Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HC NEG PRES CANIST 500CC

Facility

$148.49

Hospital Charge Code	27200136
Hospital Revenue Code	272
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$133.64
Rate for Payer: Aetna Commercial	$126.22
Rate for Payer: Aetna New Business (MI Preferred)	$96.52
Rate for Payer: BCBS Complete	$59.40
Rate for Payer: Cash Price	$118.79
Rate for Payer: Cofinity Commercial	$103.94
Rate for Payer: Cofinity Commercial	$127.70
Rate for Payer: Healthscope Commercial	$133.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$126.22
Rate for Payer: PHP Commercial	$126.22
Rate for Payer: Priority Health Cigna Priority Health	$103.94
Rate for Payer: Priority Health SBD	$93.55

HC NEG PRES CANIST 500CC

Facility

$148.49

Hospital Charge Code	27200136
Hospital Revenue Code	272
Min. Negotiated Rate	$93.55
Max. Negotiated Rate	$133.64
Rate for Payer: Aetna Commercial	$126.22
Rate for Payer: Aetna New Business (MI Preferred)	$96.52
Rate for Payer: Cash Price	$118.79
Rate for Payer: Cofinity Commercial	$103.94
Rate for Payer: Cofinity Commercial	$127.70
Rate for Payer: Healthscope Commercial	$133.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$126.22
Rate for Payer: PHP Commercial	$126.22
Rate for Payer: Priority Health Cigna Priority Health	$103.94
Rate for Payer: Priority Health SBD	$93.55

HC NEG PRES CLEANSE DRSG MED

Facility

$500.88

Hospital Charge Code	27200229
Hospital Revenue Code	272
Min. Negotiated Rate	$200.35
Max. Negotiated Rate	$450.79
Rate for Payer: Aetna Commercial	$425.75
Rate for Payer: Aetna New Business (MI Preferred)	$325.57
Rate for Payer: BCBS Complete	$200.35
Rate for Payer: Cash Price	$400.70
Rate for Payer: Cofinity Commercial	$350.62
Rate for Payer: Cofinity Commercial	$430.76
Rate for Payer: Healthscope Commercial	$450.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.75
Rate for Payer: PHP Commercial	$425.75
Rate for Payer: Priority Health Cigna Priority Health	$350.62
Rate for Payer: Priority Health SBD	$315.55

HC NEG PRES CLEANSE DRSG MED

Facility

$500.88

Hospital Charge Code	27200229
Hospital Revenue Code	272
Min. Negotiated Rate	$315.55
Max. Negotiated Rate	$450.79
Rate for Payer: Aetna Commercial	$425.75
Rate for Payer: Aetna New Business (MI Preferred)	$325.57
Rate for Payer: Cash Price	$400.70
Rate for Payer: Cofinity Commercial	$350.62
Rate for Payer: Cofinity Commercial	$430.76
Rate for Payer: Healthscope Commercial	$450.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$425.75
Rate for Payer: PHP Commercial	$425.75
Rate for Payer: Priority Health Cigna Priority Health	$350.62
Rate for Payer: Priority Health SBD	$315.55

HC NEG PRESSURE WND TX DME GT 50 SQ CM

Facility

$530.23

Service Code	CPT 97606
Hospital Charge Code	76100009
Hospital Revenue Code	761
Min. Negotiated Rate	$25.87
Max. Negotiated Rate	$1,076.20
Rate for Payer: Aetna Commercial	$450.70
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$344.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$424.18
Rate for Payer: Cash Price	$424.18
Rate for Payer: Cofinity Commercial	$371.16
Rate for Payer: Cofinity Commercial	$456.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$477.21
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$450.70
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$450.70
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$371.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$860.96
Rate for Payer: Priority Health SBD	$334.04
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$28.46
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$25.87
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

HC NEG PRESSURE WND TX DME GT 50 SQ CM

Facility

$530.23

Service Code	CPT 97606
Hospital Charge Code	76100009
Hospital Revenue Code	761
Min. Negotiated Rate	$334.04
Max. Negotiated Rate	$477.21
Rate for Payer: Aetna Commercial	$450.70
Rate for Payer: Aetna New Business (MI Preferred)	$344.65
Rate for Payer: Cash Price	$424.18
Rate for Payer: Cofinity Commercial	$371.16
Rate for Payer: Cofinity Commercial	$456.00
Rate for Payer: Healthscope Commercial	$477.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$450.70
Rate for Payer: PHP Commercial	$450.70
Rate for Payer: Priority Health Cigna Priority Health	$371.16
Rate for Payer: Priority Health SBD	$334.04

