Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC BRACE HAND/FINGER ORTHOSIS

Facility

$294.00

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$185.22
Max. Negotiated Rate	$264.60
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna New Business (MI Preferred)	$191.10
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cofinity Commercial	$205.80
Rate for Payer: Cofinity Commercial	$252.84
Rate for Payer: Healthscope Commercial	$264.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$249.90
Rate for Payer: PHP Commercial	$249.90
Rate for Payer: Priority Health Cigna Priority Health	$205.80
Rate for Payer: Priority Health SBD	$185.22

HC BRACE HAND/FINGER ORTHOSIS

Facility

$294.00

Service Code	HCPCS L3921
Hospital Charge Code	27400347
Hospital Revenue Code	274
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$974.16
Rate for Payer: Aetna Commercial	$249.90
Rate for Payer: Aetna New Business (MI Preferred)	$191.10
Rate for Payer: BCBS Complete	$117.60
Rate for Payer: BCBS Trust/PPO	$974.16
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cash Price	$235.20
Rate for Payer: Cofinity Commercial	$205.80
Rate for Payer: Cofinity Commercial	$252.84
Rate for Payer: Healthscope Commercial	$264.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$249.90
Rate for Payer: PHP Commercial	$249.90
Rate for Payer: Priority Health Cigna Priority Health	$205.80
Rate for Payer: Priority Health SBD	$185.22
Rate for Payer: UHC All Payor (Choice/PPO)	$491.62
Rate for Payer: UHC Exchange	$409.68

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$503.88

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$201.55
Max. Negotiated Rate	$821.30
Rate for Payer: Aetna Commercial	$428.30
Rate for Payer: Aetna New Business (MI Preferred)	$327.52
Rate for Payer: BCBS Complete	$201.55
Rate for Payer: BCBS Trust/PPO	$821.30
Rate for Payer: Cash Price	$403.10
Rate for Payer: Cash Price	$403.10
Rate for Payer: Cofinity Commercial	$433.34
Rate for Payer: Cofinity Commercial	$352.72
Rate for Payer: Healthscope Commercial	$453.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$428.30
Rate for Payer: PHP Commercial	$428.30
Rate for Payer: Priority Health Cigna Priority Health	$352.72
Rate for Payer: Priority Health SBD	$317.44
Rate for Payer: UHC All Payor (Choice/PPO)	$414.54
Rate for Payer: UHC Exchange	$345.45

HC BRACE HAND ORTHOT W/O JNTS CF

Facility

$503.88

Service Code	HCPCS L3919
Hospital Charge Code	27400044
Hospital Revenue Code	274
Min. Negotiated Rate	$317.44
Max. Negotiated Rate	$453.49
Rate for Payer: Aetna Commercial	$428.30
Rate for Payer: Aetna New Business (MI Preferred)	$327.52
Rate for Payer: Cash Price	$403.10
Rate for Payer: Cofinity Commercial	$352.72
Rate for Payer: Cofinity Commercial	$433.34
Rate for Payer: Healthscope Commercial	$453.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$428.30
Rate for Payer: PHP Commercial	$428.30
Rate for Payer: Priority Health Cigna Priority Health	$352.72
Rate for Payer: Priority Health SBD	$317.44

HC BRACE HARD HELMET

Facility

$412.54

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$259.90
Max. Negotiated Rate	$371.29
Rate for Payer: Aetna Commercial	$350.66
Rate for Payer: Aetna New Business (MI Preferred)	$268.15
Rate for Payer: Cash Price	$330.03
Rate for Payer: Cofinity Commercial	$288.78
Rate for Payer: Cofinity Commercial	$354.78
Rate for Payer: Healthscope Commercial	$371.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.66
Rate for Payer: PHP Commercial	$350.66
Rate for Payer: Priority Health Cigna Priority Health	$288.78
Rate for Payer: Priority Health SBD	$259.90

HC BRACE HARD HELMET

Facility

$412.54

Service Code	HCPCS A8001
Hospital Charge Code	27000021
Hospital Revenue Code	274
Min. Negotiated Rate	$165.02
Max. Negotiated Rate	$371.29
Rate for Payer: Aetna Commercial	$350.66
Rate for Payer: Aetna New Business (MI Preferred)	$268.15
Rate for Payer: BCBS Complete	$165.02
Rate for Payer: Cash Price	$330.03
Rate for Payer: Cofinity Commercial	$288.78
Rate for Payer: Cofinity Commercial	$354.78
Rate for Payer: Healthscope Commercial	$371.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$350.66
Rate for Payer: PHP Commercial	$350.66
Rate for Payer: Priority Health Cigna Priority Health	$288.78
Rate for Payer: Priority Health SBD	$259.90

HC BRACE HEEL RELIEF SHOE

Facility

$180.00

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$174.34
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCBS Trust/PPO	$174.34
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health SBD	$113.40

