Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BACLOFEN 10 MG TABLET

Facility

$406.60

Service Code	NDC 60687081501
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$365.94
Rate for Payer: Aetna Commercial	$345.61
Rate for Payer: Aetna New Business (MI Preferred)	$264.29
Rate for Payer: Cash Price	$325.28
Rate for Payer: Cofinity Commercial	$284.62
Rate for Payer: Cofinity Commercial	$349.68
Rate for Payer: Cofinity Medicare Advantage	$284.62
Rate for Payer: Encore Health Key Benefits Commercial	$325.28
Rate for Payer: Healthscope Commercial	$365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.61
Rate for Payer: PHP Commercial	$345.61
Rate for Payer: Priority Health Cigna Priority Health	$264.29
Rate for Payer: Priority Health SBD	$256.16

BACLOFEN 10 MG TABLET

Facility

$4.07

Service Code	NDC 60687081511
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$2.56
Max. Negotiated Rate	$3.66
Rate for Payer: Aetna Commercial	$3.46
Rate for Payer: Aetna New Business (MI Preferred)	$2.65
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cofinity Commercial	$2.85
Rate for Payer: Cofinity Commercial	$3.50
Rate for Payer: Cofinity Medicare Advantage	$2.85
Rate for Payer: Encore Health Key Benefits Commercial	$3.26
Rate for Payer: Healthscope Commercial	$3.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.46
Rate for Payer: PHP Commercial	$3.46
Rate for Payer: Priority Health Cigna Priority Health	$2.65
Rate for Payer: Priority Health SBD	$2.56

BACLOFEN 10 MG TABLET

Facility

$4.07

Service Code	NDC 60687081511
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.66
Rate for Payer: Aetna Commercial	$3.46
Rate for Payer: Aetna Medicare	$2.04
Rate for Payer: Aetna New Business (MI Preferred)	$2.65
Rate for Payer: BCBS Complete	$1.63
Rate for Payer: Cash Price	$3.26
Rate for Payer: Cofinity Commercial	$2.85
Rate for Payer: Cofinity Commercial	$3.50
Rate for Payer: Cofinity Medicare Advantage	$2.85
Rate for Payer: Encore Health Key Benefits Commercial	$3.26
Rate for Payer: Healthscope Commercial	$3.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.46
Rate for Payer: PHP Commercial	$3.46
Rate for Payer: Priority Health Cigna Priority Health	$2.65
Rate for Payer: Priority Health SBD	$2.56

BACLOFEN 10 MG TABLET

Facility

$1,692.00

Service Code	NDC 00172409680
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$676.80
Max. Negotiated Rate	$1,522.80
Rate for Payer: Aetna Commercial	$1,438.20
Rate for Payer: Aetna Medicare	$846.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,099.80
Rate for Payer: BCBS Complete	$676.80
Rate for Payer: Cash Price	$1,353.60
Rate for Payer: Cofinity Commercial	$1,184.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Cofinity Medicare Advantage	$1,184.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,353.60
Rate for Payer: Healthscope Commercial	$1,522.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,438.20
Rate for Payer: PHP Commercial	$1,438.20
Rate for Payer: Priority Health Cigna Priority Health	$1,099.80
Rate for Payer: Priority Health SBD	$1,065.96

BACLOFEN 10 MG TABLET

Facility

$96.35

Service Code	NDC 72888001001
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$60.70
Max. Negotiated Rate	$86.72
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$62.63
Rate for Payer: Cash Price	$77.08
Rate for Payer: Cofinity Commercial	$67.44
Rate for Payer: Cofinity Commercial	$82.86
Rate for Payer: Cofinity Medicare Advantage	$67.44
Rate for Payer: Encore Health Key Benefits Commercial	$77.08
Rate for Payer: Healthscope Commercial	$86.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.90
Rate for Payer: PHP Commercial	$81.90
Rate for Payer: Priority Health Cigna Priority Health	$62.63
Rate for Payer: Priority Health SBD	$60.70

BACLOFEN 10 MG TABLET

Facility

$131.60

Service Code	NDC 52817032010
Hospital Charge Code	860
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: Cofinity Medicare Advantage	$92.12
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health Cigna Priority Health	$85.54
Rate for Payer: Priority Health SBD	$82.91

