Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC ELECTROPHYSIOLOGY STUDY

Facility

$26,484.59

Service Code	CPT 93620
Hospital Charge Code	48100037
Hospital Revenue Code	481
Min. Negotiated Rate	$16,685.29
Max. Negotiated Rate	$23,836.13
Rate for Payer: Aetna Commercial	$22,511.90
Rate for Payer: Aetna New Business (MI Preferred)	$17,214.98
Rate for Payer: Cash Price	$21,187.67
Rate for Payer: Cofinity Commercial	$18,539.21
Rate for Payer: Cofinity Commercial	$22,776.75
Rate for Payer: Healthscope Commercial	$23,836.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22,511.90
Rate for Payer: PHP Commercial	$22,511.90
Rate for Payer: Priority Health Cigna Priority Health	$18,539.21
Rate for Payer: Priority Health SBD	$16,685.29

HC ELM IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200042
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	$17.42
Rate for Payer: Cofinity Commercial	$21.41
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 ELM IGE

Facility

$24.89

Service Code	CPT 86003
Hospital Charge Code	30200042
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 ELVAREX CHAP STYLE ONE LEG

Facility

$573.09

Service Code	HCPCS A6549
Hospital Charge Code	27000368
Hospital Revenue Code	270
Min. Negotiated Rate	$229.24
Max. Negotiated Rate	$515.78
Rate for Payer: Aetna Commercial	$487.13
Rate for Payer: Aetna New Business (MI Preferred)	$372.51
Rate for Payer: BCBS Complete	$229.24
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$458.47
Rate for Payer: Cash Price	$458.47
Rate for Payer: Cofinity Commercial	$401.16
Rate for Payer: Cofinity Commercial	$492.86
Rate for Payer: Healthscope Commercial	$515.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$487.13
Rate for Payer: PHP Commercial	$487.13
Rate for Payer: Priority Health Cigna Priority Health	$401.16
Rate for Payer: Priority Health SBD	$361.05

HC ELVAREX CHAP STYLE ONE LEG

Facility

$573.09

Service Code	HCPCS A6549
Hospital Charge Code	27000368
Hospital Revenue Code	270
Min. Negotiated Rate	$361.05
Max. Negotiated Rate	$515.78
Rate for Payer: Aetna Commercial	$487.13
Rate for Payer: Aetna New Business (MI Preferred)	$372.51
Rate for Payer: Cash Price	$458.47
Rate for Payer: Cofinity Commercial	$401.16
Rate for Payer: Cofinity Commercial	$492.86
Rate for Payer: Healthscope Commercial	$515.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$487.13
Rate for Payer: PHP Commercial	$487.13
Rate for Payer: Priority Health Cigna Priority Health	$401.16
Rate for Payer: Priority Health SBD	$361.05

HC ELVAREX CHAP STYLE TWO LEG

Facility

$1,146.15

Service Code	HCPCS A6549
Hospital Charge Code	27000369
Hospital Revenue Code	270
Min. Negotiated Rate	$722.07
Max. Negotiated Rate	$1,031.54
Rate for Payer: Aetna Commercial	$974.23
Rate for Payer: Aetna New Business (MI Preferred)	$745.00
Rate for Payer: Cash Price	$916.92
Rate for Payer: Cofinity Commercial	$802.30
Rate for Payer: Cofinity Commercial	$985.69
Rate for Payer: Healthscope Commercial	$1,031.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$974.23
Rate for Payer: PHP Commercial	$974.23
Rate for Payer: Priority Health Cigna Priority Health	$802.30
Rate for Payer: Priority Health SBD	$722.07

HC ELVAREX CHAP STYLE TWO LEG

Facility

$1,146.15

Service Code	HCPCS A6549
Hospital Charge Code	27000369
Hospital Revenue Code	270
Min. Negotiated Rate	$381.58
Max. Negotiated Rate	$1,031.54
Rate for Payer: Aetna Commercial	$974.23
Rate for Payer: Aetna New Business (MI Preferred)	$745.00
Rate for Payer: BCBS Complete	$458.46
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$916.92
Rate for Payer: Cash Price	$916.92
Rate for Payer: Cofinity Commercial	$802.30
Rate for Payer: Cofinity Commercial	$985.69
Rate for Payer: Healthscope Commercial	$1,031.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$974.23
Rate for Payer: PHP Commercial	$974.23
Rate for Payer: Priority Health Cigna Priority Health	$802.30
Rate for Payer: Priority Health SBD	$722.07

