Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ATORVASTATIN 10 MG TABLET

Facility

$451.20

Service Code	NDC 68084009701
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$284.26
Max. Negotiated Rate	$406.08
Rate for Payer: Aetna Commercial	$383.52
Rate for Payer: Aetna New Business (MI Preferred)	$293.28
Rate for Payer: Cash Price	$360.96
Rate for Payer: Cofinity Commercial	$315.84
Rate for Payer: Cofinity Commercial	$388.03
Rate for Payer: Cofinity Medicare Advantage	$315.84
Rate for Payer: Encore Health Key Benefits Commercial	$360.96
Rate for Payer: Healthscope Commercial	$406.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.52
Rate for Payer: PHP Commercial	$383.52
Rate for Payer: Priority Health Cigna Priority Health	$293.28
Rate for Payer: Priority Health SBD	$284.26

ATORVASTATIN 10 MG TABLET

Facility

$222.30

Service Code	NDC 51079020820
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$140.05
Max. Negotiated Rate	$200.07
Rate for Payer: Aetna Commercial	$188.96
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: Cash Price	$177.84
Rate for Payer: Cofinity Commercial	$155.61
Rate for Payer: Cofinity Commercial	$191.18
Rate for Payer: Cofinity Medicare Advantage	$155.61
Rate for Payer: Encore Health Key Benefits Commercial	$177.84
Rate for Payer: Healthscope Commercial	$200.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.96
Rate for Payer: PHP Commercial	$188.96
Rate for Payer: Priority Health Cigna Priority Health	$144.50
Rate for Payer: Priority Health SBD	$140.05

ATORVASTATIN 10 MG TABLET

Facility

$411.25

Service Code	NDC 00904629061
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$259.09
Max. Negotiated Rate	$370.12
Rate for Payer: Aetna Commercial	$349.56
Rate for Payer: Aetna New Business (MI Preferred)	$267.31
Rate for Payer: Cash Price	$329.00
Rate for Payer: Cofinity Commercial	$287.88
Rate for Payer: Cofinity Commercial	$353.68
Rate for Payer: Cofinity Medicare Advantage	$287.88
Rate for Payer: Encore Health Key Benefits Commercial	$329.00
Rate for Payer: Healthscope Commercial	$370.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$349.56
Rate for Payer: PHP Commercial	$349.56
Rate for Payer: Priority Health Cigna Priority Health	$267.31
Rate for Payer: Priority Health SBD	$259.09

ATORVASTATIN 10 MG TABLET

Facility

$4.70

Service Code	NDC 50268009311
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$4.23
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna New Business (MI Preferred)	$3.06
Rate for Payer: Cash Price	$3.76
Rate for Payer: Cofinity Commercial	$3.29
Rate for Payer: Cofinity Commercial	$4.04
Rate for Payer: Cofinity Medicare Advantage	$3.29
Rate for Payer: Encore Health Key Benefits Commercial	$3.76
Rate for Payer: Healthscope Commercial	$4.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.00
Rate for Payer: PHP Commercial	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.06
Rate for Payer: Priority Health SBD	$2.96

ATORVASTATIN 10 MG TABLET

Facility

$4,180.26

Service Code	NDC 00071015540
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$2,633.56
Max. Negotiated Rate	$3,762.23
Rate for Payer: Aetna Commercial	$3,553.22
Rate for Payer: Aetna New Business (MI Preferred)	$2,717.17
Rate for Payer: Cash Price	$3,344.21
Rate for Payer: Cofinity Commercial	$2,926.18
Rate for Payer: Cofinity Commercial	$3,595.02
Rate for Payer: Cofinity Medicare Advantage	$2,926.18
Rate for Payer: Encore Health Key Benefits Commercial	$3,344.21
Rate for Payer: Healthscope Commercial	$3,762.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,553.22
Rate for Payer: PHP Commercial	$3,553.22
Rate for Payer: Priority Health Cigna Priority Health	$2,717.17
Rate for Payer: Priority Health SBD	$2,633.56

