Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SODIUM HYPOCHLORITE 0.25 % SOLUTION

Facility

$12.00

Service Code	NDC 9900-0018-65
Hospital Charge Code	15950
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$34.77

Service Code	NDC 39328-062-50
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$21.91
Max. Negotiated Rate	$31.29
Rate for Payer: Aetna Commercial	$29.55
Rate for Payer: Aetna New Business (MI Preferred)	$22.60
Rate for Payer: Cash Price	$27.82
Rate for Payer: Cofinity Commercial	$24.34
Rate for Payer: Cofinity Commercial	$29.90
Rate for Payer: Healthscope Commercial	$31.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.55
Rate for Payer: PHP Commercial	$29.55
Rate for Payer: Priority Health Cigna Priority Health	$24.34
Rate for Payer: Priority Health SBD	$21.91

SODIUM HYPOCHLORITE 0.5 % SOLUTION

Facility

$12.00

Service Code	NDC 9900-0018-66
Hospital Charge Code	2110
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$10.80
Rate for Payer: Aetna Commercial	$10.20
Rate for Payer: Aetna New Business (MI Preferred)	$7.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$10.32
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Healthscope Commercial	$10.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.20
Rate for Payer: PHP Commercial	$10.20
Rate for Payer: Priority Health Cigna Priority Health	$8.40
Rate for Payer: Priority Health SBD	$7.56

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$430.62

Service Code	NDC 25021-310-02
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$271.29
Max. Negotiated Rate	$387.56
Rate for Payer: Aetna Commercial	$366.03
Rate for Payer: Aetna New Business (MI Preferred)	$279.90
Rate for Payer: Cash Price	$344.50
Rate for Payer: Cofinity Commercial	$301.43
Rate for Payer: Cofinity Commercial	$370.33
Rate for Payer: Healthscope Commercial	$387.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$366.03
Rate for Payer: PHP Commercial	$366.03
Rate for Payer: Priority Health Cigna Priority Health	$301.43
Rate for Payer: Priority Health SBD	$271.29

SODIUM NITROPRUSSIDE 25 MG/ML INTRAVENOUS SOLUTION

Facility

$47.93

Service Code	NDC 70069-261-01
Hospital Charge Code	18908
Hospital Revenue Code	250
Min. Negotiated Rate	$30.20
Max. Negotiated Rate	$43.14
Rate for Payer: Aetna Commercial	$40.74
Rate for Payer: Aetna New Business (MI Preferred)	$31.15
Rate for Payer: Cash Price	$38.34
Rate for Payer: Cofinity Commercial	$33.55
Rate for Payer: Cofinity Commercial	$41.22
Rate for Payer: Healthscope Commercial	$43.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$40.74
Rate for Payer: PHP Commercial	$40.74
Rate for Payer: Priority Health Cigna Priority Health	$33.55
Rate for Payer: Priority Health SBD	$30.20

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$246.43

Service Code	NDC 0409-7391-72
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$155.25
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$172.50
Rate for Payer: Priority Health SBD	$155.25

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$111.71

Service Code	NDC 63323-170-05
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$70.38
Max. Negotiated Rate	$100.54
Rate for Payer: Aetna Commercial	$94.95
Rate for Payer: Aetna New Business (MI Preferred)	$72.61
Rate for Payer: Cash Price	$89.37
Rate for Payer: Cofinity Commercial	$78.20
Rate for Payer: Cofinity Commercial	$96.07
Rate for Payer: Healthscope Commercial	$100.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$94.95
Rate for Payer: PHP Commercial	$94.95
Rate for Payer: Priority Health Cigna Priority Health	$78.20
Rate for Payer: Priority Health SBD	$70.38

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$285.80

Service Code	NDC 63323-170-15
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$180.05
Max. Negotiated Rate	$257.22
Rate for Payer: Aetna Commercial	$242.93
Rate for Payer: Aetna New Business (MI Preferred)	$185.77
Rate for Payer: Cash Price	$228.64
Rate for Payer: Cofinity Commercial	$200.06
Rate for Payer: Cofinity Commercial	$245.79
Rate for Payer: Healthscope Commercial	$257.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$242.93
Rate for Payer: PHP Commercial	$242.93
Rate for Payer: Priority Health Cigna Priority Health	$200.06
Rate for Payer: Priority Health SBD	$180.05