HC ELVAREX KNEE SLANT OPEN TOE

Facility

$281.25

Service Code	HCPCS A6549
Hospital Charge Code	27000366
Hospital Revenue Code	270
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$239.06
Rate for Payer: Aetna New Business (MI Preferred)	$182.81
Rate for Payer: BCBS Complete	$112.50
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cofinity Commercial	$196.88
Rate for Payer: Cofinity Commercial	$241.88
Rate for Payer: Healthscope Commercial	$253.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$239.06
Rate for Payer: PHP Commercial	$239.06
Rate for Payer: Priority Health Cigna Priority Health	$196.88
Rate for Payer: Priority Health SBD	$177.19

HC ELVAREX KNEE SLANT OPEN TOE

Facility

$281.25

Service Code	HCPCS A6549
Hospital Charge Code	27000366
Hospital Revenue Code	270
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$253.12
Rate for Payer: Aetna Commercial	$239.06
Rate for Payer: Aetna New Business (MI Preferred)	$182.81
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cofinity Commercial	$196.88
Rate for Payer: Cofinity Commercial	$241.88
Rate for Payer: Healthscope Commercial	$253.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$239.06
Rate for Payer: PHP Commercial	$239.06
Rate for Payer: Priority Health Cigna Priority Health	$196.88
Rate for Payer: Priority Health SBD	$177.19

HC ELVAREX SLEEVE

Facility

$249.60

Service Code	HCPCS A6549
Hospital Charge Code	27000365
Hospital Revenue Code	270
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$212.16
Rate for Payer: Aetna New Business (MI Preferred)	$162.24
Rate for Payer: BCBS Complete	$99.84
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Cofinity Commercial	$214.66
Rate for Payer: Healthscope Commercial	$224.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.16
Rate for Payer: PHP Commercial	$212.16
Rate for Payer: Priority Health Cigna Priority Health	$174.72
Rate for Payer: Priority Health SBD	$157.25

HC ELVAREX SLEEVE

Facility

$249.60

Service Code	HCPCS A6549
Hospital Charge Code	27000365
Hospital Revenue Code	270
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$224.64
Rate for Payer: Aetna Commercial	$212.16
Rate for Payer: Aetna New Business (MI Preferred)	$162.24
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Cofinity Commercial	$214.66
Rate for Payer: Healthscope Commercial	$224.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.16
Rate for Payer: PHP Commercial	$212.16
Rate for Payer: Priority Health Cigna Priority Health	$174.72
Rate for Payer: Priority Health SBD	$157.25

HC ELVAREX SOFT ARMSLEEVE

Facility

$249.60

Service Code	HCPCS A6549
Hospital Charge Code	27000372
Hospital Revenue Code	270
Min. Negotiated Rate	$157.25
Max. Negotiated Rate	$224.64
Rate for Payer: Aetna Commercial	$212.16
Rate for Payer: Aetna New Business (MI Preferred)	$162.24
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Cofinity Commercial	$214.66
Rate for Payer: Healthscope Commercial	$224.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.16
Rate for Payer: PHP Commercial	$212.16
Rate for Payer: Priority Health Cigna Priority Health	$174.72
Rate for Payer: Priority Health SBD	$157.25

HC ELVAREX SOFT ARMSLEEVE

Facility

$249.60

Service Code	HCPCS A6549
Hospital Charge Code	27000372
Hospital Revenue Code	270
Min. Negotiated Rate	$99.84
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$212.16
Rate for Payer: Aetna New Business (MI Preferred)	$162.24
Rate for Payer: BCBS Complete	$99.84
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cash Price	$199.68
Rate for Payer: Cofinity Commercial	$174.72
Rate for Payer: Cofinity Commercial	$214.66
Rate for Payer: Healthscope Commercial	$224.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$212.16
Rate for Payer: PHP Commercial	$212.16
Rate for Payer: Priority Health Cigna Priority Health	$174.72
Rate for Payer: Priority Health SBD	$157.25

HC ELVAREX SOFT KNEE CLOSED T

Facility

$281.25

Service Code	HCPCS A6549
Hospital Charge Code	27000373
Hospital Revenue Code	270
Min. Negotiated Rate	$177.19
Max. Negotiated Rate	$253.12
Rate for Payer: Aetna Commercial	$239.06
Rate for Payer: Aetna New Business (MI Preferred)	$182.81
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cofinity Commercial	$196.88
Rate for Payer: Cofinity Commercial	$241.88
Rate for Payer: Healthscope Commercial	$253.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$239.06
Rate for Payer: PHP Commercial	$239.06
Rate for Payer: Priority Health Cigna Priority Health	$196.88
Rate for Payer: Priority Health SBD	$177.19