HC NEG PRESSURE WND TX DME UP TO 50 SQ CM

Facility

$419.92

Service Code	CPT 97605
Hospital Charge Code	76100008
Hospital Revenue Code	761
Min. Negotiated Rate	$23.58
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$356.93
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$272.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$47.60
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$335.94
Rate for Payer: Cash Price	$335.94
Rate for Payer: Cofinity Commercial	$293.94
Rate for Payer: Cofinity Commercial	$361.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$377.93
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$356.93
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$356.93
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$293.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$264.55
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$25.94
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$23.58
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

HC NEG PRESSURE WND TX DME UP TO 50 SQ CM

Facility

$419.92

Service Code	CPT 97605
Hospital Charge Code	76100008
Hospital Revenue Code	761
Min. Negotiated Rate	$264.55
Max. Negotiated Rate	$377.93
Rate for Payer: Aetna Commercial	$356.93
Rate for Payer: Aetna New Business (MI Preferred)	$272.95
Rate for Payer: Cash Price	$335.94
Rate for Payer: Cofinity Commercial	$293.94
Rate for Payer: Cofinity Commercial	$361.13
Rate for Payer: Healthscope Commercial	$377.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$356.93
Rate for Payer: PHP Commercial	$356.93
Rate for Payer: Priority Health Cigna Priority Health	$293.94
Rate for Payer: Priority Health SBD	$264.55

HC NEG PRES TRAC PAD

Facility

$72.36

Hospital Charge Code	27000158
Hospital Revenue Code	270
Min. Negotiated Rate	$28.94
Max. Negotiated Rate	$65.12
Rate for Payer: Aetna Commercial	$61.51
Rate for Payer: Aetna New Business (MI Preferred)	$47.03
Rate for Payer: BCBS Complete	$28.94
Rate for Payer: Cash Price	$57.89
Rate for Payer: Cofinity Commercial	$50.65
Rate for Payer: Cofinity Commercial	$62.23
Rate for Payer: Healthscope Commercial	$65.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.51
Rate for Payer: PHP Commercial	$61.51
Rate for Payer: Priority Health Cigna Priority Health	$50.65
Rate for Payer: Priority Health SBD	$45.59

HC NEG PRES TRAC PAD

Facility

$72.36

Hospital Charge Code	27000158
Hospital Revenue Code	270
Min. Negotiated Rate	$45.59
Max. Negotiated Rate	$65.12
Rate for Payer: Aetna Commercial	$61.51
Rate for Payer: Aetna New Business (MI Preferred)	$47.03
Rate for Payer: Cash Price	$57.89
Rate for Payer: Cofinity Commercial	$50.65
Rate for Payer: Cofinity Commercial	$62.23
Rate for Payer: Healthscope Commercial	$65.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$61.51
Rate for Payer: PHP Commercial	$61.51
Rate for Payer: Priority Health Cigna Priority Health	$50.65
Rate for Payer: Priority Health SBD	$45.59

HC NEG PRES VF CASSETTE

Facility

$208.70

Hospital Charge Code	27200230
Hospital Revenue Code	272
Min. Negotiated Rate	$131.48
Max. Negotiated Rate	$187.83
Rate for Payer: Aetna Commercial	$177.40
Rate for Payer: Aetna New Business (MI Preferred)	$135.66
Rate for Payer: Cash Price	$166.96
Rate for Payer: Cofinity Commercial	$146.09
Rate for Payer: Cofinity Commercial	$179.48
Rate for Payer: Healthscope Commercial	$187.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.40
Rate for Payer: PHP Commercial	$177.40
Rate for Payer: Priority Health Cigna Priority Health	$146.09
Rate for Payer: Priority Health SBD	$131.48

HC NEG PRES VF CASSETTE

Facility

$208.70

Hospital Charge Code	27200230
Hospital Revenue Code	272
Min. Negotiated Rate	$83.48
Max. Negotiated Rate	$187.83
Rate for Payer: Aetna Commercial	$177.40
Rate for Payer: Aetna New Business (MI Preferred)	$135.66
Rate for Payer: BCBS Complete	$83.48
Rate for Payer: Cash Price	$166.96
Rate for Payer: Cofinity Commercial	$146.09
Rate for Payer: Cofinity Commercial	$179.48
Rate for Payer: Healthscope Commercial	$187.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$177.40
Rate for Payer: PHP Commercial	$177.40
Rate for Payer: Priority Health Cigna Priority Health	$146.09
Rate for Payer: Priority Health SBD	$131.48