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION

Facility

$285.80

Service Code	NDC 63323-170-15
Hospital Charge Code	7351
Hospital Revenue Code	250
Min. Negotiated Rate	$114.32
Max. Negotiated Rate	$257.22
Rate for Payer: Aetna Commercial	$242.93
Rate for Payer: Aetna New Business (MI Preferred)	$185.77
Rate for Payer: BCBS Complete	$114.32
Rate for Payer: Cash Price	$228.64
Rate for Payer: Cofinity Commercial	$200.06
Rate for Payer: Cofinity Commercial	$245.79
Rate for Payer: Healthscope Commercial	$257.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$242.93
Rate for Payer: PHP Commercial	$242.93
Rate for Payer: Priority Health Cigna Priority Health	$200.06
Rate for Payer: Priority Health SBD	$180.05

SODIUM PHOSPHATE 3 MMOL/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$246.43

Service Code	NDC 9900-0019-20
Hospital Charge Code	301290
Hospital Revenue Code	250
Min. Negotiated Rate	$155.25
Max. Negotiated Rate	$221.79
Rate for Payer: Aetna Commercial	$209.47
Rate for Payer: Aetna New Business (MI Preferred)	$160.18
Rate for Payer: Cash Price	$197.14
Rate for Payer: Cofinity Commercial	$172.50
Rate for Payer: Cofinity Commercial	$211.93
Rate for Payer: Healthscope Commercial	$221.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$209.47
Rate for Payer: PHP Commercial	$209.47
Rate for Payer: Priority Health Cigna Priority Health	$172.50
Rate for Payer: Priority Health SBD	$155.25

SODIUM PHOSPHATES 19 GRAM-7 GRAM/118 ML ENEMA

Facility

$31.26

Service Code	NDC 0132-0201-40
Hospital Charge Code	11395
Hospital Revenue Code	637
Min. Negotiated Rate	$19.69
Max. Negotiated Rate	$28.13
Rate for Payer: Aetna Commercial	$26.57
Rate for Payer: Aetna New Business (MI Preferred)	$20.32
Rate for Payer: Cash Price	$25.01
Rate for Payer: Cofinity Commercial	$21.88
Rate for Payer: Cofinity Commercial	$26.88
Rate for Payer: Healthscope Commercial	$28.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.57
Rate for Payer: PHP Commercial	$26.57
Rate for Payer: Priority Health Cigna Priority Health	$21.88
Rate for Payer: Priority Health SBD	$19.69

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$621.29

Service Code	NDC 46287-006-01
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$391.41
Max. Negotiated Rate	$559.16
Rate for Payer: Aetna Commercial	$528.10
Rate for Payer: Aetna New Business (MI Preferred)	$403.84
Rate for Payer: Cash Price	$497.03
Rate for Payer: Cofinity Commercial	$434.90
Rate for Payer: Cofinity Commercial	$534.31
Rate for Payer: Healthscope Commercial	$559.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$528.10
Rate for Payer: PHP Commercial	$528.10
Rate for Payer: Priority Health Cigna Priority Health	$434.90
Rate for Payer: Priority Health SBD	$391.41

SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSPENSION

Facility

$77.04

Service Code	NDC 46287-006-60
Hospital Charge Code	27999
Hospital Revenue Code	637
Min. Negotiated Rate	$48.54
Max. Negotiated Rate	$69.34
Rate for Payer: Aetna Commercial	$65.48
Rate for Payer: Aetna New Business (MI Preferred)	$50.08
Rate for Payer: Cash Price	$61.63
Rate for Payer: Cofinity Commercial	$53.93
Rate for Payer: Cofinity Commercial	$66.25
Rate for Payer: Healthscope Commercial	$69.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$65.48
Rate for Payer: PHP Commercial	$65.48
Rate for Payer: Priority Health Cigna Priority Health	$53.93
Rate for Payer: Priority Health SBD	$48.54

SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) INTRAVENOUS SOLUTION

Facility

$344.35

Service Code	HCPCS J0208
Hospital Charge Code	7364
Hospital Revenue Code	636
Min. Negotiated Rate	$216.94
Max. Negotiated Rate	$309.92
Rate for Payer: Aetna Commercial	$292.70
Rate for Payer: Aetna New Business (MI Preferred)	$223.83
Rate for Payer: Cash Price	$275.48
Rate for Payer: Cofinity Commercial	$241.04
Rate for Payer: Cofinity Commercial	$296.14
Rate for Payer: Healthscope Commercial	$309.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$292.70
Rate for Payer: PHP Commercial	$292.70
Rate for Payer: Priority Health Cigna Priority Health	$241.04
Rate for Payer: Priority Health SBD	$216.94

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$16.00

Service Code	NDC 0310-1110-01
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna New Business (MI Preferred)	$10.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$11.20
Rate for Payer: Cofinity Commercial	$13.76
Rate for Payer: Healthscope Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: PHP Commercial	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health SBD	$10.08