HC ELVAREX SOFT KNEE CLOSED T

Facility

$281.25

Service Code	HCPCS A6549
Hospital Charge Code	27000373
Hospital Revenue Code	270
Min. Negotiated Rate	$112.50
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$239.06
Rate for Payer: Aetna New Business (MI Preferred)	$182.81
Rate for Payer: BCBS Complete	$112.50
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cofinity Commercial	$196.88
Rate for Payer: Cofinity Commercial	$241.88
Rate for Payer: Healthscope Commercial	$253.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$239.06
Rate for Payer: PHP Commercial	$239.06
Rate for Payer: Priority Health Cigna Priority Health	$196.88
Rate for Payer: Priority Health SBD	$177.19

HC ELVAREX THIGH SLANT OPEN TOE

Facility

$411.39

Service Code	HCPCS A6549
Hospital Charge Code	27000367
Hospital Revenue Code	270
Min. Negotiated Rate	$259.18
Max. Negotiated Rate	$370.25
Rate for Payer: Aetna Commercial	$349.68
Rate for Payer: Aetna New Business (MI Preferred)	$267.40
Rate for Payer: Cash Price	$329.11
Rate for Payer: Cofinity Commercial	$287.97
Rate for Payer: Cofinity Commercial	$353.80
Rate for Payer: Healthscope Commercial	$370.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$349.68
Rate for Payer: PHP Commercial	$349.68
Rate for Payer: Priority Health Cigna Priority Health	$287.97
Rate for Payer: Priority Health SBD	$259.18

HC ELVAREX THIGH SLANT OPEN TOE

Facility

$411.39

Service Code	HCPCS A6549
Hospital Charge Code	27000367
Hospital Revenue Code	270
Min. Negotiated Rate	$164.56
Max. Negotiated Rate	$381.58
Rate for Payer: Aetna Commercial	$349.68
Rate for Payer: Aetna New Business (MI Preferred)	$267.40
Rate for Payer: BCBS Complete	$164.56
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$329.11
Rate for Payer: Cash Price	$329.11
Rate for Payer: Cofinity Commercial	$287.97
Rate for Payer: Cofinity Commercial	$353.80
Rate for Payer: Healthscope Commercial	$370.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$349.68
Rate for Payer: PHP Commercial	$349.68
Rate for Payer: Priority Health Cigna Priority Health	$287.97
Rate for Payer: Priority Health SBD	$259.18

HC ELVAREX WAIST HIGH PRESSURE

Facility

$528.36

Service Code	HCPCS A6549
Hospital Charge Code	27000370
Hospital Revenue Code	270
Min. Negotiated Rate	$332.87
Max. Negotiated Rate	$475.52
Rate for Payer: Aetna Commercial	$449.11
Rate for Payer: Aetna New Business (MI Preferred)	$343.43
Rate for Payer: Cash Price	$422.69
Rate for Payer: Cofinity Commercial	$369.85
Rate for Payer: Cofinity Commercial	$454.39
Rate for Payer: Healthscope Commercial	$475.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$449.11
Rate for Payer: PHP Commercial	$449.11
Rate for Payer: Priority Health Cigna Priority Health	$369.85
Rate for Payer: Priority Health SBD	$332.87

HC ELVAREX WAIST HIGH PRESSURE

Facility

$528.36

Service Code	HCPCS A6549
Hospital Charge Code	27000370
Hospital Revenue Code	270
Min. Negotiated Rate	$211.34
Max. Negotiated Rate	$475.52
Rate for Payer: Aetna Commercial	$449.11
Rate for Payer: Aetna New Business (MI Preferred)	$343.43
Rate for Payer: BCBS Complete	$211.34
Rate for Payer: BCBS Trust/PPO	$381.58
Rate for Payer: Cash Price	$422.69
Rate for Payer: Cash Price	$422.69
Rate for Payer: Cofinity Commercial	$369.85
Rate for Payer: Cofinity Commercial	$454.39
Rate for Payer: Healthscope Commercial	$475.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$449.11
Rate for Payer: PHP Commercial	$449.11
Rate for Payer: Priority Health Cigna Priority Health	$369.85
Rate for Payer: Priority Health SBD	$332.87

HC ELVAREX ZIPPER

Facility

$67.92

Service Code	HCPCS A9270
Hospital Charge Code	27000371
Hospital Revenue Code	270
Min. Negotiated Rate	$42.79
Max. Negotiated Rate	$61.13
Rate for Payer: Aetna Commercial	$57.73
Rate for Payer: Aetna New Business (MI Preferred)	$44.15
Rate for Payer: Cash Price	$54.34
Rate for Payer: Cofinity Commercial	$47.54
Rate for Payer: Cofinity Commercial	$58.41
Rate for Payer: Healthscope Commercial	$61.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.73
Rate for Payer: PHP Commercial	$57.73
Rate for Payer: Priority Health Cigna Priority Health	$47.54
Rate for Payer: Priority Health SBD	$42.79

