Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUSPIRONE 15 MG TABLET

Facility

$4.56

Service Code	NDC 51079096001
Hospital Charge Code	17464
Hospital Revenue Code	637
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.96
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cofinity Commercial	$3.19
Rate for Payer: Cofinity Commercial	$3.92
Rate for Payer: Cofinity Medicare Advantage	$3.19
Rate for Payer: Encore Health Key Benefits Commercial	$3.65
Rate for Payer: Healthscope Commercial	$4.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.88
Rate for Payer: PHP Commercial	$3.88
Rate for Payer: Priority Health Cigna Priority Health	$2.96
Rate for Payer: Priority Health SBD	$2.87

BUSPIRONE 15 MG TABLET

Facility

$455.05

Service Code	NDC 51079096020
Hospital Charge Code	17464
Hospital Revenue Code	637
Min. Negotiated Rate	$286.68
Max. Negotiated Rate	$409.55
Rate for Payer: Aetna Commercial	$386.79
Rate for Payer: Aetna New Business (MI Preferred)	$295.78
Rate for Payer: Cash Price	$364.04
Rate for Payer: Cofinity Commercial	$318.54
Rate for Payer: Cofinity Commercial	$391.34
Rate for Payer: Cofinity Medicare Advantage	$318.54
Rate for Payer: Encore Health Key Benefits Commercial	$364.04
Rate for Payer: Healthscope Commercial	$409.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$386.79
Rate for Payer: PHP Commercial	$386.79
Rate for Payer: Priority Health Cigna Priority Health	$295.78
Rate for Payer: Priority Health SBD	$286.68

BUSPIRONE 15 MG TABLET

Facility

$4.56

Service Code	NDC 51079096001
Hospital Charge Code	17464
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna Medicare	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$2.96
Rate for Payer: BCBS Complete	$1.82
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cofinity Commercial	$3.19
Rate for Payer: Cofinity Commercial	$3.92
Rate for Payer: Cofinity Medicare Advantage	$3.19
Rate for Payer: Encore Health Key Benefits Commercial	$3.65
Rate for Payer: Healthscope Commercial	$4.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.88
Rate for Payer: PHP Commercial	$3.88
Rate for Payer: Priority Health Cigna Priority Health	$2.96
Rate for Payer: Priority Health SBD	$2.87

BUSPIRONE 15 MG TABLET

Facility

$455.05

Service Code	NDC 51079096020
Hospital Charge Code	17464
Hospital Revenue Code	637
Min. Negotiated Rate	$182.02
Max. Negotiated Rate	$409.55
Rate for Payer: Aetna Commercial	$386.79
Rate for Payer: Aetna Medicare	$227.53
Rate for Payer: Aetna New Business (MI Preferred)	$295.78
Rate for Payer: BCBS Complete	$182.02
Rate for Payer: Cash Price	$364.04
Rate for Payer: Cofinity Commercial	$318.54
Rate for Payer: Cofinity Commercial	$391.34
Rate for Payer: Cofinity Medicare Advantage	$318.54
Rate for Payer: Encore Health Key Benefits Commercial	$364.04
Rate for Payer: Healthscope Commercial	$409.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$386.79
Rate for Payer: PHP Commercial	$386.79
Rate for Payer: Priority Health Cigna Priority Health	$295.78
Rate for Payer: Priority Health SBD	$286.68

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$131.60
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: BCBS Complete	$131.60
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Commercial	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Cofinity Medicare Advantage	$230.30
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health Cigna Priority Health	$213.85
Rate for Payer: Priority Health SBD	$207.27

BUSPIRONE 5 MG TABLET

Facility

$209.15

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$83.66
Max. Negotiated Rate	$188.24
Rate for Payer: Aetna Commercial	$177.78
Rate for Payer: Aetna Medicare	$104.58
Rate for Payer: Aetna New Business (MI Preferred)	$135.95
Rate for Payer: BCBS Complete	$83.66
Rate for Payer: Cash Price	$167.32
Rate for Payer: Cofinity Commercial	$146.41
Rate for Payer: Cofinity Commercial	$179.87
Rate for Payer: Cofinity Medicare Advantage	$146.41
Rate for Payer: Encore Health Key Benefits Commercial	$167.32
Rate for Payer: Healthscope Commercial	$188.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.78
Rate for Payer: PHP Commercial	$177.78
Rate for Payer: Priority Health Cigna Priority Health	$135.95
Rate for Payer: Priority Health SBD	$131.76

BUSPIRONE 5 MG TABLET

Facility

$2.52

Service Code	NDC 51079098501
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health Cigna Priority Health	$1.64
Rate for Payer: Priority Health SBD	$1.59

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

BUSPIRONE 5 MG TABLET

Facility

$564.00

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$507.60
Rate for Payer: Aetna Commercial	$479.40
Rate for Payer: Aetna Medicare	$282.00
Rate for Payer: Aetna New Business (MI Preferred)	$366.60
Rate for Payer: BCBS Complete	$225.60
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cofinity Commercial	$394.80
Rate for Payer: Cofinity Commercial	$485.04
Rate for Payer: Cofinity Medicare Advantage	$394.80
Rate for Payer: Encore Health Key Benefits Commercial	$451.20
Rate for Payer: Healthscope Commercial	$507.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$479.40
Rate for Payer: PHP Commercial	$479.40
Rate for Payer: Priority Health Cigna Priority Health	$366.60
Rate for Payer: Priority Health SBD	$355.32