BACLOFEN 10 MG TABLET

Facility

$131.60

Service Code	NDC 52817032010
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$52.64
Max. Negotiated Rate	$118.44
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna Medicare	$65.80
Rate for Payer: Aetna New Business (MI Preferred)	$85.54
Rate for Payer: BCBS Complete	$52.64
Rate for Payer: Cash Price	$105.28
Rate for Payer: Cofinity Commercial	$113.18
Rate for Payer: Cofinity Commercial	$92.12
Rate for Payer: Cofinity Medicare Advantage	$92.12
Rate for Payer: Encore Health Key Benefits Commercial	$105.28
Rate for Payer: Healthscope Commercial	$118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.86
Rate for Payer: PHP Commercial	$111.86
Rate for Payer: Priority Health Cigna Priority Health	$85.54
Rate for Payer: Priority Health SBD	$82.91

BACLOFEN 10 MG TABLET

Facility

$2.55

Service Code	NDC 60687050311
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.29
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna Medicare	$1.27
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: BCBS Complete	$1.02
Rate for Payer: Cash Price	$2.04
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Commercial	$2.19
Rate for Payer: Cofinity Medicare Advantage	$1.78
Rate for Payer: Encore Health Key Benefits Commercial	$2.04
Rate for Payer: Healthscope Commercial	$2.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.17
Rate for Payer: PHP Commercial	$2.17
Rate for Payer: Priority Health Cigna Priority Health	$1.66
Rate for Payer: Priority Health SBD	$1.61

BACLOFEN 10 MG TABLET

Facility

$158.18

Service Code	NDC 50268010615
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$99.65
Max. Negotiated Rate	$142.36
Rate for Payer: Aetna Commercial	$134.45
Rate for Payer: Aetna New Business (MI Preferred)	$102.82
Rate for Payer: Cash Price	$126.54
Rate for Payer: Cofinity Commercial	$110.73
Rate for Payer: Cofinity Commercial	$136.03
Rate for Payer: Cofinity Medicare Advantage	$110.73
Rate for Payer: Encore Health Key Benefits Commercial	$126.54
Rate for Payer: Healthscope Commercial	$142.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.45
Rate for Payer: PHP Commercial	$134.45
Rate for Payer: Priority Health Cigna Priority Health	$102.82
Rate for Payer: Priority Health SBD	$99.65

BACLOFEN 10 MG TABLET

Facility

$178.60

Service Code	NDC 00172409660
Hospital Charge Code	860
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

BACLOFEN 10 MG TABLET

Facility

$406.60

Service Code	NDC 60687081501
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$162.64
Max. Negotiated Rate	$365.94
Rate for Payer: Aetna Commercial	$345.61
Rate for Payer: Aetna Medicare	$203.30
Rate for Payer: Aetna New Business (MI Preferred)	$264.29
Rate for Payer: BCBS Complete	$162.64
Rate for Payer: Cash Price	$325.28
Rate for Payer: Cofinity Commercial	$284.62
Rate for Payer: Cofinity Commercial	$349.68
Rate for Payer: Cofinity Medicare Advantage	$284.62
Rate for Payer: Encore Health Key Benefits Commercial	$325.28
Rate for Payer: Healthscope Commercial	$365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.61
Rate for Payer: PHP Commercial	$345.61
Rate for Payer: Priority Health Cigna Priority Health	$264.29
Rate for Payer: Priority Health SBD	$256.16

BACLOFEN 10 MG TABLET

Facility

$3.17

Service Code	NDC 50268010611
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.06
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.22
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Cofinity Medicare Advantage	$2.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.06
Rate for Payer: Priority Health SBD	$2.00

BACLOFEN 10 MG TABLET

Facility

$3.17

Service Code	NDC 50268010611
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$2.06
Rate for Payer: BCBS Complete	$1.27
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.22
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Cofinity Medicare Advantage	$2.22
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.06
Rate for Payer: Priority Health SBD	$2.00

BACLOFEN 10 MG TABLET

Facility

$341.05

Service Code	NDC 00904647561
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$214.86
Max. Negotiated Rate	$306.94
Rate for Payer: Aetna Commercial	$289.89
Rate for Payer: Aetna New Business (MI Preferred)	$221.68
Rate for Payer: Cash Price	$272.84
Rate for Payer: Cofinity Commercial	$238.74
Rate for Payer: Cofinity Commercial	$293.30
Rate for Payer: Cofinity Medicare Advantage	$238.74
Rate for Payer: Encore Health Key Benefits Commercial	$272.84
Rate for Payer: Healthscope Commercial	$306.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.89
Rate for Payer: PHP Commercial	$289.89
Rate for Payer: Priority Health Cigna Priority Health	$221.68
Rate for Payer: Priority Health SBD	$214.86

