Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BOSTON SCI CRT ICD

Facility

$25,806.00

Service Code	HCPCS C1882
Hospital Charge Code	27500003
Hospital Revenue Code	275
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$23,225.40
Rate for Payer: Aetna Commercial	$21,935.10
Rate for Payer: Aetna New Business (MI Preferred)	$16,773.90
Rate for Payer: BCBS Complete	$10,322.40
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$20,644.80
Rate for Payer: Cash Price	$20,644.80
Rate for Payer: Cofinity Commercial	$18,064.20
Rate for Payer: Cofinity Commercial	$22,193.16
Rate for Payer: Healthscope Commercial	$23,225.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21,935.10
Rate for Payer: PHP Commercial	$21,935.10
Rate for Payer: Priority Health Cigna Priority Health	$18,064.20
Rate for Payer: Priority Health SBD	$16,257.78

HC BOSTON SCI CRT LEAD

Facility

$6,751.77

Service Code	HCPCS C1900
Hospital Charge Code	27800076
Hospital Revenue Code	278
Min. Negotiated Rate	$4,253.62
Max. Negotiated Rate	$6,076.59
Rate for Payer: Aetna Commercial	$5,739.00
Rate for Payer: Aetna New Business (MI Preferred)	$4,388.65
Rate for Payer: Cash Price	$5,401.42
Rate for Payer: Cofinity Commercial	$4,726.24
Rate for Payer: Cofinity Commercial	$5,806.52
Rate for Payer: Healthscope Commercial	$6,076.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,739.00
Rate for Payer: PHP Commercial	$5,739.00
Rate for Payer: Priority Health Cigna Priority Health	$4,726.24
Rate for Payer: Priority Health SBD	$4,253.62

HC BOSTON SCI CRT LEAD

Facility

$6,751.77

Service Code	HCPCS C1900
Hospital Charge Code	27800076
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$6,076.59
Rate for Payer: Aetna Commercial	$5,739.00
Rate for Payer: Aetna New Business (MI Preferred)	$4,388.65
Rate for Payer: BCBS Complete	$2,700.71
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: Cash Price	$5,401.42
Rate for Payer: Cash Price	$5,401.42
Rate for Payer: Cofinity Commercial	$4,726.24
Rate for Payer: Cofinity Commercial	$5,806.52
Rate for Payer: Healthscope Commercial	$6,076.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,739.00
Rate for Payer: PHP Commercial	$5,739.00
Rate for Payer: Priority Health Cigna Priority Health	$4,726.24
Rate for Payer: Priority Health SBD	$4,253.62

HC BOSTON SCI DUAL PACEMAKER

Facility

$8,404.80

Service Code	HCPCS C1785
Hospital Charge Code	27500004
Hospital Revenue Code	275
Min. Negotiated Rate	$3,361.92
Max. Negotiated Rate	$7,564.32
Rate for Payer: Aetna Commercial	$7,144.08
Rate for Payer: Aetna New Business (MI Preferred)	$5,463.12
Rate for Payer: BCBS Complete	$3,361.92
Rate for Payer: Cash Price	$6,723.84
Rate for Payer: Cofinity Commercial	$5,883.36
Rate for Payer: Cofinity Commercial	$7,228.13
Rate for Payer: Healthscope Commercial	$7,564.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,144.08
Rate for Payer: PHP Commercial	$7,144.08
Rate for Payer: Priority Health Cigna Priority Health	$5,883.36
Rate for Payer: Priority Health SBD	$5,295.02

HC BOSTON SCI DUAL PACEMAKER

Facility

$8,404.80

Service Code	HCPCS C1785
Hospital Charge Code	27500004
Hospital Revenue Code	275
Min. Negotiated Rate	$5,295.02
Max. Negotiated Rate	$7,564.32
Rate for Payer: Aetna Commercial	$7,144.08
Rate for Payer: Aetna New Business (MI Preferred)	$5,463.12
Rate for Payer: Cash Price	$6,723.84
Rate for Payer: Cofinity Commercial	$5,883.36
Rate for Payer: Cofinity Commercial	$7,228.13
Rate for Payer: Healthscope Commercial	$7,564.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,144.08
Rate for Payer: PHP Commercial	$7,144.08
Rate for Payer: Priority Health Cigna Priority Health	$5,883.36
Rate for Payer: Priority Health SBD	$5,295.02