HC NEG PRES VF DRSG MED

Facility

$436.37

Hospital Charge Code	27200228
Hospital Revenue Code	272
Min. Negotiated Rate	$174.55
Max. Negotiated Rate	$392.73
Rate for Payer: Aetna Commercial	$370.91
Rate for Payer: Aetna New Business (MI Preferred)	$283.64
Rate for Payer: BCBS Complete	$174.55
Rate for Payer: Cash Price	$349.10
Rate for Payer: Cofinity Commercial	$305.46
Rate for Payer: Cofinity Commercial	$375.28
Rate for Payer: Healthscope Commercial	$392.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$370.91
Rate for Payer: PHP Commercial	$370.91
Rate for Payer: Priority Health Cigna Priority Health	$305.46
Rate for Payer: Priority Health SBD	$274.91

HC NEG PRES VF DRSG MED

Facility

$436.37

Hospital Charge Code	27200228
Hospital Revenue Code	272
Min. Negotiated Rate	$274.91
Max. Negotiated Rate	$392.73
Rate for Payer: Aetna Commercial	$370.91
Rate for Payer: Aetna New Business (MI Preferred)	$283.64
Rate for Payer: Cash Price	$349.10
Rate for Payer: Cofinity Commercial	$305.46
Rate for Payer: Cofinity Commercial	$375.28
Rate for Payer: Healthscope Commercial	$392.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$370.91
Rate for Payer: PHP Commercial	$370.91
Rate for Payer: Priority Health Cigna Priority Health	$305.46
Rate for Payer: Priority Health SBD	$274.91

HC NEG PRES VF DRSG SMA

Facility

$371.86

Hospital Charge Code	27200227
Hospital Revenue Code	272
Min. Negotiated Rate	$234.27
Max. Negotiated Rate	$334.67
Rate for Payer: Aetna Commercial	$316.08
Rate for Payer: Aetna New Business (MI Preferred)	$241.71
Rate for Payer: Cash Price	$297.49
Rate for Payer: Cofinity Commercial	$260.30
Rate for Payer: Cofinity Commercial	$319.80
Rate for Payer: Healthscope Commercial	$334.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$316.08
Rate for Payer: PHP Commercial	$316.08
Rate for Payer: Priority Health Cigna Priority Health	$260.30
Rate for Payer: Priority Health SBD	$234.27

HC NEG PRES VF DRSG SMA

Facility

$371.86

Hospital Charge Code	27200227
Hospital Revenue Code	272
Min. Negotiated Rate	$148.74
Max. Negotiated Rate	$334.67
Rate for Payer: Aetna Commercial	$316.08
Rate for Payer: Aetna New Business (MI Preferred)	$241.71
Rate for Payer: BCBS Complete	$148.74
Rate for Payer: Cash Price	$297.49
Rate for Payer: Cofinity Commercial	$260.30
Rate for Payer: Cofinity Commercial	$319.80
Rate for Payer: Healthscope Commercial	$334.67
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$316.08
Rate for Payer: PHP Commercial	$316.08
Rate for Payer: Priority Health Cigna Priority Health	$260.30
Rate for Payer: Priority Health SBD	$234.27

HC NEG PRES VF DUO TRAC PAD

Facility

$284.59

Hospital Charge Code	27200231
Hospital Revenue Code	272
Min. Negotiated Rate	$113.84
Max. Negotiated Rate	$256.13
Rate for Payer: Aetna Commercial	$241.90
Rate for Payer: Aetna New Business (MI Preferred)	$184.98
Rate for Payer: BCBS Complete	$113.84
Rate for Payer: Cash Price	$227.67
Rate for Payer: Cofinity Commercial	$199.21
Rate for Payer: Cofinity Commercial	$244.75
Rate for Payer: Healthscope Commercial	$256.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$241.90
Rate for Payer: PHP Commercial	$241.90
Rate for Payer: Priority Health Cigna Priority Health	$199.21
Rate for Payer: Priority Health SBD	$179.29