BACLOFEN 10 MG TABLET

Facility

$1,692.00

Service Code	NDC 00172409680
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1,065.96
Max. Negotiated Rate	$1,522.80
Rate for Payer: Aetna Commercial	$1,438.20
Rate for Payer: Aetna New Business (MI Preferred)	$1,099.80
Rate for Payer: Cash Price	$1,353.60
Rate for Payer: Cofinity Commercial	$1,184.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Cofinity Medicare Advantage	$1,184.40
Rate for Payer: Encore Health Key Benefits Commercial	$1,353.60
Rate for Payer: Healthscope Commercial	$1,522.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,438.20
Rate for Payer: PHP Commercial	$1,438.20
Rate for Payer: Priority Health Cigna Priority Health	$1,099.80
Rate for Payer: Priority Health SBD	$1,065.96

BACLOFEN 10 MG TABLET

Facility

$341.05

Service Code	NDC 00904647561
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$136.42
Max. Negotiated Rate	$306.94
Rate for Payer: Aetna Commercial	$289.89
Rate for Payer: Aetna Medicare	$170.53
Rate for Payer: Aetna New Business (MI Preferred)	$221.68
Rate for Payer: BCBS Complete	$136.42
Rate for Payer: Cash Price	$272.84
Rate for Payer: Cofinity Commercial	$238.74
Rate for Payer: Cofinity Commercial	$293.30
Rate for Payer: Cofinity Medicare Advantage	$238.74
Rate for Payer: Encore Health Key Benefits Commercial	$272.84
Rate for Payer: Healthscope Commercial	$306.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.89
Rate for Payer: PHP Commercial	$289.89
Rate for Payer: Priority Health Cigna Priority Health	$221.68
Rate for Payer: Priority Health SBD	$214.86

BACLOFEN 10 MG TABLET

Facility

$178.60

Service Code	NDC 00172409660
Hospital Charge Code	860
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

BACLOFEN 10 MG TABLET

Facility

$254.88

Service Code	NDC 60687050301
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$101.95
Max. Negotiated Rate	$229.39
Rate for Payer: Aetna Commercial	$216.65
Rate for Payer: Aetna Medicare	$127.44
Rate for Payer: Aetna New Business (MI Preferred)	$165.67
Rate for Payer: BCBS Complete	$101.95
Rate for Payer: Cash Price	$203.90
Rate for Payer: Cofinity Commercial	$178.42
Rate for Payer: Cofinity Commercial	$219.20
Rate for Payer: Cofinity Medicare Advantage	$178.42
Rate for Payer: Encore Health Key Benefits Commercial	$203.90
Rate for Payer: Healthscope Commercial	$229.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.65
Rate for Payer: PHP Commercial	$216.65
Rate for Payer: Priority Health Cigna Priority Health	$165.67
Rate for Payer: Priority Health SBD	$160.57

BACLOFEN 10 MG TABLET

Facility

$158.18

Service Code	NDC 50268010615
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$63.27
Max. Negotiated Rate	$142.36
Rate for Payer: Aetna Commercial	$134.45
Rate for Payer: Aetna Medicare	$79.09
Rate for Payer: Aetna New Business (MI Preferred)	$102.82
Rate for Payer: BCBS Complete	$63.27
Rate for Payer: Cash Price	$126.54
Rate for Payer: Cofinity Commercial	$110.73
Rate for Payer: Cofinity Commercial	$136.03
Rate for Payer: Cofinity Medicare Advantage	$110.73
Rate for Payer: Encore Health Key Benefits Commercial	$126.54
Rate for Payer: Healthscope Commercial	$142.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.45
Rate for Payer: PHP Commercial	$134.45
Rate for Payer: Priority Health Cigna Priority Health	$102.82
Rate for Payer: Priority Health SBD	$99.65

BACLOFEN 10 MG TABLET

Facility

$96.35

Service Code	NDC 72888001001
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$86.72
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna Medicare	$48.17
Rate for Payer: Aetna New Business (MI Preferred)	$62.63
Rate for Payer: BCBS Complete	$38.54
Rate for Payer: Cash Price	$77.08
Rate for Payer: Cofinity Commercial	$67.44
Rate for Payer: Cofinity Commercial	$82.86
Rate for Payer: Cofinity Medicare Advantage	$67.44
Rate for Payer: Encore Health Key Benefits Commercial	$77.08
Rate for Payer: Healthscope Commercial	$86.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$81.90
Rate for Payer: PHP Commercial	$81.90
Rate for Payer: Priority Health Cigna Priority Health	$62.63
Rate for Payer: Priority Health SBD	$60.70