ATORVASTATIN 10 MG TABLET

Facility

$222.30

Service Code	NDC 51079020820
Hospital Charge Code	19176
Hospital Revenue Code	637
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$200.07
Rate for Payer: Aetna Commercial	$188.96
Rate for Payer: Aetna Medicare	$111.15
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: BCBS Complete	$88.92
Rate for Payer: Cash Price	$177.84
Rate for Payer: Cofinity Commercial	$155.61
Rate for Payer: Cofinity Commercial	$191.18
Rate for Payer: Cofinity Medicare Advantage	$155.61
Rate for Payer: Encore Health Key Benefits Commercial	$177.84
Rate for Payer: Healthscope Commercial	$200.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$188.96
Rate for Payer: PHP Commercial	$188.96
Rate for Payer: Priority Health Cigna Priority Health	$144.50
Rate for Payer: Priority Health SBD	$140.05

ATORVASTATIN 20 MG TABLET

Facility

$253.65

Service Code	NDC 51079020920
Hospital Charge Code	19178
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

ATORVASTATIN 20 MG TABLET

Facility

$229.90

Service Code	NDC 68084009801
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

ATORVASTATIN 20 MG TABLET

Facility

$2.30

Service Code	NDC 68084009811
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna Medicare	$1.15
Rate for Payer: Aetna New Business (MI Preferred)	$1.50
Rate for Payer: BCBS Complete	$0.92
Rate for Payer: Cash Price	$1.84
Rate for Payer: Cofinity Commercial	$1.61
Rate for Payer: Cofinity Commercial	$1.98
Rate for Payer: Cofinity Medicare Advantage	$1.61
Rate for Payer: Encore Health Key Benefits Commercial	$1.84
Rate for Payer: Healthscope Commercial	$2.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.96
Rate for Payer: PHP Commercial	$1.96
Rate for Payer: Priority Health Cigna Priority Health	$1.50
Rate for Payer: Priority Health SBD	$1.45

ATORVASTATIN 20 MG TABLET

Facility

$209.00

Service Code	NDC 00904629161
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$131.67
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cofinity Commercial	$146.30
Rate for Payer: Cofinity Commercial	$179.74
Rate for Payer: Cofinity Medicare Advantage	$146.30
Rate for Payer: Encore Health Key Benefits Commercial	$167.20
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.65
Rate for Payer: PHP Commercial	$177.65
Rate for Payer: Priority Health Cigna Priority Health	$135.85
Rate for Payer: Priority Health SBD	$131.67

ATORVASTATIN 20 MG TABLET

Facility

$209.00

Service Code	NDC 00904629161
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$83.60
Max. Negotiated Rate	$188.10
Rate for Payer: Aetna Commercial	$177.65
Rate for Payer: Aetna Medicare	$104.50
Rate for Payer: Aetna New Business (MI Preferred)	$135.85
Rate for Payer: BCBS Complete	$83.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cofinity Commercial	$146.30
Rate for Payer: Cofinity Commercial	$179.74
Rate for Payer: Cofinity Medicare Advantage	$146.30
Rate for Payer: Encore Health Key Benefits Commercial	$167.20
Rate for Payer: Healthscope Commercial	$188.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.65
Rate for Payer: PHP Commercial	$177.65
Rate for Payer: Priority Health Cigna Priority Health	$135.85
Rate for Payer: Priority Health SBD	$131.67

ATORVASTATIN 20 MG TABLET

Facility

$2.30

Service Code	NDC 68084009811
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$2.07
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$1.50
Rate for Payer: Cash Price	$1.84
Rate for Payer: Cofinity Commercial	$1.61
Rate for Payer: Cofinity Commercial	$1.98
Rate for Payer: Cofinity Medicare Advantage	$1.61
Rate for Payer: Encore Health Key Benefits Commercial	$1.84
Rate for Payer: Healthscope Commercial	$2.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.96
Rate for Payer: PHP Commercial	$1.96
Rate for Payer: Priority Health Cigna Priority Health	$1.50
Rate for Payer: Priority Health SBD	$1.45

ATORVASTATIN 20 MG TABLET

Facility

$253.65

Service Code	NDC 51079020920
Hospital Charge Code	19178
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