HC BOSTON SCI ICD DUAL

Facility

$18,156.00

Service Code	HCPCS C1721
Hospital Charge Code	27800002
Hospital Revenue Code	278
Min. Negotiated Rate	$7,262.40
Max. Negotiated Rate	$16,340.40
Rate for Payer: Aetna Commercial	$15,432.60
Rate for Payer: Aetna New Business (MI Preferred)	$11,801.40
Rate for Payer: BCBS Complete	$7,262.40
Rate for Payer: Cash Price	$14,524.80
Rate for Payer: Cofinity Commercial	$12,709.20
Rate for Payer: Cofinity Commercial	$15,614.16
Rate for Payer: Healthscope Commercial	$16,340.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,432.60
Rate for Payer: PHP Commercial	$15,432.60
Rate for Payer: Priority Health Cigna Priority Health	$12,709.20
Rate for Payer: Priority Health SBD	$11,438.28

HC BOSTON SCI ICD DUAL

Facility

$18,156.00

Service Code	HCPCS C1721
Hospital Charge Code	27800002
Hospital Revenue Code	278
Min. Negotiated Rate	$11,438.28
Max. Negotiated Rate	$16,340.40
Rate for Payer: Aetna Commercial	$15,432.60
Rate for Payer: Aetna New Business (MI Preferred)	$11,801.40
Rate for Payer: Cash Price	$14,524.80
Rate for Payer: Cofinity Commercial	$12,709.20
Rate for Payer: Cofinity Commercial	$15,614.16
Rate for Payer: Healthscope Commercial	$16,340.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15,432.60
Rate for Payer: PHP Commercial	$15,432.60
Rate for Payer: Priority Health Cigna Priority Health	$12,709.20
Rate for Payer: Priority Health SBD	$11,438.28

HC BOSTON SCI ICD SINGLE

Facility

$21,624.00

Service Code	HCPCS C1722
Hospital Charge Code	27800003
Hospital Revenue Code	278
Min. Negotiated Rate	$8,649.60
Max. Negotiated Rate	$19,461.60
Rate for Payer: Aetna Commercial	$18,380.40
Rate for Payer: Aetna New Business (MI Preferred)	$14,055.60
Rate for Payer: BCBS Complete	$8,649.60
Rate for Payer: Cash Price	$17,299.20
Rate for Payer: Cofinity Commercial	$15,136.80
Rate for Payer: Cofinity Commercial	$18,596.64
Rate for Payer: Healthscope Commercial	$19,461.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18,380.40
Rate for Payer: PHP Commercial	$18,380.40
Rate for Payer: Priority Health Cigna Priority Health	$15,136.80
Rate for Payer: Priority Health SBD	$13,623.12

HC BOSTON SCI ICD SINGLE

Facility

$21,624.00

Service Code	HCPCS C1722
Hospital Charge Code	27800003
Hospital Revenue Code	278
Min. Negotiated Rate	$13,623.12
Max. Negotiated Rate	$19,461.60
Rate for Payer: Aetna Commercial	$18,380.40
Rate for Payer: Aetna New Business (MI Preferred)	$14,055.60
Rate for Payer: Cash Price	$17,299.20
Rate for Payer: Cofinity Commercial	$15,136.80
Rate for Payer: Cofinity Commercial	$18,596.64
Rate for Payer: Healthscope Commercial	$19,461.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18,380.40
Rate for Payer: PHP Commercial	$18,380.40
Rate for Payer: Priority Health Cigna Priority Health	$15,136.80
Rate for Payer: Priority Health SBD	$13,623.12

