Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NOVASOURCE RENAL INTERMITTENT FEED

Facility

$22.20

Service Code	NDC 43900035180
Hospital Charge Code	200086
Hospital Revenue Code	637
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Cofinity Medicare Advantage	$15.54
Rate for Payer: Encore Health Key Benefits Commercial	$17.76
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$14.43
Rate for Payer: Priority Health SBD	$13.99

NOVASOURCE RENAL INTERMITTENT FEED

Facility

$22.20

Service Code	NDC 43900035180
Hospital Charge Code	200086
Hospital Revenue Code	637
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna Medicare	$11.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: BCBS Complete	$8.88
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Cofinity Medicare Advantage	$15.54
Rate for Payer: Encore Health Key Benefits Commercial	$17.76
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: Priority Health Cigna Priority Health	$14.43
Rate for Payer: Priority Health SBD	$13.99

NURSING CASE MANAGEMENT

Professional

Both

$26.00

Service Code	HCPCS RN001
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.90
Rate for Payer: Priority Health Cigna Priority Health	$16.90

NUTREN 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	180645
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 BOLUS FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	180645
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	181405
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	181405
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	200083
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	200083
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	200082
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 1.5 INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716016354
Hospital Charge Code	200082
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: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

NUTREN 2.0 BOLUS FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	150720
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 BOLUS FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	150720
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CONTINUOUS FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	168944
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CONTINUOUS FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	168944
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CYCLIC FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	200085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 CYCLIC FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	200085
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 INTERMITTENT FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	200084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUTREN 2.0 INTERMITTENT FEED

Facility

$4.75

Service Code	NDC 98716006230
Hospital Charge Code	200084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.04
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.80
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.80
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.04
Rate for Payer: PHP Commercial	$4.04
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$2.99

NUT.TX. COMPROMISED IMMUNE SYSTEM,REG 0.06 GRAM-1 KCAL/ML ORAL LIQUID

Facility

$55.50

Service Code	NDC 00212358114
Hospital Charge Code	118217
Hospital Revenue Code	637
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$49.95
Rate for Payer: Aetna Commercial	$47.17
Rate for Payer: Aetna Medicare	$27.75
Rate for Payer: Aetna New Business (MI Preferred)	$36.08
Rate for Payer: BCBS Complete	$22.20
Rate for Payer: Cash Price	$44.40
Rate for Payer: Cofinity Commercial	$38.85
Rate for Payer: Cofinity Commercial	$47.73
Rate for Payer: Cofinity Medicare Advantage	$38.85
Rate for Payer: Encore Health Key Benefits Commercial	$44.40
Rate for Payer: Healthscope Commercial	$49.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.17
Rate for Payer: PHP Commercial	$47.17
Rate for Payer: Priority Health Cigna Priority Health	$36.08
Rate for Payer: Priority Health SBD	$34.97

NUT.TX. COMPROMISED IMMUNE SYSTEM,REG 0.06 GRAM-1 KCAL/ML ORAL LIQUID

Facility

$55.50

Service Code	NDC 00212358114
Hospital Charge Code	118217
Hospital Revenue Code	637
Min. Negotiated Rate	$34.97
Max. Negotiated Rate	$49.95
Rate for Payer: Aetna Commercial	$47.17
Rate for Payer: Aetna New Business (MI Preferred)	$36.08
Rate for Payer: Cash Price	$44.40
Rate for Payer: Cofinity Commercial	$38.85
Rate for Payer: Cofinity Commercial	$47.73
Rate for Payer: Cofinity Medicare Advantage	$38.85
Rate for Payer: Encore Health Key Benefits Commercial	$44.40
Rate for Payer: Healthscope Commercial	$49.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.17
Rate for Payer: PHP Commercial	$47.17
Rate for Payer: Priority Health Cigna Priority Health	$36.08
Rate for Payer: Priority Health SBD	$34.97

NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM

Facility

$18.09

Service Code	NDC 45802005935
Hospital Charge Code	5749
Hospital Revenue Code	637
Min. Negotiated Rate	$11.40
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna New Business (MI Preferred)	$11.76
Rate for Payer: Cash Price	$14.47
Rate for Payer: Cofinity Commercial	$12.66
Rate for Payer: Cofinity Commercial	$15.56
Rate for Payer: Cofinity Medicare Advantage	$12.66
Rate for Payer: Encore Health Key Benefits Commercial	$14.47
Rate for Payer: Healthscope Commercial	$16.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.38
Rate for Payer: PHP Commercial	$15.38
Rate for Payer: Priority Health Cigna Priority Health	$11.76
Rate for Payer: Priority Health SBD	$11.40

NYSTATIN 100,000 UNIT/GRAM TOPICAL CREAM

Facility

$18.09

Service Code	NDC 45802005935
Hospital Charge Code	5749
Hospital Revenue Code	637
Min. Negotiated Rate	$7.24
Max. Negotiated Rate	$16.28
Rate for Payer: Aetna Commercial	$15.38
Rate for Payer: Aetna Medicare	$9.04
Rate for Payer: Aetna New Business (MI Preferred)	$11.76
Rate for Payer: BCBS Complete	$7.24
Rate for Payer: Cash Price	$14.47
Rate for Payer: Cofinity Commercial	$12.66
Rate for Payer: Cofinity Commercial	$15.56
Rate for Payer: Cofinity Medicare Advantage	$12.66
Rate for Payer: Encore Health Key Benefits Commercial	$14.47
Rate for Payer: Healthscope Commercial	$16.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.38
Rate for Payer: PHP Commercial	$15.38
Rate for Payer: Priority Health Cigna Priority Health	$11.76
Rate for Payer: Priority Health SBD	$11.40

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$4.68

Service Code	NDC 00121086840
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.98
Rate for Payer: Aetna Medicare	$2.34
Rate for Payer: Aetna New Business (MI Preferred)	$3.04
Rate for Payer: BCBS Complete	$1.87
Rate for Payer: Cash Price	$3.74
Rate for Payer: Cofinity Commercial	$3.28
Rate for Payer: Cofinity Commercial	$4.02
Rate for Payer: Cofinity Medicare Advantage	$3.28
Rate for Payer: Encore Health Key Benefits Commercial	$3.74
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.98
Rate for Payer: PHP Commercial	$3.98
Rate for Payer: Priority Health Cigna Priority Health	$3.04
Rate for Payer: Priority Health SBD	$2.95

NYSTATIN 100,000 UNIT/ML ORAL SUSPENSION

Facility

$35.07

Service Code	NDC 69315050460
Hospital Charge Code	5751
Hospital Revenue Code	637
Min. Negotiated Rate	$14.03
Max. Negotiated Rate	$31.56
Rate for Payer: Aetna Commercial	$29.81
Rate for Payer: Aetna Medicare	$17.54
Rate for Payer: Aetna New Business (MI Preferred)	$22.80
Rate for Payer: BCBS Complete	$14.03
Rate for Payer: Cash Price	$28.06
Rate for Payer: Cofinity Commercial	$24.55
Rate for Payer: Cofinity Commercial	$30.16
Rate for Payer: Cofinity Medicare Advantage	$24.55
Rate for Payer: Encore Health Key Benefits Commercial	$28.06
Rate for Payer: Healthscope Commercial	$31.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$29.81
Rate for Payer: PHP Commercial	$29.81
Rate for Payer: Priority Health Cigna Priority Health	$22.80
Rate for Payer: Priority Health SBD	$22.09

Know your out-of-pocket cost for care.

All Charges