Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LOSARTAN 100 MG TABLET

Facility

$3.58

Service Code	NDC 50268050611
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$2.26
Max. Negotiated Rate	$3.22
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna New Business (MI Preferred)	$2.33
Rate for Payer: Cash Price	$2.86
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Medicare Advantage	$2.51
Rate for Payer: Encore Health Key Benefits Commercial	$2.86
Rate for Payer: Healthscope Commercial	$3.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.04
Rate for Payer: PHP Commercial	$3.04
Rate for Payer: Priority Health Cigna Priority Health	$2.33
Rate for Payer: Priority Health SBD	$2.26

LOSARTAN 100 MG TABLET

Facility

$178.60

Service Code	NDC 50268050615
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$112.52
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Cofinity Medicare Advantage	$125.02
Rate for Payer: Encore Health Key Benefits Commercial	$142.88
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$116.09
Rate for Payer: Priority Health SBD	$112.52

LOSARTAN 100 MG TABLET

Facility

$44.42

Service Code	NDC 65862020330
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$17.77
Max. Negotiated Rate	$39.98
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: Aetna Medicare	$22.21
Rate for Payer: Aetna New Business (MI Preferred)	$28.87
Rate for Payer: BCBS Complete	$17.77
Rate for Payer: Cash Price	$35.54
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Commercial	$38.20
Rate for Payer: Cofinity Medicare Advantage	$31.09
Rate for Payer: Encore Health Key Benefits Commercial	$35.54
Rate for Payer: Healthscope Commercial	$39.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.76
Rate for Payer: PHP Commercial	$37.76
Rate for Payer: Priority Health Cigna Priority Health	$28.87
Rate for Payer: Priority Health SBD	$27.98

LOSARTAN 100 MG TABLET

Facility

$178.60

Service Code	NDC 50268050615
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna Medicare	$89.30
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: BCBS Complete	$71.44
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Cofinity Medicare Advantage	$125.02
Rate for Payer: Encore Health Key Benefits Commercial	$142.88
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$116.09
Rate for Payer: Priority Health SBD	$112.52

LOSARTAN 100 MG TABLET

Facility

$44.42

Service Code	NDC 65862020330
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$39.98
Rate for Payer: Aetna Commercial	$37.76
Rate for Payer: Aetna New Business (MI Preferred)	$28.87
Rate for Payer: Cash Price	$35.54
Rate for Payer: Cofinity Commercial	$31.09
Rate for Payer: Cofinity Commercial	$38.20
Rate for Payer: Cofinity Medicare Advantage	$31.09
Rate for Payer: Encore Health Key Benefits Commercial	$35.54
Rate for Payer: Healthscope Commercial	$39.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.76
Rate for Payer: PHP Commercial	$37.76
Rate for Payer: Priority Health Cigna Priority Health	$28.87
Rate for Payer: Priority Health SBD	$27.98

LOSARTAN 100 MG TABLET

Facility

$3.58

Service Code	NDC 50268050611
Hospital Charge Code	22588
Hospital Revenue Code	637
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$3.22
Rate for Payer: Aetna Commercial	$3.04
Rate for Payer: Aetna Medicare	$1.79
Rate for Payer: Aetna New Business (MI Preferred)	$2.33
Rate for Payer: BCBS Complete	$1.43
Rate for Payer: Cash Price	$2.86
Rate for Payer: Cofinity Commercial	$2.51
Rate for Payer: Cofinity Commercial	$3.08
Rate for Payer: Cofinity Medicare Advantage	$2.51
Rate for Payer: Encore Health Key Benefits Commercial	$2.86
Rate for Payer: Healthscope Commercial	$3.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.04
Rate for Payer: PHP Commercial	$3.04
Rate for Payer: Priority Health Cigna Priority Health	$2.33
Rate for Payer: Priority Health SBD	$2.26

