Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$639.00

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$1,369.63
Rate for Payer: Aetna Commercial	$543.15
Rate for Payer: Aetna New Business (MI Preferred)	$415.35
Rate for Payer: BCBS Complete	$255.60
Rate for Payer: BCBS Trust/PPO	$1,369.63
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$447.30
Rate for Payer: Cofinity Commercial	$549.54
Rate for Payer: Healthscope Commercial	$575.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.15
Rate for Payer: PHP Commercial	$543.15
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health SBD	$402.57
Rate for Payer: UHC All Payor (Choice/PPO)	$691.49
Rate for Payer: UHC Exchange	$576.24

HC BRACE LO SAG RGD A&P L1-L5 PREFAB

Facility

$639.00

Service Code	HCPCS L0627
Hospital Charge Code	27400025
Hospital Revenue Code	274
Min. Negotiated Rate	$402.57
Max. Negotiated Rate	$575.10
Rate for Payer: Aetna Commercial	$543.15
Rate for Payer: Aetna New Business (MI Preferred)	$415.35
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$447.30
Rate for Payer: Cofinity Commercial	$549.54
Rate for Payer: Healthscope Commercial	$575.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.15
Rate for Payer: PHP Commercial	$543.15
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health SBD	$402.57

HC BRACE LS CORSET CUSTOM

Facility

$182.00

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$114.66
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna Commercial	$154.70
Rate for Payer: Aetna New Business (MI Preferred)	$118.30
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cofinity Commercial	$127.40
Rate for Payer: Cofinity Commercial	$156.52
Rate for Payer: Healthscope Commercial	$163.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.70
Rate for Payer: PHP Commercial	$154.70
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: Priority Health SBD	$114.66

HC BRACE LS CORSET CUSTOM

Facility

$182.00

Service Code	HCPCS L0626
Hospital Charge Code	27400005
Hospital Revenue Code	274
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$259.74
Rate for Payer: Aetna Commercial	$154.70
Rate for Payer: Aetna New Business (MI Preferred)	$118.30
Rate for Payer: BCBS Complete	$72.80
Rate for Payer: BCBS Trust/PPO	$259.74
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cofinity Commercial	$127.40
Rate for Payer: Cofinity Commercial	$156.52
Rate for Payer: Healthscope Commercial	$163.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.70
Rate for Payer: PHP Commercial	$154.70
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: Priority Health SBD	$114.66
Rate for Payer: UHC All Payor (Choice/PPO)	$131.11
Rate for Payer: UHC Exchange	$109.26

HC BRACE LS CORSET OTS

Facility

$191.10

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$120.39
Max. Negotiated Rate	$171.99
Rate for Payer: Aetna Commercial	$162.44
Rate for Payer: Aetna New Business (MI Preferred)	$124.22
Rate for Payer: Cash Price	$152.88
Rate for Payer: Cofinity Commercial	$133.77
Rate for Payer: Cofinity Commercial	$164.35
Rate for Payer: Healthscope Commercial	$171.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.44
Rate for Payer: PHP Commercial	$162.44
Rate for Payer: Priority Health Cigna Priority Health	$133.77
Rate for Payer: Priority Health SBD	$120.39

HC BRACE LS CORSET OTS

Facility

$191.10

Service Code	HCPCS L0641
Hospital Charge Code	27400019
Hospital Revenue Code	274
Min. Negotiated Rate	$76.44
Max. Negotiated Rate	$171.99
Rate for Payer: Aetna Commercial	$162.44
Rate for Payer: Aetna New Business (MI Preferred)	$124.22
Rate for Payer: BCBS Complete	$76.44
Rate for Payer: BCBS Trust/PPO	$170.83
Rate for Payer: Cash Price	$152.88
Rate for Payer: Cash Price	$152.88
Rate for Payer: Cofinity Commercial	$164.35
Rate for Payer: Cofinity Commercial	$133.77
Rate for Payer: Healthscope Commercial	$171.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.44
Rate for Payer: PHP Commercial	$162.44
Rate for Payer: Priority Health Cigna Priority Health	$133.77
Rate for Payer: Priority Health SBD	$120.39