HC BRACE HEEL RELIEF SHOE

Facility

$180.00

Service Code	HCPCS L3260
Hospital Charge Code	27000467
Hospital Revenue Code	274
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health SBD	$113.40

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$125.00

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$277.00
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS Trust/PPO	$277.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75
Rate for Payer: UHC All Payor (Choice/PPO)	$134.65
Rate for Payer: UHC Exchange	$112.21

HC BRACE HFO NONTORSION JNTS PRE CST

Facility

$125.00

Service Code	HCPCS L3929
Hospital Charge Code	27400051
Hospital Revenue Code	274
Min. Negotiated Rate	$78.75
Max. Negotiated Rate	$112.50
Rate for Payer: Aetna Commercial	$106.25
Rate for Payer: Aetna New Business (MI Preferred)	$81.25
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$107.50
Rate for Payer: Cofinity Commercial	$87.50
Rate for Payer: Healthscope Commercial	$112.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$106.25
Rate for Payer: PHP Commercial	$106.25
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health SBD	$78.75

HC BRACE HFO W/O JOINTS CF

Facility

$252.96

Service Code	HCPCS L3913
Hospital Charge Code	27400042
Hospital Revenue Code	274
Min. Negotiated Rate	$101.18
Max. Negotiated Rate	$821.30
Rate for Payer: Aetna Commercial	$215.02
Rate for Payer: Aetna New Business (MI Preferred)	$164.42
Rate for Payer: BCBS Complete	$101.18
Rate for Payer: BCBS Trust/PPO	$821.30
Rate for Payer: Cash Price	$202.37
Rate for Payer: Cash Price	$202.37
Rate for Payer: Cofinity Commercial	$177.07
Rate for Payer: Cofinity Commercial	$217.55
Rate for Payer: Healthscope Commercial	$227.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.02
Rate for Payer: PHP Commercial	$215.02
Rate for Payer: Priority Health Cigna Priority Health	$177.07
Rate for Payer: Priority Health SBD	$159.36
Rate for Payer: UHC All Payor (Choice/PPO)	$414.54
Rate for Payer: UHC Exchange	$345.45

HC BRACE HFO W/O JOINTS CF

Facility

$252.96

Service Code	HCPCS L3913
Hospital Charge Code	27400042
Hospital Revenue Code	274
Min. Negotiated Rate	$159.36
Max. Negotiated Rate	$227.66
Rate for Payer: Aetna Commercial	$215.02
Rate for Payer: Aetna New Business (MI Preferred)	$164.42
Rate for Payer: Cash Price	$202.37
Rate for Payer: Cofinity Commercial	$177.07
Rate for Payer: Cofinity Commercial	$217.55
Rate for Payer: Healthscope Commercial	$227.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$215.02
Rate for Payer: PHP Commercial	$215.02
Rate for Payer: Priority Health Cigna Priority Health	$177.07
Rate for Payer: Priority Health SBD	$159.36

HC BRACE HIP ABDUCTION

Facility

$1,811.44

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$724.58
Max. Negotiated Rate	$3,122.41
Rate for Payer: Aetna Commercial	$1,539.72
Rate for Payer: Aetna New Business (MI Preferred)	$1,177.44
Rate for Payer: BCBS Complete	$724.58
Rate for Payer: BCBS Trust/PPO	$3,122.41
Rate for Payer: Cash Price	$1,449.15
Rate for Payer: Cash Price	$1,449.15
Rate for Payer: Cofinity Commercial	$1,557.84
Rate for Payer: Cofinity Commercial	$1,268.01
Rate for Payer: Healthscope Commercial	$1,630.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.72
Rate for Payer: PHP Commercial	$1,539.72
Rate for Payer: Priority Health Cigna Priority Health	$1,268.01
Rate for Payer: Priority Health SBD	$1,141.21
Rate for Payer: UHC All Payor (Choice/PPO)	$1,605.73
Rate for Payer: UHC Exchange	$1,338.11

HC BRACE HIP ABDUCTION

Facility

$1,811.44

Service Code	HCPCS L1686
Hospital Charge Code	27000007
Hospital Revenue Code	274
Min. Negotiated Rate	$1,141.21
Max. Negotiated Rate	$1,630.30
Rate for Payer: Aetna Commercial	$1,539.72
Rate for Payer: Aetna New Business (MI Preferred)	$1,177.44
Rate for Payer: Cash Price	$1,449.15
Rate for Payer: Cofinity Commercial	$1,268.01
Rate for Payer: Cofinity Commercial	$1,557.84
Rate for Payer: Healthscope Commercial	$1,630.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.72
Rate for Payer: PHP Commercial	$1,539.72
Rate for Payer: Priority Health Cigna Priority Health	$1,268.01
Rate for Payer: Priority Health SBD	$1,141.21