LOSARTAN 25 MG TABLET

Facility

$339.15

Service Code	NDC 68084034601
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$135.66
Max. Negotiated Rate	$305.24
Rate for Payer: Aetna Commercial	$288.28
Rate for Payer: Aetna Medicare	$169.57
Rate for Payer: Aetna New Business (MI Preferred)	$220.45
Rate for Payer: BCBS Complete	$135.66
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cofinity Commercial	$237.41
Rate for Payer: Cofinity Commercial	$291.67
Rate for Payer: Cofinity Medicare Advantage	$237.41
Rate for Payer: Encore Health Key Benefits Commercial	$271.32
Rate for Payer: Healthscope Commercial	$305.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.28
Rate for Payer: PHP Commercial	$288.28
Rate for Payer: Priority Health Cigna Priority Health	$220.45
Rate for Payer: Priority Health SBD	$213.66

LOSARTAN 25 MG TABLET

Facility

$339.15

Service Code	NDC 68084034601
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$213.66
Max. Negotiated Rate	$305.24
Rate for Payer: Aetna Commercial	$288.28
Rate for Payer: Aetna New Business (MI Preferred)	$220.45
Rate for Payer: Cash Price	$271.32
Rate for Payer: Cofinity Commercial	$237.41
Rate for Payer: Cofinity Commercial	$291.67
Rate for Payer: Cofinity Medicare Advantage	$237.41
Rate for Payer: Encore Health Key Benefits Commercial	$271.32
Rate for Payer: Healthscope Commercial	$305.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$288.28
Rate for Payer: PHP Commercial	$288.28
Rate for Payer: Priority Health Cigna Priority Health	$220.45
Rate for Payer: Priority Health SBD	$213.66

LOSARTAN 25 MG TABLET

Facility

$3.40

Service Code	NDC 68084034611
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna New Business (MI Preferred)	$2.21
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cofinity Commercial	$2.38
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Cofinity Medicare Advantage	$2.38
Rate for Payer: Encore Health Key Benefits Commercial	$2.72
Rate for Payer: Healthscope Commercial	$3.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.89
Rate for Payer: PHP Commercial	$2.89
Rate for Payer: Priority Health Cigna Priority Health	$2.21
Rate for Payer: Priority Health SBD	$2.14

LOSARTAN 25 MG TABLET

Facility

$3.40

Service Code	NDC 68084034611
Hospital Charge Code	14823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.06
Rate for Payer: Aetna Commercial	$2.89
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.21
Rate for Payer: BCBS Complete	$1.36
Rate for Payer: Cash Price	$2.72
Rate for Payer: Cofinity Commercial	$2.38
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Cofinity Medicare Advantage	$2.38
Rate for Payer: Encore Health Key Benefits Commercial	$2.72
Rate for Payer: Healthscope Commercial	$3.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.89
Rate for Payer: PHP Commercial	$2.89
Rate for Payer: Priority Health Cigna Priority Health	$2.21
Rate for Payer: Priority Health SBD	$2.14

LOSARTAN 50 MG TABLET

Facility

$99.41

Service Code	NDC 68180037709
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$39.76
Max. Negotiated Rate	$89.47
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna Medicare	$49.70
Rate for Payer: Aetna New Business (MI Preferred)	$64.62
Rate for Payer: BCBS Complete	$39.76
Rate for Payer: Cash Price	$79.53
Rate for Payer: Cofinity Commercial	$69.59
Rate for Payer: Cofinity Commercial	$85.49
Rate for Payer: Cofinity Medicare Advantage	$69.59
Rate for Payer: Encore Health Key Benefits Commercial	$79.53
Rate for Payer: Healthscope Commercial	$89.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.50
Rate for Payer: PHP Commercial	$84.50
Rate for Payer: Priority Health Cigna Priority Health	$64.62
Rate for Payer: Priority Health SBD	$62.63