HC BRACE LSO CUSTOM

Facility

$2,504.42

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,577.78
Max. Negotiated Rate	$2,253.98
Rate for Payer: Aetna Commercial	$2,128.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,627.87
Rate for Payer: Cash Price	$2,003.54
Rate for Payer: Cofinity Commercial	$1,753.09
Rate for Payer: Cofinity Commercial	$2,153.80
Rate for Payer: Healthscope Commercial	$2,253.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,128.76
Rate for Payer: PHP Commercial	$2,128.76
Rate for Payer: Priority Health Cigna Priority Health	$1,753.09
Rate for Payer: Priority Health SBD	$1,577.78

HC BRACE LSO CUSTOM

Facility

$2,504.42

Hospital Charge Code	27400006
Hospital Revenue Code	274
Min. Negotiated Rate	$1,001.77
Max. Negotiated Rate	$2,253.98
Rate for Payer: Aetna Commercial	$2,128.76
Rate for Payer: Aetna New Business (MI Preferred)	$1,627.87
Rate for Payer: BCBS Complete	$1,001.77
Rate for Payer: Cash Price	$2,003.54
Rate for Payer: Cofinity Commercial	$2,153.80
Rate for Payer: Cofinity Commercial	$1,753.09
Rate for Payer: Healthscope Commercial	$2,253.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,128.76
Rate for Payer: PHP Commercial	$2,128.76
Rate for Payer: Priority Health Cigna Priority Health	$1,753.09
Rate for Payer: Priority Health SBD	$1,577.78

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,665.96

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,679.55
Max. Negotiated Rate	$2,399.36
Rate for Payer: Aetna Commercial	$2,266.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,732.87
Rate for Payer: Cash Price	$2,132.77
Rate for Payer: Cofinity Commercial	$1,866.17
Rate for Payer: Cofinity Commercial	$2,292.73
Rate for Payer: Healthscope Commercial	$2,399.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,266.07
Rate for Payer: PHP Commercial	$2,266.07
Rate for Payer: Priority Health Cigna Priority Health	$1,866.17
Rate for Payer: Priority Health SBD	$1,679.55

HC BRACE LSO SC CTRL RIGID AP PNL CSTM

Facility

$2,665.96

Service Code	HCPCS L0637
Hospital Charge Code	27400046
Hospital Revenue Code	274
Min. Negotiated Rate	$1,066.38
Max. Negotiated Rate	$4,317.00
Rate for Payer: Aetna Commercial	$2,266.07
Rate for Payer: Aetna New Business (MI Preferred)	$1,732.87
Rate for Payer: BCBS Complete	$1,066.38
Rate for Payer: BCBS Trust/PPO	$4,317.00
Rate for Payer: Cash Price	$2,132.77
Rate for Payer: Cash Price	$2,132.77
Rate for Payer: Cofinity Commercial	$1,866.17
Rate for Payer: Cofinity Commercial	$2,292.73
Rate for Payer: Healthscope Commercial	$2,399.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,266.07
Rate for Payer: PHP Commercial	$2,266.07
Rate for Payer: Priority Health Cigna Priority Health	$1,866.17
Rate for Payer: Priority Health SBD	$1,679.55
Rate for Payer: UHC All Payor (Choice/PPO)	$1,973.95
Rate for Payer: UHC Exchange	$1,644.96