HC BOSTON SCI PACEMAKER LEAD

Facility

$2,213.49

Service Code	HCPCS C1898
Hospital Charge Code	27800074
Hospital Revenue Code	278
Min. Negotiated Rate	$885.40
Max. Negotiated Rate	$1,992.14
Rate for Payer: Aetna Commercial	$1,881.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,438.77
Rate for Payer: BCBS Complete	$885.40
Rate for Payer: Cash Price	$1,770.79
Rate for Payer: Cofinity Commercial	$1,549.44
Rate for Payer: Cofinity Commercial	$1,903.60
Rate for Payer: Healthscope Commercial	$1,992.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,881.47
Rate for Payer: PHP Commercial	$1,881.47
Rate for Payer: Priority Health Cigna Priority Health	$1,549.44
Rate for Payer: Priority Health SBD	$1,394.50

HC BOSTON SCI PACEMAKER LEAD

Facility

$2,213.49

Service Code	HCPCS C1898
Hospital Charge Code	27800074
Hospital Revenue Code	278
Min. Negotiated Rate	$1,394.50
Max. Negotiated Rate	$1,992.14
Rate for Payer: Aetna Commercial	$1,881.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,438.77
Rate for Payer: Cash Price	$1,770.79
Rate for Payer: Cofinity Commercial	$1,549.44
Rate for Payer: Cofinity Commercial	$1,903.60
Rate for Payer: Healthscope Commercial	$1,992.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,881.47
Rate for Payer: PHP Commercial	$1,881.47
Rate for Payer: Priority Health Cigna Priority Health	$1,549.44
Rate for Payer: Priority Health SBD	$1,394.50

HC BOSTON SCI PERIPHERAL STENT

Facility

$2,626.53

Service Code	HCPCS C1876
Hospital Charge Code	27800004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,654.71
Max. Negotiated Rate	$2,363.88
Rate for Payer: Aetna Commercial	$2,232.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,707.24
Rate for Payer: Cash Price	$2,101.22
Rate for Payer: Cofinity Commercial	$1,838.57
Rate for Payer: Cofinity Commercial	$2,258.82
Rate for Payer: Healthscope Commercial	$2,363.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,232.55
Rate for Payer: PHP Commercial	$2,232.55
Rate for Payer: Priority Health Cigna Priority Health	$1,838.57
Rate for Payer: Priority Health SBD	$1,654.71

HC BOSTON SCI PERIPHERAL STENT

Facility

$2,626.53

Service Code	HCPCS C1876
Hospital Charge Code	27800004
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.61
Max. Negotiated Rate	$2,363.88
Rate for Payer: Aetna Commercial	$2,232.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,707.24
Rate for Payer: BCBS Complete	$1,050.61
Rate for Payer: Cash Price	$2,101.22
Rate for Payer: Cofinity Commercial	$1,838.57
Rate for Payer: Cofinity Commercial	$2,258.82
Rate for Payer: Healthscope Commercial	$2,363.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,232.55
Rate for Payer: PHP Commercial	$2,232.55
Rate for Payer: Priority Health Cigna Priority Health	$1,838.57
Rate for Payer: Priority Health SBD	$1,654.71

HC BOSTON SCI SINGLE PACEMAKER

Facility

$13,947.49

Service Code	HCPCS C1786
Hospital Charge Code	27500005
Hospital Revenue Code	275
Min. Negotiated Rate	$8,786.92
Max. Negotiated Rate	$12,552.74
Rate for Payer: Aetna Commercial	$11,855.37
Rate for Payer: Aetna New Business (MI Preferred)	$9,065.87
Rate for Payer: Cash Price	$11,157.99
Rate for Payer: Cofinity Commercial	$11,994.84
Rate for Payer: Cofinity Commercial	$9,763.24
Rate for Payer: Healthscope Commercial	$12,552.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,855.37
Rate for Payer: PHP Commercial	$11,855.37
Rate for Payer: Priority Health Cigna Priority Health	$9,763.24
Rate for Payer: Priority Health SBD	$8,786.92