BACLOFEN 10 MG TABLET

Facility

$2.55

Service Code	NDC 60687050311
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$2.29
Rate for Payer: Aetna Commercial	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$1.66
Rate for Payer: Cash Price	$2.04
Rate for Payer: Cofinity Commercial	$1.78
Rate for Payer: Cofinity Commercial	$2.19
Rate for Payer: Cofinity Medicare Advantage	$1.78
Rate for Payer: Encore Health Key Benefits Commercial	$2.04
Rate for Payer: Healthscope Commercial	$2.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.17
Rate for Payer: PHP Commercial	$2.17
Rate for Payer: Priority Health Cigna Priority Health	$1.66
Rate for Payer: Priority Health SBD	$1.61

BACLOFEN 10 MG TABLET

Facility

$254.88

Service Code	NDC 60687050301
Hospital Charge Code	860
Hospital Revenue Code	637
Min. Negotiated Rate	$160.57
Max. Negotiated Rate	$229.39
Rate for Payer: Aetna Commercial	$216.65
Rate for Payer: Aetna New Business (MI Preferred)	$165.67
Rate for Payer: Cash Price	$203.90
Rate for Payer: Cofinity Commercial	$178.42
Rate for Payer: Cofinity Commercial	$219.20
Rate for Payer: Cofinity Medicare Advantage	$178.42
Rate for Payer: Encore Health Key Benefits Commercial	$203.90
Rate for Payer: Healthscope Commercial	$229.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$216.65
Rate for Payer: PHP Commercial	$216.65
Rate for Payer: Priority Health Cigna Priority Health	$165.67
Rate for Payer: Priority Health SBD	$160.57

BACLOFEN 20 MG TABLET

Facility

$246.72

Service Code	NDC 00904647661
Hospital Charge Code	861
Hospital Revenue Code	637
Min. Negotiated Rate	$98.69
Max. Negotiated Rate	$222.05
Rate for Payer: Aetna Commercial	$209.71
Rate for Payer: Aetna Medicare	$123.36
Rate for Payer: Aetna New Business (MI Preferred)	$160.37
Rate for Payer: BCBS Complete	$98.69
Rate for Payer: Cash Price	$197.38
Rate for Payer: Cofinity Commercial	$172.70
Rate for Payer: Cofinity Commercial	$212.18
Rate for Payer: Cofinity Medicare Advantage	$172.70
Rate for Payer: Encore Health Key Benefits Commercial	$197.38
Rate for Payer: Healthscope Commercial	$222.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.71
Rate for Payer: PHP Commercial	$209.71
Rate for Payer: Priority Health Cigna Priority Health	$160.37
Rate for Payer: Priority Health SBD	$155.43

BACLOFEN 20 MG TABLET

Facility

$246.72

Service Code	NDC 00904647661
Hospital Charge Code	861
Hospital Revenue Code	637
Min. Negotiated Rate	$155.43
Max. Negotiated Rate	$222.05
Rate for Payer: Aetna Commercial	$209.71
Rate for Payer: Aetna New Business (MI Preferred)	$160.37
Rate for Payer: Cash Price	$197.38
Rate for Payer: Cofinity Commercial	$172.70
Rate for Payer: Cofinity Commercial	$212.18
Rate for Payer: Cofinity Medicare Advantage	$172.70
Rate for Payer: Encore Health Key Benefits Commercial	$197.38
Rate for Payer: Healthscope Commercial	$222.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$209.71
Rate for Payer: PHP Commercial	$209.71
Rate for Payer: Priority Health Cigna Priority Health	$160.37
Rate for Payer: Priority Health SBD	$155.43

BACLOFEN 5 MG TABLET

Facility

$261.84

Service Code	NDC 50268010515
Hospital Charge Code	186653
Hospital Revenue Code	637
Min. Negotiated Rate	$104.74
Max. Negotiated Rate	$235.66
Rate for Payer: Aetna Commercial	$222.56
Rate for Payer: Aetna Medicare	$130.92
Rate for Payer: Aetna New Business (MI Preferred)	$170.20
Rate for Payer: BCBS Complete	$104.74
Rate for Payer: Cash Price	$209.47
Rate for Payer: Cofinity Commercial	$183.29
Rate for Payer: Cofinity Commercial	$225.18
Rate for Payer: Cofinity Medicare Advantage	$183.29
Rate for Payer: Encore Health Key Benefits Commercial	$209.47
Rate for Payer: Healthscope Commercial	$235.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.56
Rate for Payer: PHP Commercial	$222.56
Rate for Payer: Priority Health Cigna Priority Health	$170.20
Rate for Payer: Priority Health SBD	$164.96

Know your out-of-pocket cost for care.

All Charges