Payer: VA VA	$19,464.71

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR

Facility

$7,957.04

Service Code	CPT 63030
Hospital Revenue Code	360
Min. Negotiated Rate	$911.93
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$4,143.11
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1,003.12
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$911.93
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

LAMOTRIGINE 100 MG TABLET

Facility

$246.75

Service Code	NDC 51079-499-20
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$155.45
Max. Negotiated Rate	$222.08
Rate for Payer: Aetna Commercial	$209.74
Rate for Payer: Aetna New Business (MI Preferred)	$160.39
Rate for Payer: Cash Price	$197.40
Rate for Payer: Cofinity Commercial	$172.72
Rate for Payer: Cofinity Commercial	$212.20
Rate for Payer: Healthscope Commercial	$222.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$209.74
Rate for Payer: PHP Commercial	$209.74
Rate for Payer: Priority Health Cigna Priority Health	$172.72
Rate for Payer: Priority Health SBD	$155.45

LAMOTRIGINE 100 MG TABLET

Facility

$2.47

Service Code	NDC 51079-499-01
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$2.22
Rate for Payer: Aetna Commercial	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$1.61
Rate for Payer: Cash Price	$1.98
Rate for Payer: Cofinity Commercial	$1.73
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Healthscope Commercial	$2.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.10
Rate for Payer: PHP Commercial	$2.10
Rate for Payer: Priority Health Cigna Priority Health	$1.73
Rate for Payer: Priority Health SBD	$1.56

LAMOTRIGINE 100 MG TABLET

Facility

$387.75

Service Code	NDC 68084-319-01
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$271.42
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$271.42
Rate for Payer: Priority Health SBD	$244.28

LAMOTRIGINE 100 MG TABLET

Facility

$249.10

Service Code	NDC 0904-7008-61
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$156.93
Max. Negotiated Rate	$224.19
Rate for Payer: Aetna Commercial	$211.74
Rate for Payer: Aetna New Business (MI Preferred)	$161.92
Rate for Payer: Cash Price	$199.28
Rate for Payer: Cofinity Commercial	$174.37
Rate for Payer: Cofinity Commercial	$214.23
Rate for Payer: Healthscope Commercial	$224.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.74
Rate for Payer: PHP Commercial	$211.74
Rate for Payer: Priority Health Cigna Priority Health	$174.37
Rate for Payer: Priority Health SBD	$156.93

LAMOTRIGINE 100 MG TABLET

Facility

$387.75

Service Code	NDC 68084-319-11
Hospital Charge Code	13982
Hospital Revenue Code	637
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Cofinity Commercial	$271.42
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$271.42
Rate for Payer: Priority Health SBD	$244.28

LAMOTRIGINE 150 MG TABLET

Facility

$115.62

Service Code	NDC 51672-4132-4
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$72.84
Max. Negotiated Rate	$104.06
Rate for Payer: Aetna Commercial	$98.28
Rate for Payer: Aetna New Business (MI Preferred)	$75.15
Rate for Payer: Cash Price	$92.50
Rate for Payer: Cofinity Commercial	$80.93
Rate for Payer: Cofinity Commercial	$99.43
Rate for Payer: Healthscope Commercial	$104.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.28
Rate for Payer: PHP Commercial	$98.28
Rate for Payer: Priority Health Cigna Priority Health	$80.93
Rate for Payer: Priority Health SBD	$72.84

LAMOTRIGINE 150 MG TABLET

Facility

$117.03

Service Code	NDC 13668-048-60
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$73.73
Max. Negotiated Rate	$105.33
Rate for Payer: Aetna Commercial	$99.48
Rate for Payer: Aetna New Business (MI Preferred)	$76.07
Rate for Payer: Cash Price	$93.62
Rate for Payer: Cofinity Commercial	$100.65
Rate for Payer: Cofinity Commercial	$81.92
Rate for Payer: Healthscope Commercial	$105.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.48
Rate for Payer: PHP Commercial	$99.48
Rate for Payer: Priority Health Cigna Priority Health	$81.92
Rate for Payer: Priority Health SBD	$73.73

LAMOTRIGINE 150 MG TABLET

Facility

$3.63

Service Code	NDC 60687-693-11
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$3.27
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna New Business (MI Preferred)	$2.36
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.54
Rate for Payer: Cofinity Commercial	$3.12
Rate for Payer: Healthscope Commercial	$3.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.09
Rate for Payer: PHP Commercial	$3.09
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.29

LAMOTRIGINE 150 MG TABLET

Facility

$362.90

Service Code	NDC 60687-693-01
Hospital Charge Code	14266
Hospital Revenue Code	637
Min. Negotiated Rate	$228.63
Max. Negotiated Rate	$326.61
Rate for Payer: Aetna Commercial	$308.46
Rate for Payer: Aetna New Business (MI Preferred)	$235.88
Rate for Payer: Cash Price	$290.32
Rate for Payer: Cofinity Commercial	$312.09
Rate for Payer: Cofinity Commercial	$254.03
Rate for Payer: Healthscope Commercial	$326.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$308.46
Rate for Payer: PHP Commercial	$308.46
Rate for Payer: Priority Health Cigna Priority Health	$254.03
Rate for Payer: Priority Health SBD	$228.63

LAMOTRIGINE 25 MG TABLET

Facility

$361.90

Service Code	NDC 68084-318-01
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$253.33
Rate for Payer: Priority Health SBD	$228.00

LAMOTRIGINE 25 MG TABLET

Facility

$131.60

Service Code	NDC 51672-4130-1
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$82.91
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.12
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$111.86
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health Cigna Priority Health	$92.12
Rate for Payer: Priority Health SBD	$82.91

LAMOTRIGINE 25 MG TABLET

Facility

$317.25

Service Code	NDC 0904-7007-61
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$199.87
Max. Negotiated Rate	$285.52
Rate for Payer: Aetna Commercial	$269.66
Rate for Payer: Aetna New Business (MI Preferred)	$206.21
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cofinity Commercial	$222.08
Rate for Payer: Cofinity Commercial	$272.84
Rate for Payer: Healthscope Commercial	$285.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$269.66
Rate for Payer: PHP Commercial	$269.66
Rate for Payer: Priority Health Cigna Priority Health	$222.08
Rate for Payer: Priority Health SBD	$199.87

LAMOTRIGINE 25 MG TABLET

Facility

$3.62

Service Code	NDC 68084-318-11
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$3.26
Rate for Payer: Aetna Commercial	$3.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.35
Rate for Payer: Cash Price	$2.90
Rate for Payer: Cofinity Commercial	$2.53
Rate for Payer: Cofinity Commercial	$3.11
Rate for Payer: Healthscope Commercial	$3.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.08
Rate for Payer: PHP Commercial	$3.08
Rate for Payer: Priority Health Cigna Priority Health	$2.53
Rate for Payer: Priority Health SBD	$2.28

LAMOTRIGINE 25 MG TABLET

Facility

$336.05

Service Code	NDC 63739-670-10
Hospital Charge Code	13981
Hospital Revenue Code	637
Min. Negotiated Rate	$211.71
Max. Negotiated Rate	$302.44
Rate for Payer: Aetna Commercial	$285.64
Rate for Payer: Aetna New Business (MI Preferred)	$218.43
Rate for Payer: Cash Price	$268.84
Rate for Payer: Cofinity Commercial	$235.24
Rate for Payer: Cofinity Commercial	$289.00
Rate for Payer: Healthscope Commercial	$302.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$285.64
Rate for Payer: PHP Commercial	$285.64
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$211.71

Know your out-of-pocket cost for care.

All Charges