HC BOSTON SCI SINGLE PACEMAKER

Facility

$13,947.49

Service Code	HCPCS C1786
Hospital Charge Code	27500005
Hospital Revenue Code	275
Min. Negotiated Rate	$5,579.00
Max. Negotiated Rate	$12,552.74
Rate for Payer: Aetna Commercial	$11,855.37
Rate for Payer: Aetna New Business (MI Preferred)	$9,065.87
Rate for Payer: BCBS Complete	$5,579.00
Rate for Payer: Cash Price	$11,157.99
Rate for Payer: Cofinity Commercial	$11,994.84
Rate for Payer: Cofinity Commercial	$9,763.24
Rate for Payer: Healthscope Commercial	$12,552.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,855.37
Rate for Payer: PHP Commercial	$11,855.37
Rate for Payer: Priority Health Cigna Priority Health	$9,763.24
Rate for Payer: Priority Health SBD	$8,786.92

HC BOSTON SCI TACHY (ICD) LEAD

Facility

$8,600.98

Service Code	HCPCS C1895
Hospital Charge Code	27800075
Hospital Revenue Code	278
Min. Negotiated Rate	$5,418.62
Max. Negotiated Rate	$7,740.88
Rate for Payer: Aetna Commercial	$7,310.83
Rate for Payer: Aetna New Business (MI Preferred)	$5,590.64
Rate for Payer: Cash Price	$6,880.78
Rate for Payer: Cofinity Commercial	$6,020.69
Rate for Payer: Cofinity Commercial	$7,396.84
Rate for Payer: Healthscope Commercial	$7,740.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,310.83
Rate for Payer: PHP Commercial	$7,310.83
Rate for Payer: Priority Health Cigna Priority Health	$6,020.69
Rate for Payer: Priority Health SBD	$5,418.62

HC BOSTON SCI TACHY (ICD) LEAD

Facility

$8,600.98

Service Code	HCPCS C1895
Hospital Charge Code	27800075
Hospital Revenue Code	278
Min. Negotiated Rate	$3,440.39
Max. Negotiated Rate	$7,740.88
Rate for Payer: Aetna Commercial	$7,310.83
Rate for Payer: Aetna New Business (MI Preferred)	$5,590.64
Rate for Payer: BCBS Complete	$3,440.39
Rate for Payer: Cash Price	$6,880.78
Rate for Payer: Cofinity Commercial	$6,020.69
Rate for Payer: Cofinity Commercial	$7,396.84
Rate for Payer: Healthscope Commercial	$7,740.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,310.83
Rate for Payer: PHP Commercial	$7,310.83
Rate for Payer: Priority Health Cigna Priority Health	$6,020.69
Rate for Payer: Priority Health SBD	$5,418.62

HC BOTRYTIS CINEREA IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200075
Hospital Revenue Code	302
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.52
Rate for Payer: Amish Plain Church Group Commercial	$6.52
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: BCBS MAPPO	$5.22
Rate for Payer: BCBS Trust/PPO	$4.09
Rate for Payer: BCN Medicare Advantage	$5.22
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.22
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Mclaren Medicaid	$2.86
Rate for Payer: Mclaren Medicare	$5.22
Rate for Payer: Meridian Medicaid	$3.00
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5.48
Rate for Payer: MI Amish Medical Board Commercial	$6.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PACE Medicare	$4.96
Rate for Payer: PACE SWMI	$5.22
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: PHP Medicare Advantage	$5.22
Rate for Payer: Priority Health Choice Medicaid	$2.86
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health Medicare	$5.22
Rate for Payer: Priority Health SBD	$15.68
Rate for Payer: Railroad Medicare Medicare	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$6.26
Rate for Payer: UHC Core	$8.87
Rate for Payer: UHC Dual Complete DSNP	$5.22
Rate for Payer: UHC Exchange	$5.22
Rate for Payer: UHC Medicare Advantage	$5.38
Rate for Payer: VA VA	$5.22