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$364.52

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$145.81
Max. Negotiated Rate	$523.58
Rate for Payer: Aetna Commercial	$309.84
Rate for Payer: Aetna New Business (MI Preferred)	$236.94
Rate for Payer: BCBS Complete	$145.81
Rate for Payer: BCBS Trust/PPO	$523.58
Rate for Payer: Cash Price	$291.62
Rate for Payer: Cash Price	$291.62
Rate for Payer: Cofinity Commercial	$255.16
Rate for Payer: Cofinity Commercial	$313.49
Rate for Payer: Healthscope Commercial	$328.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$309.84
Rate for Payer: PHP Commercial	$309.84
Rate for Payer: Priority Health Cigna Priority Health	$255.16
Rate for Payer: Priority Health SBD	$229.65
Rate for Payer: UHC All Payor (Choice/PPO)	$235.85
Rate for Payer: UHC Exchange	$196.54

HC BRACE PAVLIK HARNESS CUSTOM

Facility

$364.52

Service Code	HCPCS L1620
Hospital Charge Code	27000010
Hospital Revenue Code	274
Min. Negotiated Rate	$229.65
Max. Negotiated Rate	$328.07
Rate for Payer: Aetna Commercial	$309.84
Rate for Payer: Aetna New Business (MI Preferred)	$236.94
Rate for Payer: Cash Price	$291.62
Rate for Payer: Cofinity Commercial	$255.16
Rate for Payer: Cofinity Commercial	$313.49
Rate for Payer: Healthscope Commercial	$328.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$309.84
Rate for Payer: PHP Commercial	$309.84
Rate for Payer: Priority Health Cigna Priority Health	$255.16
Rate for Payer: Priority Health SBD	$229.65

HC BRACE PRAFO CUSTOM

Facility

$389.30

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$155.72
Max. Negotiated Rate	$559.20
Rate for Payer: Aetna Commercial	$330.90
Rate for Payer: Aetna New Business (MI Preferred)	$253.04
Rate for Payer: BCBS Complete	$155.72
Rate for Payer: BCBS Trust/PPO	$559.20
Rate for Payer: Cash Price	$311.44
Rate for Payer: Cash Price	$311.44
Rate for Payer: Cofinity Commercial	$334.80
Rate for Payer: Cofinity Commercial	$272.51
Rate for Payer: Healthscope Commercial	$350.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$330.90
Rate for Payer: PHP Commercial	$330.90
Rate for Payer: Priority Health Cigna Priority Health	$272.51
Rate for Payer: Priority Health SBD	$245.26
Rate for Payer: UHC All Payor (Choice/PPO)	$281.72
Rate for Payer: UHC Exchange	$234.77

HC BRACE PRAFO CUSTOM

Facility

$389.30

Service Code	HCPCS L4396
Hospital Charge Code	27000012
Hospital Revenue Code	274
Min. Negotiated Rate	$245.26
Max. Negotiated Rate	$350.37
Rate for Payer: Aetna Commercial	$330.90
Rate for Payer: Aetna New Business (MI Preferred)	$253.04
Rate for Payer: Cash Price	$311.44
Rate for Payer: Cofinity Commercial	$272.51
Rate for Payer: Cofinity Commercial	$334.80
Rate for Payer: Healthscope Commercial	$350.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$330.90
Rate for Payer: PHP Commercial	$330.90
Rate for Payer: Priority Health Cigna Priority Health	$272.51
Rate for Payer: Priority Health SBD	$245.26

HC BRACE PRAFO OTS

Facility

$428.23

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$171.29
Max. Negotiated Rate	$559.20
Rate for Payer: Aetna Commercial	$364.00
Rate for Payer: Aetna New Business (MI Preferred)	$278.35
Rate for Payer: BCBS Complete	$171.29
Rate for Payer: BCBS Trust/PPO	$559.20
Rate for Payer: Cash Price	$342.58
Rate for Payer: Cash Price	$342.58
Rate for Payer: Cofinity Commercial	$368.28
Rate for Payer: Cofinity Commercial	$299.76
Rate for Payer: Healthscope Commercial	$385.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.00
Rate for Payer: PHP Commercial	$364.00
Rate for Payer: Priority Health Cigna Priority Health	$299.76
Rate for Payer: Priority Health SBD	$269.78
Rate for Payer: UHC All Payor (Choice/PPO)	$281.72
Rate for Payer: UHC Exchange	$234.77