ATORVASTATIN 20 MG TABLET

Facility

$229.90

Service Code	NDC 68084009801
Hospital Charge Code	19178
Hospital Revenue Code	637
Min. Negotiated Rate	$91.96
Max. Negotiated Rate	$206.91
Rate for Payer: Aetna Commercial	$195.41
Rate for Payer: Aetna Medicare	$114.95
Rate for Payer: Aetna New Business (MI Preferred)	$149.44
Rate for Payer: BCBS Complete	$91.96
Rate for Payer: Cash Price	$183.92
Rate for Payer: Cofinity Commercial	$160.93
Rate for Payer: Cofinity Commercial	$197.71
Rate for Payer: Cofinity Medicare Advantage	$160.93
Rate for Payer: Encore Health Key Benefits Commercial	$183.92
Rate for Payer: Healthscope Commercial	$206.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.41
Rate for Payer: PHP Commercial	$195.41
Rate for Payer: Priority Health Cigna Priority Health	$149.44
Rate for Payer: Priority Health SBD	$144.84

ATORVASTATIN 40 MG TABLET

Facility

$241.30

Service Code	NDC 68084009901
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$96.52
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna Medicare	$120.65
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: BCBS Complete	$96.52
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Cofinity Medicare Advantage	$168.91
Rate for Payer: Encore Health Key Benefits Commercial	$193.04
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$156.84
Rate for Payer: Priority Health SBD	$152.02

ATORVASTATIN 40 MG TABLET

Facility

$235.00

Service Code	NDC 00904629206
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna Commercial	$199.75
Rate for Payer: Aetna Medicare	$117.50
Rate for Payer: Aetna New Business (MI Preferred)	$152.75
Rate for Payer: BCBS Complete	$94.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cofinity Commercial	$164.50
Rate for Payer: Cofinity Commercial	$202.10
Rate for Payer: Cofinity Medicare Advantage	$164.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.00
Rate for Payer: Healthscope Commercial	$211.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$199.75
Rate for Payer: PHP Commercial	$199.75
Rate for Payer: Priority Health Cigna Priority Health	$152.75
Rate for Payer: Priority Health SBD	$148.05

ATORVASTATIN 40 MG TABLET

Facility

$2.09

Service Code	NDC 50268009511
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna New Business (MI Preferred)	$1.36
Rate for Payer: Cash Price	$1.67
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Cofinity Medicare Advantage	$1.46
Rate for Payer: Encore Health Key Benefits Commercial	$1.67
Rate for Payer: Healthscope Commercial	$1.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.78
Rate for Payer: PHP Commercial	$1.78
Rate for Payer: Priority Health Cigna Priority Health	$1.36
Rate for Payer: Priority Health SBD	$1.32

ATORVASTATIN 40 MG TABLET

Facility

$3.86

Service Code	NDC 51079021001
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$3.47
Rate for Payer: Aetna Commercial	$3.28
Rate for Payer: Aetna Medicare	$1.93
Rate for Payer: Aetna New Business (MI Preferred)	$2.51
Rate for Payer: BCBS Complete	$1.54
Rate for Payer: Cash Price	$3.09
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Cofinity Commercial	$3.32
Rate for Payer: Cofinity Medicare Advantage	$2.70
Rate for Payer: Encore Health Key Benefits Commercial	$3.09
Rate for Payer: Healthscope Commercial	$3.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.28
Rate for Payer: PHP Commercial	$3.28
Rate for Payer: Priority Health Cigna Priority Health	$2.51
Rate for Payer: Priority Health SBD	$2.43

ATORVASTATIN 40 MG TABLET

Facility

$235.00

Service Code	NDC 00904629206
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$148.05
Max. Negotiated Rate	$211.50
Rate for Payer: Aetna Commercial	$199.75
Rate for Payer: Aetna New Business (MI Preferred)	$152.75
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cofinity Commercial	$164.50
Rate for Payer: Cofinity Commercial	$202.10
Rate for Payer: Cofinity Medicare Advantage	$164.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.00
Rate for Payer: Healthscope Commercial	$211.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$199.75
Rate for Payer: PHP Commercial	$199.75
Rate for Payer: Priority Health Cigna Priority Health	$152.75
Rate for Payer: Priority Health SBD	$148.05