HC BRACE HUMERAL SLEEVE

Facility

$816.74

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$514.55
Max. Negotiated Rate	$735.07
Rate for Payer: Aetna Commercial	$694.23
Rate for Payer: Aetna New Business (MI Preferred)	$530.88
Rate for Payer: Cash Price	$653.39
Rate for Payer: Cofinity Commercial	$571.72
Rate for Payer: Cofinity Commercial	$702.40
Rate for Payer: Healthscope Commercial	$735.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$694.23
Rate for Payer: PHP Commercial	$694.23
Rate for Payer: Priority Health Cigna Priority Health	$571.72
Rate for Payer: Priority Health SBD	$514.55

HC BRACE HUMERAL SLEEVE

Facility

$816.74

Service Code	HCPCS L3980
Hospital Charge Code	27000008
Hospital Revenue Code	274
Min. Negotiated Rate	$326.70
Max. Negotiated Rate	$1,173.23
Rate for Payer: Aetna Commercial	$694.23
Rate for Payer: Aetna New Business (MI Preferred)	$530.88
Rate for Payer: BCBS Complete	$326.70
Rate for Payer: BCBS Trust/PPO	$1,173.23
Rate for Payer: Cash Price	$653.39
Rate for Payer: Cash Price	$653.39
Rate for Payer: Cofinity Commercial	$702.40
Rate for Payer: Cofinity Commercial	$571.72
Rate for Payer: Healthscope Commercial	$735.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$694.23
Rate for Payer: PHP Commercial	$694.23
Rate for Payer: Priority Health Cigna Priority Health	$571.72
Rate for Payer: Priority Health SBD	$514.55
Rate for Payer: UHC All Payor (Choice/PPO)	$532.52
Rate for Payer: UHC Exchange	$443.77

HC BRACE JEWETT/CASH

Facility

$939.18

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$591.68
Max. Negotiated Rate	$845.26
Rate for Payer: Aetna Commercial	$798.30
Rate for Payer: Aetna New Business (MI Preferred)	$610.47
Rate for Payer: Cash Price	$751.34
Rate for Payer: Cofinity Commercial	$657.43
Rate for Payer: Cofinity Commercial	$807.69
Rate for Payer: Healthscope Commercial	$845.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.30
Rate for Payer: PHP Commercial	$798.30
Rate for Payer: Priority Health Cigna Priority Health	$657.43
Rate for Payer: Priority Health SBD	$591.68

HC BRACE JEWETT/CASH

Facility

$939.18

Service Code	HCPCS L0472
Hospital Charge Code	27400003
Hospital Revenue Code	274
Min. Negotiated Rate	$375.67
Max. Negotiated Rate	$1,349.12
Rate for Payer: Aetna Commercial	$798.30
Rate for Payer: Aetna New Business (MI Preferred)	$610.47
Rate for Payer: BCBS Complete	$375.67
Rate for Payer: BCBS Trust/PPO	$1,349.12
Rate for Payer: Cash Price	$751.34
Rate for Payer: Cash Price	$751.34
Rate for Payer: Cofinity Commercial	$807.69
Rate for Payer: Cofinity Commercial	$657.43
Rate for Payer: Healthscope Commercial	$845.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$798.30
Rate for Payer: PHP Commercial	$798.30
Rate for Payer: Priority Health Cigna Priority Health	$657.43
Rate for Payer: Priority Health SBD	$591.68
Rate for Payer: UHC All Payor (Choice/PPO)	$711.77
Rate for Payer: UHC Exchange	$593.14

HC BRACE KAFO CUSTOM

Facility

$4,873.55

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$3,070.34
Max. Negotiated Rate	$4,386.20
Rate for Payer: Aetna Commercial	$4,142.52
Rate for Payer: Aetna New Business (MI Preferred)	$3,167.81
Rate for Payer: Cash Price	$3,898.84
Rate for Payer: Cofinity Commercial	$3,411.48
Rate for Payer: Cofinity Commercial	$4,191.25
Rate for Payer: Healthscope Commercial	$4,386.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,142.52
Rate for Payer: PHP Commercial	$4,142.52
Rate for Payer: Priority Health Cigna Priority Health	$3,411.48
Rate for Payer: Priority Health SBD	$3,070.34

HC BRACE KAFO CUSTOM

Facility

$4,873.55

Hospital Charge Code	27000033
Hospital Revenue Code	274
Min. Negotiated Rate	$1,949.42
Max. Negotiated Rate	$4,386.20
Rate for Payer: Aetna Commercial	$4,142.52
Rate for Payer: Aetna New Business (MI Preferred)	$3,167.81
Rate for Payer: BCBS Complete	$1,949.42
Rate for Payer: Cash Price	$3,898.84
Rate for Payer: Cofinity Commercial	$3,411.48
Rate for Payer: Cofinity Commercial	$4,191.25
Rate for Payer: Healthscope Commercial	$4,386.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,142.52
Rate for Payer: PHP Commercial	$4,142.52
Rate for Payer: Priority Health Cigna Priority Health	$3,411.48
Rate for Payer: Priority Health SBD	$3,070.34