HC BRACE PRAFO OTS

Facility

$428.23

Service Code	HCPCS L4397
Hospital Charge Code	27000456
Hospital Revenue Code	274
Min. Negotiated Rate	$269.78
Max. Negotiated Rate	$385.41
Rate for Payer: Aetna Commercial	$364.00
Rate for Payer: Aetna New Business (MI Preferred)	$278.35
Rate for Payer: Cash Price	$342.58
Rate for Payer: Cofinity Commercial	$299.76
Rate for Payer: Cofinity Commercial	$368.28
Rate for Payer: Healthscope Commercial	$385.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$364.00
Rate for Payer: PHP Commercial	$364.00
Rate for Payer: Priority Health Cigna Priority Health	$299.76
Rate for Payer: Priority Health SBD	$269.78

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$527.89

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$332.57
Max. Negotiated Rate	$475.10
Rate for Payer: Aetna Commercial	$448.71
Rate for Payer: Aetna New Business (MI Preferred)	$343.13
Rate for Payer: Cash Price	$422.31
Rate for Payer: Cofinity Commercial	$369.52
Rate for Payer: Cofinity Commercial	$453.99
Rate for Payer: Healthscope Commercial	$475.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.71
Rate for Payer: PHP Commercial	$448.71
Rate for Payer: Priority Health Cigna Priority Health	$369.52
Rate for Payer: Priority Health SBD	$332.57

HC BRACE RESTING NIGHTSPLINT CUSTOM

Facility

$527.89

Service Code	HCPCS L3807
Hospital Charge Code	27000200
Hospital Revenue Code	274
Min. Negotiated Rate	$211.16
Max. Negotiated Rate	$758.30
Rate for Payer: Aetna Commercial	$448.71
Rate for Payer: Aetna New Business (MI Preferred)	$343.13
Rate for Payer: BCBS Complete	$211.16
Rate for Payer: BCBS Trust/PPO	$758.30
Rate for Payer: Cash Price	$422.31
Rate for Payer: Cash Price	$422.31
Rate for Payer: Cofinity Commercial	$453.99
Rate for Payer: Cofinity Commercial	$369.52
Rate for Payer: Healthscope Commercial	$475.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.71
Rate for Payer: PHP Commercial	$448.71
Rate for Payer: Priority Health Cigna Priority Health	$369.52
Rate for Payer: Priority Health SBD	$332.57
Rate for Payer: UHC All Payor (Choice/PPO)	$382.72
Rate for Payer: UHC Exchange	$318.93

HC BRACE RIGID NECK

Facility

$181.43

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$114.30
Max. Negotiated Rate	$163.29
Rate for Payer: Aetna Commercial	$154.22
Rate for Payer: Aetna New Business (MI Preferred)	$117.93
Rate for Payer: Cash Price	$145.14
Rate for Payer: Cofinity Commercial	$127.00
Rate for Payer: Cofinity Commercial	$156.03
Rate for Payer: Healthscope Commercial	$163.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.22
Rate for Payer: PHP Commercial	$154.22
Rate for Payer: Priority Health Cigna Priority Health	$127.00
Rate for Payer: Priority Health SBD	$114.30

HC BRACE RIGID NECK

Facility

$181.43

Service Code	HCPCS L0140
Hospital Charge Code	27400009
Hospital Revenue Code	274
Min. Negotiated Rate	$72.57
Max. Negotiated Rate	$199.48
Rate for Payer: Aetna Commercial	$154.22
Rate for Payer: Aetna New Business (MI Preferred)	$117.93
Rate for Payer: BCBS Complete	$72.57
Rate for Payer: BCBS Trust/PPO	$199.48
Rate for Payer: Cash Price	$145.14
Rate for Payer: Cash Price	$145.14
Rate for Payer: Cofinity Commercial	$156.03
Rate for Payer: Cofinity Commercial	$127.00
Rate for Payer: Healthscope Commercial	$163.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$154.22
Rate for Payer: PHP Commercial	$154.22
Rate for Payer: Priority Health Cigna Priority Health	$127.00
Rate for Payer: Priority Health SBD	$114.30
Rate for Payer: UHC All Payor (Choice/PPO)	$112.69
Rate for Payer: UHC Exchange	$93.91