HC ELVAREX ZIPPER

Facility

$67.92

Service Code	HCPCS A9270
Hospital Charge Code	27000371
Hospital Revenue Code	270
Min. Negotiated Rate	$27.17
Max. Negotiated Rate	$61.13
Rate for Payer: Aetna Commercial	$57.73
Rate for Payer: Aetna New Business (MI Preferred)	$44.15
Rate for Payer: BCBS Complete	$27.17
Rate for Payer: Cash Price	$54.34
Rate for Payer: Cofinity Commercial	$58.41
Rate for Payer: Cofinity Commercial	$47.54
Rate for Payer: Healthscope Commercial	$61.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$57.73
Rate for Payer: PHP Commercial	$57.73
Rate for Payer: Priority Health Cigna Priority Health	$47.54
Rate for Payer: Priority Health SBD	$42.79

HC EMBOLIC GLUE LVL

Facility

$11,625.00

Hospital Charge Code	27800128
Hospital Revenue Code	278
Min. Negotiated Rate	$4,650.00
Max. Negotiated Rate	$10,462.50
Rate for Payer: Aetna Commercial	$9,881.25
Rate for Payer: Aetna New Business (MI Preferred)	$7,556.25
Rate for Payer: BCBS Complete	$4,650.00
Rate for Payer: Cash Price	$9,300.00
Rate for Payer: Cofinity Commercial	$8,137.50
Rate for Payer: Cofinity Commercial	$9,997.50
Rate for Payer: Healthscope Commercial	$10,462.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,881.25
Rate for Payer: PHP Commercial	$9,881.25
Rate for Payer: Priority Health Cigna Priority Health	$8,137.50
Rate for Payer: Priority Health SBD	$7,323.75

HC EMBOLIC GLUE LVL

Facility

$11,625.00

Hospital Charge Code	27800128
Hospital Revenue Code	278
Min. Negotiated Rate	$7,323.75
Max. Negotiated Rate	$10,462.50
Rate for Payer: Aetna Commercial	$9,881.25
Rate for Payer: Aetna New Business (MI Preferred)	$7,556.25
Rate for Payer: Cash Price	$9,300.00
Rate for Payer: Cofinity Commercial	$8,137.50
Rate for Payer: Cofinity Commercial	$9,997.50
Rate for Payer: Healthscope Commercial	$10,462.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9,881.25
Rate for Payer: PHP Commercial	$9,881.25
Rate for Payer: Priority Health Cigna Priority Health	$8,137.50
Rate for Payer: Priority Health SBD	$7,323.75

HC EMBOLIC GLUE LVL 1

Facility

$5,545.11

Hospital Charge Code	27800050
Hospital Revenue Code	278
Min. Negotiated Rate	$2,218.04
Max. Negotiated Rate	$4,990.60
Rate for Payer: Aetna Commercial	$4,713.34
Rate for Payer: Aetna New Business (MI Preferred)	$3,604.32
Rate for Payer: BCBS Complete	$2,218.04
Rate for Payer: Cash Price	$4,436.09
Rate for Payer: Cofinity Commercial	$3,881.58
Rate for Payer: Cofinity Commercial	$4,768.79
Rate for Payer: Healthscope Commercial	$4,990.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,713.34
Rate for Payer: PHP Commercial	$4,713.34
Rate for Payer: Priority Health Cigna Priority Health	$3,881.58
Rate for Payer: Priority Health SBD	$3,493.42

HC EMBOLIC GLUE LVL 1

Facility

$5,545.11

Hospital Charge Code	27800050
Hospital Revenue Code	278
Min. Negotiated Rate	$3,493.42
Max. Negotiated Rate	$4,990.60
Rate for Payer: Aetna Commercial	$4,713.34
Rate for Payer: Aetna New Business (MI Preferred)	$3,604.32
Rate for Payer: Cash Price	$4,436.09
Rate for Payer: Cofinity Commercial	$3,881.58
Rate for Payer: Cofinity Commercial	$4,768.79
Rate for Payer: Healthscope Commercial	$4,990.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,713.34
Rate for Payer: PHP Commercial	$4,713.34
Rate for Payer: Priority Health Cigna Priority Health	$3,881.58
Rate for Payer: Priority Health SBD	$3,493.42

Know your out-of-pocket cost for care.

All Charges