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$209.15

Service Code	NDC 00904712261
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$131.76
Max. Negotiated Rate	$188.24
Rate for Payer: Aetna Commercial	$177.78
Rate for Payer: Aetna New Business (MI Preferred)	$135.95
Rate for Payer: Cash Price	$167.32
Rate for Payer: Cofinity Commercial	$146.41
Rate for Payer: Cofinity Commercial	$179.87
Rate for Payer: Cofinity Medicare Advantage	$146.41
Rate for Payer: Encore Health Key Benefits Commercial	$167.32
Rate for Payer: Healthscope Commercial	$188.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$177.78
Rate for Payer: PHP Commercial	$177.78
Rate for Payer: Priority Health Cigna Priority Health	$135.95
Rate for Payer: Priority Health SBD	$131.76

BUSPIRONE 5 MG TABLET

Facility

$251.45

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$100.58
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: BCBS Complete	$100.58
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.01
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.01
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

BUSPIRONE 5 MG TABLET

Facility

$564.00

Service Code	NDC 00093005305
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$355.32
Max. Negotiated Rate	$507.60
Rate for Payer: Aetna Commercial	$479.40
Rate for Payer: Aetna New Business (MI Preferred)	$366.60
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cofinity Commercial	$394.80
Rate for Payer: Cofinity Commercial	$485.04
Rate for Payer: Cofinity Medicare Advantage	$394.80
Rate for Payer: Encore Health Key Benefits Commercial	$451.20
Rate for Payer: Healthscope Commercial	$507.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$479.40
Rate for Payer: PHP Commercial	$479.40
Rate for Payer: Priority Health Cigna Priority Health	$366.60
Rate for Payer: Priority Health SBD	$355.32

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$94.00

Service Code	NDC 23155002301
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$59.22
Max. Negotiated Rate	$84.60
Rate for Payer: Aetna Commercial	$79.90
Rate for Payer: Aetna New Business (MI Preferred)	$61.10
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$65.80
Rate for Payer: Cofinity Commercial	$80.84
Rate for Payer: Cofinity Medicare Advantage	$65.80
Rate for Payer: Encore Health Key Benefits Commercial	$75.20
Rate for Payer: Healthscope Commercial	$84.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.90
Rate for Payer: PHP Commercial	$79.90
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health SBD	$59.22

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$26.32
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna Medicare	$32.90
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: BCBS Complete	$26.32
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Commercial	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Cofinity Medicare Advantage	$46.06
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: Priority Health SBD	$41.45

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 64380074106
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 68382018001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$105.75

Service Code	NDC 24689078101
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$42.30
Max. Negotiated Rate	$95.17
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna Medicare	$52.88
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: BCBS Complete	$42.30
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.03
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Cofinity Medicare Advantage	$74.03
Rate for Payer: Encore Health Key Benefits Commercial	$84.60
Rate for Payer: Healthscope Commercial	$95.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$68.74
Rate for Payer: Priority Health SBD	$66.62

BUSPIRONE 5 MG TABLET

Facility

$251.45

Service Code	NDC 51079098520
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.31
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.01
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$176.01
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Healthscope Commercial	$226.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$158.41

BUSPIRONE 5 MG TABLET

Facility

$65.80

Service Code	NDC 16729020001
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$41.45
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Commercial	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Cofinity Medicare Advantage	$46.06
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$55.93
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health Cigna Priority Health	$42.77
Rate for Payer: Priority Health SBD	$41.45

BUSPIRONE 5 MG TABLET

Facility

$329.00

Service Code	NDC 16729020016
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$207.27
Max. Negotiated Rate	$296.10
Rate for Payer: Aetna Commercial	$279.65
Rate for Payer: Aetna New Business (MI Preferred)	$213.85
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cofinity Commercial	$230.30
Rate for Payer: Cofinity Commercial	$282.94
Rate for Payer: Cofinity Medicare Advantage	$230.30
Rate for Payer: Encore Health Key Benefits Commercial	$263.20
Rate for Payer: Healthscope Commercial	$296.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$279.65
Rate for Payer: PHP Commercial	$279.65
Rate for Payer: Priority Health Cigna Priority Health	$213.85
Rate for Payer: Priority Health SBD	$207.27

BUSPIRONE 5 MG TABLET

Facility

$2.52

Service Code	NDC 51079098501
Hospital Charge Code	9324
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: BCBS Complete	$1.01
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health Cigna Priority Health	$1.64
Rate for Payer: Priority Health SBD	$1.59

BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET

Facility

$735.70

Service Code	NDC 00603254421
Hospital Charge Code	8958
Hospital Revenue Code	637
Min. Negotiated Rate	$463.49
Max. Negotiated Rate	$662.13
Rate for Payer: Aetna Commercial	$625.35
Rate for Payer: Aetna New Business (MI Preferred)	$478.20
Rate for Payer: Cash Price	$588.56
Rate for Payer: Cofinity Commercial	$514.99
Rate for Payer: Cofinity Commercial	$632.70
Rate for Payer: Cofinity Medicare Advantage	$514.99
Rate for Payer: Encore Health Key Benefits Commercial	$588.56
Rate for Payer: Healthscope Commercial	$662.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$625.35
Rate for Payer: PHP Commercial	$625.35
Rate for Payer: Priority Health Cigna Priority Health	$478.20
Rate for Payer: Priority Health SBD	$463.49

Know your out-of-pocket cost for care.

All Charges