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$527.34

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$210.94
Max. Negotiated Rate	$2,186.77
Rate for Payer: Aetna Commercial	$448.24
Rate for Payer: Aetna New Business (MI Preferred)	$342.77
Rate for Payer: BCBS Complete	$210.94
Rate for Payer: BCBS Trust/PPO	$2,186.77
Rate for Payer: Cash Price	$421.87
Rate for Payer: Cash Price	$421.87
Rate for Payer: Cofinity Commercial	$453.51
Rate for Payer: Cofinity Commercial	$369.14
Rate for Payer: Healthscope Commercial	$474.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.24
Rate for Payer: PHP Commercial	$448.24
Rate for Payer: Priority Health Cigna Priority Health	$369.14
Rate for Payer: Priority Health SBD	$332.22
Rate for Payer: UHC All Payor (Choice/PPO)	$1,044.26
Rate for Payer: UHC Exchange	$870.22

HC BRACE SOCKET INSERT W/O LOCK MECH

Facility

$527.34

Service Code	HCPCS L5679
Hospital Charge Code	27400035
Hospital Revenue Code	274
Min. Negotiated Rate	$332.22
Max. Negotiated Rate	$474.61
Rate for Payer: Aetna Commercial	$448.24
Rate for Payer: Aetna New Business (MI Preferred)	$342.77
Rate for Payer: Cash Price	$421.87
Rate for Payer: Cofinity Commercial	$369.14
Rate for Payer: Cofinity Commercial	$453.51
Rate for Payer: Healthscope Commercial	$474.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$448.24
Rate for Payer: PHP Commercial	$448.24
Rate for Payer: Priority Health Cigna Priority Health	$369.14
Rate for Payer: Priority Health SBD	$332.22

HC BRACE SOFT COLLAR

Facility

$58.04

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$88.13
Rate for Payer: Aetna Commercial	$49.33
Rate for Payer: Aetna New Business (MI Preferred)	$37.73
Rate for Payer: BCBS Complete	$23.22
Rate for Payer: BCBS Trust/PPO	$88.13
Rate for Payer: Cash Price	$46.43
Rate for Payer: Cash Price	$46.43
Rate for Payer: Cofinity Commercial	$49.91
Rate for Payer: Cofinity Commercial	$40.63
Rate for Payer: Healthscope Commercial	$52.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.33
Rate for Payer: PHP Commercial	$49.33
Rate for Payer: Priority Health Cigna Priority Health	$40.63
Rate for Payer: Priority Health SBD	$36.57
Rate for Payer: UHC All Payor (Choice/PPO)	$46.72
Rate for Payer: UHC Exchange	$38.93

HC BRACE SOFT COLLAR

Facility

$58.04

Service Code	HCPCS L0120
Hospital Charge Code	27400010
Hospital Revenue Code	274
Min. Negotiated Rate	$36.57
Max. Negotiated Rate	$52.24
Rate for Payer: Aetna Commercial	$49.33
Rate for Payer: Aetna New Business (MI Preferred)	$37.73
Rate for Payer: Cash Price	$46.43
Rate for Payer: Cofinity Commercial	$40.63
Rate for Payer: Cofinity Commercial	$49.91
Rate for Payer: Healthscope Commercial	$52.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$49.33
Rate for Payer: PHP Commercial	$49.33
Rate for Payer: Priority Health Cigna Priority Health	$40.63
Rate for Payer: Priority Health SBD	$36.57

Know your out-of-pocket cost for care.

All Charges