HC BOTRYTIS CINEREA IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200075
Hospital Revenue Code	302
Min. Negotiated Rate	$15.68
Max. Negotiated Rate	$22.40
Rate for Payer: Aetna Commercial	$21.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.18
Rate for Payer: Cash Price	$19.91
Rate for Payer: Cofinity Commercial	$21.41
Rate for Payer: Cofinity Commercial	$17.42
Rate for Payer: Healthscope Commercial	$22.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.16
Rate for Payer: PHP Commercial	$21.16
Rate for Payer: Priority Health Cigna Priority Health	$17.42
Rate for Payer: Priority Health SBD	$15.68

HC BOTTLE A/B CDI 500

Facility

$198.00

Hospital Charge Code	27000684
Hospital Revenue Code	270
Min. Negotiated Rate	$124.74
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Aetna New Business (MI Preferred)	$128.70
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cofinity Commercial	$138.60
Rate for Payer: Cofinity Commercial	$170.28
Rate for Payer: Healthscope Commercial	$178.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.30
Rate for Payer: PHP Commercial	$168.30
Rate for Payer: Priority Health Cigna Priority Health	$138.60
Rate for Payer: Priority Health SBD	$124.74

HC BOTTLE A/B CDI 500

Facility

$198.00

Hospital Charge Code	27000684
Hospital Revenue Code	270
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$178.20
Rate for Payer: Aetna Commercial	$168.30
Rate for Payer: Aetna New Business (MI Preferred)	$128.70
Rate for Payer: BCBS Complete	$79.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cofinity Commercial	$138.60
Rate for Payer: Cofinity Commercial	$170.28
Rate for Payer: Healthscope Commercial	$178.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.30
Rate for Payer: PHP Commercial	$168.30
Rate for Payer: Priority Health Cigna Priority Health	$138.60
Rate for Payer: Priority Health SBD	$124.74

HC BOWL

Facility

$225.00

Hospital Charge Code	27000091
Hospital Revenue Code	270
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: BCBS Complete	$90.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC BOWL

Facility

$225.00

Hospital Charge Code	27000091
Hospital Revenue Code	270
Min. Negotiated Rate	$141.75
Max. Negotiated Rate	$202.50
Rate for Payer: Aetna Commercial	$191.25
Rate for Payer: Aetna New Business (MI Preferred)	$146.25
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cofinity Commercial	$157.50
Rate for Payer: Cofinity Commercial	$193.50
Rate for Payer: Healthscope Commercial	$202.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.25
Rate for Payer: PHP Commercial	$191.25
Rate for Payer: Priority Health Cigna Priority Health	$157.50
Rate for Payer: Priority Health SBD	$141.75

HC BOWL ATS 55 ML

Facility

$248.50

Hospital Charge Code	27000283
Hospital Revenue Code	270
Min. Negotiated Rate	$99.40
Max. Negotiated Rate	$223.65
Rate for Payer: Aetna Commercial	$211.22
Rate for Payer: Aetna New Business (MI Preferred)	$161.52
Rate for Payer: BCBS Complete	$99.40
Rate for Payer: Cash Price	$198.80
Rate for Payer: Cofinity Commercial	$173.95
Rate for Payer: Cofinity Commercial	$213.71
Rate for Payer: Healthscope Commercial	$223.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.22
Rate for Payer: PHP Commercial	$211.22
Rate for Payer: Priority Health Cigna Priority Health	$173.95
Rate for Payer: Priority Health SBD	$156.56

HC BOWL ATS 55 ML

Facility

$248.50

Hospital Charge Code	27000283
Hospital Revenue Code	270
Min. Negotiated Rate	$156.56
Max. Negotiated Rate	$223.65
Rate for Payer: Aetna Commercial	$211.22
Rate for Payer: Aetna New Business (MI Preferred)	$161.52
Rate for Payer: Cash Price	$198.80
Rate for Payer: Cofinity Commercial	$173.95
Rate for Payer: Cofinity Commercial	$213.71
Rate for Payer: Healthscope Commercial	$223.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$211.22
Rate for Payer: PHP Commercial	$211.22
Rate for Payer: Priority Health Cigna Priority Health	$173.95
Rate for Payer: Priority Health SBD	$156.56

Know your out-of-pocket cost for care.

All Charges