ATORVASTATIN 40 MG TABLET

Facility

$2.42

Service Code	NDC 68084009911
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna Medicare	$1.21
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: BCBS Complete	$0.97
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

ATORVASTATIN 40 MG TABLET

Facility

$241.30

Service Code	NDC 68084009901
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$152.02
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Cofinity Medicare Advantage	$168.91
Rate for Payer: Encore Health Key Benefits Commercial	$193.04
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$156.84
Rate for Payer: Priority Health SBD	$152.02

ATORVASTATIN 40 MG TABLET

Facility

$304.56

Service Code	NDC 00378395277
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$121.82
Max. Negotiated Rate	$274.10
Rate for Payer: Aetna Commercial	$258.88
Rate for Payer: Aetna Medicare	$152.28
Rate for Payer: Aetna New Business (MI Preferred)	$197.96
Rate for Payer: BCBS Complete	$121.82
Rate for Payer: Cash Price	$243.65
Rate for Payer: Cofinity Commercial	$213.19
Rate for Payer: Cofinity Commercial	$261.92
Rate for Payer: Cofinity Medicare Advantage	$213.19
Rate for Payer: Encore Health Key Benefits Commercial	$243.65
Rate for Payer: Healthscope Commercial	$274.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.88
Rate for Payer: PHP Commercial	$258.88
Rate for Payer: Priority Health Cigna Priority Health	$197.96
Rate for Payer: Priority Health SBD	$191.87

ATORVASTATIN 40 MG TABLET

Facility

$219.45

Service Code	NDC 00904629261
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$87.78
Max. Negotiated Rate	$197.50
Rate for Payer: Aetna Commercial	$186.53
Rate for Payer: Aetna Medicare	$109.72
Rate for Payer: Aetna New Business (MI Preferred)	$142.64
Rate for Payer: BCBS Complete	$87.78
Rate for Payer: Cash Price	$175.56
Rate for Payer: Cofinity Commercial	$153.62
Rate for Payer: Cofinity Commercial	$188.73
Rate for Payer: Cofinity Medicare Advantage	$153.62
Rate for Payer: Encore Health Key Benefits Commercial	$175.56
Rate for Payer: Healthscope Commercial	$197.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$186.53
Rate for Payer: PHP Commercial	$186.53
Rate for Payer: Priority Health Cigna Priority Health	$142.64
Rate for Payer: Priority Health SBD	$138.25

ATORVASTATIN 40 MG TABLET

Facility

$2.42

Service Code	NDC 68084009911
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$2.18
Rate for Payer: Aetna Commercial	$2.06
Rate for Payer: Aetna New Business (MI Preferred)	$1.57
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.69
Rate for Payer: Cofinity Commercial	$2.08
Rate for Payer: Cofinity Medicare Advantage	$1.69
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.06
Rate for Payer: PHP Commercial	$2.06
Rate for Payer: Priority Health Cigna Priority Health	$1.57
Rate for Payer: Priority Health SBD	$1.52

ATORVASTATIN 40 MG TABLET

Facility

$385.70

Service Code	NDC 51079021020
Hospital Charge Code	19177
Hospital Revenue Code	637
Min. Negotiated Rate	$242.99
Max. Negotiated Rate	$347.13
Rate for Payer: Aetna Commercial	$327.85
Rate for Payer: Aetna New Business (MI Preferred)	$250.71
Rate for Payer: Cash Price	$308.56
Rate for Payer: Cofinity Commercial	$269.99
Rate for Payer: Cofinity Commercial	$331.70
Rate for Payer: Cofinity Medicare Advantage	$269.99
Rate for Payer: Encore Health Key Benefits Commercial	$308.56
Rate for Payer: Healthscope Commercial	$347.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.85
Rate for Payer: PHP Commercial	$327.85
Rate for Payer: Priority Health Cigna Priority Health	$250.71
Rate for Payer: Priority Health SBD	$242.99

Know your out-of-pocket cost for care.

All Charges