LOSARTAN 50 MG TABLET

Facility

$253.65

Service Code	NDC 68084034701
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$228.28
Rate for Payer: Aetna Commercial	$215.60
Rate for Payer: Aetna New Business (MI Preferred)	$164.87
Rate for Payer: Cash Price	$202.92
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Cofinity Commercial	$218.14
Rate for Payer: Cofinity Medicare Advantage	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$202.92
Rate for Payer: Healthscope Commercial	$228.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.60
Rate for Payer: PHP Commercial	$215.60
Rate for Payer: Priority Health Cigna Priority Health	$164.87
Rate for Payer: Priority Health SBD	$159.80

LOSARTAN 50 MG TABLET

Facility

$57.11

Service Code	NDC 65862020290
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$35.98
Max. Negotiated Rate	$51.40
Rate for Payer: Aetna Commercial	$48.54
Rate for Payer: Aetna New Business (MI Preferred)	$37.12
Rate for Payer: Cash Price	$45.69
Rate for Payer: Cofinity Commercial	$39.98
Rate for Payer: Cofinity Commercial	$49.11
Rate for Payer: Cofinity Medicare Advantage	$39.98
Rate for Payer: Encore Health Key Benefits Commercial	$45.69
Rate for Payer: Healthscope Commercial	$51.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.54
Rate for Payer: PHP Commercial	$48.54
Rate for Payer: Priority Health Cigna Priority Health	$37.12
Rate for Payer: Priority Health SBD	$35.98

LOSARTAN 50 MG TABLET

Facility

$99.41

Service Code	NDC 68180037709
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$62.63
Max. Negotiated Rate	$89.47
Rate for Payer: Aetna Commercial	$84.50
Rate for Payer: Aetna New Business (MI Preferred)	$64.62
Rate for Payer: Cash Price	$79.53
Rate for Payer: Cofinity Commercial	$69.59
Rate for Payer: Cofinity Commercial	$85.49
Rate for Payer: Cofinity Medicare Advantage	$69.59
Rate for Payer: Encore Health Key Benefits Commercial	$79.53
Rate for Payer: Healthscope Commercial	$89.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.50
Rate for Payer: PHP Commercial	$84.50
Rate for Payer: Priority Health Cigna Priority Health	$64.62
Rate for Payer: Priority Health SBD	$62.63

LOSARTAN 50 MG TABLET

Facility

$253.65

Service Code	NDC 68084034711
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$228.28
Rate for Payer: Aetna Commercial	$215.60
Rate for Payer: Aetna New Business (MI Preferred)	$164.87
Rate for Payer: Cash Price	$202.92
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Cofinity Commercial	$218.14
Rate for Payer: Cofinity Medicare Advantage	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$202.92
Rate for Payer: Healthscope Commercial	$228.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.60
Rate for Payer: PHP Commercial	$215.60
Rate for Payer: Priority Health Cigna Priority Health	$164.87
Rate for Payer: Priority Health SBD	$159.80

LOSARTAN 50 MG TABLET

Facility

$1,152.85

Service Code	NDC 00006095254
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$726.30
Max. Negotiated Rate	$1,037.57
Rate for Payer: Aetna Commercial	$979.92
Rate for Payer: Aetna New Business (MI Preferred)	$749.35
Rate for Payer: Cash Price	$922.28
Rate for Payer: Cofinity Commercial	$807.00
Rate for Payer: Cofinity Commercial	$991.45
Rate for Payer: Cofinity Medicare Advantage	$807.00
Rate for Payer: Encore Health Key Benefits Commercial	$922.28
Rate for Payer: Healthscope Commercial	$1,037.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$979.92
Rate for Payer: PHP Commercial	$979.92
Rate for Payer: Priority Health Cigna Priority Health	$749.35
Rate for Payer: Priority Health SBD	$726.30

LOSARTAN 50 MG TABLET

Facility

$253.65

Service Code	NDC 68084034711
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$101.46
Max. Negotiated Rate	$228.28
Rate for Payer: Aetna Commercial	$215.60
Rate for Payer: Aetna Medicare	$126.83
Rate for Payer: Aetna New Business (MI Preferred)	$164.87
Rate for Payer: BCBS Complete	$101.46
Rate for Payer: Cash Price	$202.92
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Cofinity Commercial	$218.14
Rate for Payer: Cofinity Medicare Advantage	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$202.92
Rate for Payer: Healthscope Commercial	$228.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.60
Rate for Payer: PHP Commercial	$215.60
Rate for Payer: Priority Health Cigna Priority Health	$164.87
Rate for Payer: Priority Health SBD	$159.80