SODIUM ZIRCONIUM CYCLOSILICATE 10 GRAM ORAL POWDER PACKET

Facility

$479.97

Service Code	NDC 0310-1110-30
Hospital Charge Code	188049
Hospital Revenue Code	637
Min. Negotiated Rate	$302.38
Max. Negotiated Rate	$431.97
Rate for Payer: Aetna Commercial	$407.97
Rate for Payer: Aetna New Business (MI Preferred)	$311.98
Rate for Payer: Cash Price	$383.98
Rate for Payer: Cofinity Commercial	$335.98
Rate for Payer: Cofinity Commercial	$412.77
Rate for Payer: Healthscope Commercial	$431.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$407.97
Rate for Payer: PHP Commercial	$407.97
Rate for Payer: Priority Health Cigna Priority Health	$335.98
Rate for Payer: Priority Health SBD	$302.38

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$175.99

Service Code	NDC 0310-1105-39
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$110.87
Max. Negotiated Rate	$158.39
Rate for Payer: Aetna Commercial	$149.59
Rate for Payer: Aetna New Business (MI Preferred)	$114.39
Rate for Payer: Cash Price	$140.79
Rate for Payer: Cofinity Commercial	$123.19
Rate for Payer: Cofinity Commercial	$151.35
Rate for Payer: Healthscope Commercial	$158.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.59
Rate for Payer: PHP Commercial	$149.59
Rate for Payer: Priority Health Cigna Priority Health	$123.19
Rate for Payer: Priority Health SBD	$110.87

SODIUM ZIRCONIUM CYCLOSILICATE 5 GRAM ORAL POWDER PACKET

Facility

$16.00

Service Code	NDC 0310-1105-01
Hospital Charge Code	188048
Hospital Revenue Code	637
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$14.40
Rate for Payer: Aetna Commercial	$13.60
Rate for Payer: Aetna New Business (MI Preferred)	$10.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cofinity Commercial	$11.20
Rate for Payer: Cofinity Commercial	$13.76
Rate for Payer: Healthscope Commercial	$14.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.60
Rate for Payer: PHP Commercial	$13.60
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health SBD	$10.08

SOFT TISSUE PROCEDURES WITH CC

Facility

$31,135.67

Service Code	MS-DRG 501
Min. Negotiated Rate	$12,343.24
Max. Negotiated Rate	$31,135.67
Rate for Payer: Aetna Medicare	$13,512.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,241.10
Rate for Payer: Amish Plain Church Group Commercial	$16,241.10
Rate for Payer: BCBS MAPPO	$12,992.88
Rate for Payer: BCBS Trust/PPO	$31,135.67
Rate for Payer: BCN Medicare Advantage	$12,992.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,992.88
Rate for Payer: Mclaren Medicare	$12,992.88
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,642.52
Rate for Payer: MI Amish Medical Board Commercial	$14,941.81
Rate for Payer: PACE Medicare	$12,343.24
Rate for Payer: PACE SWMI	$12,992.88
Rate for Payer: PHP Medicare Advantage	$12,992.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24,907.16
Rate for Payer: Priority Health Medicare	$12,992.88
Rate for Payer: Priority Health Narrow Network	$19,925.73
Rate for Payer: Railroad Medicare Medicare	$12,992.88
Rate for Payer: UHC All Payor (Choice/PPO)	$26,476.37
Rate for Payer: UHC Core	$16,246.15
Rate for Payer: UHC Dual Complete DSNP	$12,992.88
Rate for Payer: UHC Exchange	$17,400.39
Rate for Payer: UHC Medicare Advantage	$13,382.67
Rate for Payer: VA VA	$12,992.88

SOFT TISSUE PROCEDURES WITH MCC

Facility

$64,276.19

Service Code	MS-DRG 500
Min. Negotiated Rate	$22,654.37
Max. Negotiated Rate	$64,276.19
Rate for Payer: Aetna Medicare	$24,800.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$29,808.39
Rate for Payer: Amish Plain Church Group Commercial	$29,808.39
Rate for Payer: BCBS MAPPO	$23,846.71
Rate for Payer: BCBS Trust/PPO	$64,276.19
Rate for Payer: BCN Medicare Advantage	$23,846.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,846.71
Rate for Payer: Mclaren Medicare	$23,846.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$25,039.05
Rate for Payer: MI Amish Medical Board Commercial	$27,423.72
Rate for Payer: PACE Medicare	$22,654.37
Rate for Payer: PACE SWMI	$23,846.71
Rate for Payer: PHP Medicare Advantage	$23,846.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$46,533.92
Rate for Payer: Priority Health Medicare	$23,846.71
Rate for Payer: Priority Health Narrow Network	$37,227.14
Rate for Payer: Railroad Medicare Medicare	$23,846.71
Rate for Payer: UHC All Payor (Choice/PPO)	$49,465.67
Rate for Payer: UHC Core	$30,352.61
Rate for Payer: UHC Dual Complete DSNP	$23,846.71
Rate for Payer: UHC Exchange	$32,509.07
Rate for Payer: UHC Medicare Advantage	$24,562.11
Rate for Payer: VA VA	$23,846.71