HC BRACE KNEE HINGED CUSTOM

Facility

$1,358.21

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$543.28
Max. Negotiated Rate	$2,295.27
Rate for Payer: Aetna Commercial	$1,154.48
Rate for Payer: Aetna New Business (MI Preferred)	$882.84
Rate for Payer: BCBS Complete	$543.28
Rate for Payer: BCBS Trust/PPO	$2,295.27
Rate for Payer: Cash Price	$1,086.57
Rate for Payer: Cash Price	$1,086.57
Rate for Payer: Cofinity Commercial	$950.75
Rate for Payer: Cofinity Commercial	$1,168.06
Rate for Payer: Healthscope Commercial	$1,222.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,154.48
Rate for Payer: PHP Commercial	$1,154.48
Rate for Payer: Priority Health Cigna Priority Health	$950.75
Rate for Payer: Priority Health SBD	$855.67
Rate for Payer: UHC All Payor (Choice/PPO)	$1,070.20
Rate for Payer: UHC Exchange	$891.83

HC BRACE KNEE HINGED CUSTOM

Facility

$1,358.21

Service Code	HCPCS L1832
Hospital Charge Code	27400004
Hospital Revenue Code	274
Min. Negotiated Rate	$855.67
Max. Negotiated Rate	$1,222.39
Rate for Payer: Aetna Commercial	$1,154.48
Rate for Payer: Aetna New Business (MI Preferred)	$882.84
Rate for Payer: Cash Price	$1,086.57
Rate for Payer: Cofinity Commercial	$1,168.06
Rate for Payer: Cofinity Commercial	$950.75
Rate for Payer: Healthscope Commercial	$1,222.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,154.48
Rate for Payer: PHP Commercial	$1,154.48
Rate for Payer: Priority Health Cigna Priority Health	$950.75
Rate for Payer: Priority Health SBD	$855.67

HC BRACE KNEE HINGED OTS

Facility

$1,597.90

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$1,006.68
Max. Negotiated Rate	$1,438.11
Rate for Payer: Aetna Commercial	$1,358.22
Rate for Payer: Aetna New Business (MI Preferred)	$1,038.64
Rate for Payer: Cash Price	$1,278.32
Rate for Payer: Cofinity Commercial	$1,118.53
Rate for Payer: Cofinity Commercial	$1,374.19
Rate for Payer: Healthscope Commercial	$1,438.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,358.22
Rate for Payer: PHP Commercial	$1,358.22
Rate for Payer: Priority Health Cigna Priority Health	$1,118.53
Rate for Payer: Priority Health SBD	$1,006.68

HC BRACE KNEE HINGED OTS

Facility

$1,597.90

Service Code	HCPCS L1833
Hospital Charge Code	27400021
Hospital Revenue Code	274
Min. Negotiated Rate	$639.16
Max. Negotiated Rate	$1,623.76
Rate for Payer: Aetna Commercial	$1,358.22
Rate for Payer: Aetna New Business (MI Preferred)	$1,038.64
Rate for Payer: BCBS Complete	$639.16
Rate for Payer: BCBS Trust/PPO	$1,623.76
Rate for Payer: Cash Price	$1,278.32
Rate for Payer: Cash Price	$1,278.32
Rate for Payer: Cofinity Commercial	$1,118.53
Rate for Payer: Cofinity Commercial	$1,374.19
Rate for Payer: Healthscope Commercial	$1,438.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,358.22
Rate for Payer: PHP Commercial	$1,358.22
Rate for Payer: Priority Health Cigna Priority Health	$1,118.53
Rate for Payer: Priority Health SBD	$1,006.68

HC BRACE KNEE IMMOBILIZER

Facility

$198.85

Service Code	HCPCS L1830
Hospital Charge Code	27400008
Hospital Revenue Code	274
Min. Negotiated Rate	$125.28
Max. Negotiated Rate	$178.96
Rate for Payer: Aetna Commercial	$169.02
Rate for Payer: Aetna New Business (MI Preferred)	$129.25
Rate for Payer: Cash Price	$159.08
Rate for Payer: Cofinity Commercial	$139.20
Rate for Payer: Cofinity Commercial	$171.01
Rate for Payer: Healthscope Commercial	$178.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$169.02
Rate for Payer: PHP Commercial	$169.02
Rate for Payer: Priority Health Cigna Priority Health	$139.20
Rate for Payer: Priority Health SBD	$125.28

Know your out-of-pocket cost for care.

All Charges