LOSARTAN 50 MG TABLET

Facility

$57.11

Service Code	NDC 65862020290
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$22.84
Max. Negotiated Rate	$51.40
Rate for Payer: Aetna Commercial	$48.54
Rate for Payer: Aetna Medicare	$28.55
Rate for Payer: Aetna New Business (MI Preferred)	$37.12
Rate for Payer: BCBS Complete	$22.84
Rate for Payer: Cash Price	$45.69
Rate for Payer: Cofinity Commercial	$39.98
Rate for Payer: Cofinity Commercial	$49.11
Rate for Payer: Cofinity Medicare Advantage	$39.98
Rate for Payer: Encore Health Key Benefits Commercial	$45.69
Rate for Payer: Healthscope Commercial	$51.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$48.54
Rate for Payer: PHP Commercial	$48.54
Rate for Payer: Priority Health Cigna Priority Health	$37.12
Rate for Payer: Priority Health SBD	$35.98

LOSARTAN 50 MG TABLET

Facility

$293.55

Service Code	NDC 63739068610
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$184.94
Max. Negotiated Rate	$264.19
Rate for Payer: Aetna Commercial	$249.52
Rate for Payer: Aetna New Business (MI Preferred)	$190.81
Rate for Payer: Cash Price	$234.84
Rate for Payer: Cofinity Commercial	$205.49
Rate for Payer: Cofinity Commercial	$252.45
Rate for Payer: Cofinity Medicare Advantage	$205.49
Rate for Payer: Encore Health Key Benefits Commercial	$234.84
Rate for Payer: Healthscope Commercial	$264.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$249.52
Rate for Payer: PHP Commercial	$249.52
Rate for Payer: Priority Health Cigna Priority Health	$190.81
Rate for Payer: Priority Health SBD	$184.94

LOSARTAN 50 MG TABLET

Facility

$253.65

Service Code	NDC 68084034701
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$101.46
Max. Negotiated Rate	$228.28
Rate for Payer: Aetna Commercial	$215.60
Rate for Payer: Aetna Medicare	$126.83
Rate for Payer: Aetna New Business (MI Preferred)	$164.87
Rate for Payer: BCBS Complete	$101.46
Rate for Payer: Cash Price	$202.92
Rate for Payer: Cofinity Commercial	$177.56
Rate for Payer: Cofinity Commercial	$218.14
Rate for Payer: Cofinity Medicare Advantage	$177.56
Rate for Payer: Encore Health Key Benefits Commercial	$202.92
Rate for Payer: Healthscope Commercial	$228.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$215.60
Rate for Payer: PHP Commercial	$215.60
Rate for Payer: Priority Health Cigna Priority Health	$164.87
Rate for Payer: Priority Health SBD	$159.80

LOSARTAN 50 MG TABLET

Facility

$293.55

Service Code	NDC 63739068610
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$264.19
Rate for Payer: Aetna Commercial	$249.52
Rate for Payer: Aetna Medicare	$146.78
Rate for Payer: Aetna New Business (MI Preferred)	$190.81
Rate for Payer: BCBS Complete	$117.42
Rate for Payer: Cash Price	$234.84
Rate for Payer: Cofinity Commercial	$205.49
Rate for Payer: Cofinity Commercial	$252.45
Rate for Payer: Cofinity Medicare Advantage	$205.49
Rate for Payer: Encore Health Key Benefits Commercial	$234.84
Rate for Payer: Healthscope Commercial	$264.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$249.52
Rate for Payer: PHP Commercial	$249.52
Rate for Payer: Priority Health Cigna Priority Health	$190.81
Rate for Payer: Priority Health SBD	$184.94