SOFT TISSUE PROCEDURES WITHOUT CC/MCC

Facility

$26,923.93

Service Code	MS-DRG 502
Min. Negotiated Rate	$9,928.13
Max. Negotiated Rate	$26,923.93
Rate for Payer: Aetna Medicare	$10,868.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,063.32
Rate for Payer: Amish Plain Church Group Commercial	$13,063.32
Rate for Payer: BCBS MAPPO	$10,450.66
Rate for Payer: BCBS Trust/PPO	$26,923.93
Rate for Payer: BCN Medicare Advantage	$10,450.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,450.66
Rate for Payer: Mclaren Medicare	$10,450.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,973.19
Rate for Payer: MI Amish Medical Board Commercial	$12,018.26
Rate for Payer: PACE Medicare	$9,928.13
Rate for Payer: PACE SWMI	$10,450.66
Rate for Payer: PHP Medicare Advantage	$10,450.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,841.63
Rate for Payer: Priority Health Medicare	$10,450.66
Rate for Payer: Priority Health Narrow Network	$15,873.30
Rate for Payer: Railroad Medicare Medicare	$10,450.66
Rate for Payer: UHC All Payor (Choice/PPO)	$21,091.71
Rate for Payer: UHC Core	$12,942.07
Rate for Payer: UHC Dual Complete DSNP	$10,450.66
Rate for Payer: UHC Exchange	$13,861.57
Rate for Payer: UHC Medicare Advantage	$10,764.18
Rate for Payer: VA VA	$10,450.66

SORBITOL 70 % SOLUTION

Facility

$29.76

Service Code	NDC 802391316
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$26.78
Rate for Payer: Aetna Commercial	$25.30
Rate for Payer: Aetna New Business (MI Preferred)	$19.34
Rate for Payer: Cash Price	$23.81
Rate for Payer: Cofinity Commercial	$20.83
Rate for Payer: Cofinity Commercial	$25.59
Rate for Payer: Healthscope Commercial	$26.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.30
Rate for Payer: PHP Commercial	$25.30
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$18.75

SORBITOL 70 % SOLUTION

Facility

$10.51

Service Code	NDC 57896-435-16
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$9.46
Rate for Payer: Aetna Commercial	$8.93
Rate for Payer: Aetna New Business (MI Preferred)	$6.83
Rate for Payer: Cash Price	$8.41
Rate for Payer: Cofinity Commercial	$7.36
Rate for Payer: Cofinity Commercial	$9.04
Rate for Payer: Healthscope Commercial	$9.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.93
Rate for Payer: PHP Commercial	$8.93
Rate for Payer: Priority Health Cigna Priority Health	$7.36
Rate for Payer: Priority Health SBD	$6.62

SORBITOL 70 % SOLUTION

Facility

$52.51

Service Code	NDC 4628750001
Hospital Charge Code	7413
Hospital Revenue Code	637
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$47.26
Rate for Payer: Aetna Commercial	$44.63
Rate for Payer: Aetna New Business (MI Preferred)	$34.13
Rate for Payer: Cash Price	$42.01
Rate for Payer: Cofinity Commercial	$36.76
Rate for Payer: Cofinity Commercial	$45.16
Rate for Payer: Healthscope Commercial	$47.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$44.63
Rate for Payer: PHP Commercial	$44.63
Rate for Payer: Priority Health Cigna Priority Health	$36.76
Rate for Payer: Priority Health SBD	$33.08

SOTALOL 80 MG TABLET

Facility

$5.01

Service Code	NDC 68084-654-11
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$4.51
Rate for Payer: Aetna Commercial	$4.26
Rate for Payer: Aetna New Business (MI Preferred)	$3.26
Rate for Payer: Cash Price	$4.01
Rate for Payer: Cofinity Commercial	$3.51
Rate for Payer: Cofinity Commercial	$4.31
Rate for Payer: Healthscope Commercial	$4.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.26
Rate for Payer: PHP Commercial	$4.26
Rate for Payer: Priority Health Cigna Priority Health	$3.51
Rate for Payer: Priority Health SBD	$3.16

Know your out-of-pocket cost for care.

All Charges