LOSARTAN 50 MG TABLET

Facility

$1,152.85

Service Code	NDC 00006095254
Hospital Charge Code	14824
Hospital Revenue Code	637
Min. Negotiated Rate	$461.14
Max. Negotiated Rate	$1,037.57
Rate for Payer: Aetna Commercial	$979.92
Rate for Payer: Aetna Medicare	$576.42
Rate for Payer: Aetna New Business (MI Preferred)	$749.35
Rate for Payer: BCBS Complete	$461.14
Rate for Payer: Cash Price	$922.28
Rate for Payer: Cofinity Commercial	$807.00
Rate for Payer: Cofinity Commercial	$991.45
Rate for Payer: Cofinity Medicare Advantage	$807.00
Rate for Payer: Encore Health Key Benefits Commercial	$922.28
Rate for Payer: Healthscope Commercial	$1,037.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$979.92
Rate for Payer: PHP Commercial	$979.92
Rate for Payer: Priority Health Cigna Priority Health	$749.35
Rate for Payer: Priority Health SBD	$726.30

LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS

Facility

$843.29

Service Code	NDC 24208050307
Hospital Charge Code	163667
Hospital Revenue Code	637
Min. Negotiated Rate	$531.27
Max. Negotiated Rate	$758.96
Rate for Payer: Aetna Commercial	$716.80
Rate for Payer: Aetna New Business (MI Preferred)	$548.14
Rate for Payer: Cash Price	$674.63
Rate for Payer: Cofinity Commercial	$590.30
Rate for Payer: Cofinity Commercial	$725.23
Rate for Payer: Cofinity Medicare Advantage	$590.30
Rate for Payer: Encore Health Key Benefits Commercial	$674.63
Rate for Payer: Healthscope Commercial	$758.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.80
Rate for Payer: PHP Commercial	$716.80
Rate for Payer: Priority Health Cigna Priority Health	$548.14
Rate for Payer: Priority Health SBD	$531.27

LOTEPREDNOL ETABONATE 0.5 % EYE GEL DROPS

Facility

$843.29

Service Code	NDC 24208050307
Hospital Charge Code	163667
Hospital Revenue Code	637
Min. Negotiated Rate	$337.32
Max. Negotiated Rate	$758.96
Rate for Payer: Aetna Commercial	$716.80
Rate for Payer: Aetna Medicare	$421.64
Rate for Payer: Aetna New Business (MI Preferred)	$548.14
Rate for Payer: BCBS Complete	$337.32
Rate for Payer: Cash Price	$674.63
Rate for Payer: Cofinity Commercial	$590.30
Rate for Payer: Cofinity Commercial	$725.23
Rate for Payer: Cofinity Medicare Advantage	$590.30
Rate for Payer: Encore Health Key Benefits Commercial	$674.63
Rate for Payer: Healthscope Commercial	$758.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.80
Rate for Payer: PHP Commercial	$716.80
Rate for Payer: Priority Health Cigna Priority Health	$548.14
Rate for Payer: Priority Health SBD	$531.27

LUBIPROSTONE 8 MCG CAPSULE

Facility

$45.17

Service Code	NDC 69339016298
Hospital Charge Code	91534
Hospital Revenue Code	637
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$40.65
Rate for Payer: Aetna Commercial	$38.39
Rate for Payer: Aetna Medicare	$22.59
Rate for Payer: Aetna New Business (MI Preferred)	$29.36
Rate for Payer: BCBS Complete	$18.07
Rate for Payer: Cash Price	$36.14
Rate for Payer: Cofinity Commercial	$31.62
Rate for Payer: Cofinity Commercial	$38.85
Rate for Payer: Cofinity Medicare Advantage	$31.62
Rate for Payer: Encore Health Key Benefits Commercial	$36.14
Rate for Payer: Healthscope Commercial	$40.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.39
Rate for Payer: PHP Commercial	$38.39
Rate for Payer: Priority Health Cigna Priority Health	$29.36
Rate for Payer: Priority Health SBD	$28.46

Know your out-of-pocket cost for care.

All Charges