HC NEG PRES VF DUO TRAC PAD

Facility

$284.59

Hospital Charge Code	27200231
Hospital Revenue Code	272
Min. Negotiated Rate	$179.29
Max. Negotiated Rate	$256.13
Rate for Payer: Aetna Commercial	$241.90
Rate for Payer: Aetna New Business (MI Preferred)	$184.98
Rate for Payer: Cash Price	$227.67
Rate for Payer: Cofinity Commercial	$199.21
Rate for Payer: Cofinity Commercial	$244.75
Rate for Payer: Healthscope Commercial	$256.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$241.90
Rate for Payer: PHP Commercial	$241.90
Rate for Payer: Priority Health Cigna Priority Health	$199.21
Rate for Payer: Priority Health SBD	$179.29

HC NEG PRES WHT FOAM DRSG

Facility

$176.57

Hospital Charge Code	27200158
Hospital Revenue Code	272
Min. Negotiated Rate	$111.24
Max. Negotiated Rate	$158.91
Rate for Payer: Aetna Commercial	$150.08
Rate for Payer: Aetna New Business (MI Preferred)	$114.77
Rate for Payer: Cash Price	$141.26
Rate for Payer: Cofinity Commercial	$123.60
Rate for Payer: Cofinity Commercial	$151.85
Rate for Payer: Healthscope Commercial	$158.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$150.08
Rate for Payer: PHP Commercial	$150.08
Rate for Payer: Priority Health Cigna Priority Health	$123.60
Rate for Payer: Priority Health SBD	$111.24

HC NEG PRES WHT FOAM DRSG

Facility

$176.57

Hospital Charge Code	27200158
Hospital Revenue Code	272
Min. Negotiated Rate	$70.63
Max. Negotiated Rate	$158.91
Rate for Payer: Aetna Commercial	$150.08
Rate for Payer: Aetna New Business (MI Preferred)	$114.77
Rate for Payer: BCBS Complete	$70.63
Rate for Payer: Cash Price	$141.26
Rate for Payer: Cofinity Commercial	$123.60
Rate for Payer: Cofinity Commercial	$151.85
Rate for Payer: Healthscope Commercial	$158.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$150.08
Rate for Payer: PHP Commercial	$150.08
Rate for Payer: Priority Health Cigna Priority Health	$123.60
Rate for Payer: Priority Health SBD	$111.24

HC NEG PRES WND THRPY DSG EXLGE

Facility

$373.77

Hospital Charge Code	27200137
Hospital Revenue Code	272
Min. Negotiated Rate	$235.48
Max. Negotiated Rate	$336.39
Rate for Payer: Aetna Commercial	$317.70
Rate for Payer: Aetna New Business (MI Preferred)	$242.95
Rate for Payer: Cash Price	$299.02
Rate for Payer: Cofinity Commercial	$261.64
Rate for Payer: Cofinity Commercial	$321.44
Rate for Payer: Healthscope Commercial	$336.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$317.70
Rate for Payer: PHP Commercial	$317.70
Rate for Payer: Priority Health Cigna Priority Health	$261.64
Rate for Payer: Priority Health SBD	$235.48

HC NEG PRES WND THRPY DSG EXLGE

Facility

$373.77

Hospital Charge Code	27200137
Hospital Revenue Code	272
Min. Negotiated Rate	$149.51
Max. Negotiated Rate	$336.39
Rate for Payer: Aetna Commercial	$317.70
Rate for Payer: Aetna New Business (MI Preferred)	$242.95
Rate for Payer: BCBS Complete	$149.51
Rate for Payer: Cash Price	$299.02
Rate for Payer: Cofinity Commercial	$261.64
Rate for Payer: Cofinity Commercial	$321.44
Rate for Payer: Healthscope Commercial	$336.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$317.70
Rate for Payer: PHP Commercial	$317.70
Rate for Payer: Priority Health Cigna Priority Health	$261.64
Rate for Payer: Priority Health SBD	$235.48

HC NEG PRES WND THRPY DSG SET LAR

Facility

$198.58

Hospital Charge Code	27200138
Hospital Revenue Code	272
Min. Negotiated Rate	$79.43
Max. Negotiated Rate	$178.72
Rate for Payer: Aetna Commercial	$168.79
Rate for Payer: Aetna New Business (MI Preferred)	$129.08
Rate for Payer: BCBS Complete	$79.43
Rate for Payer: Cash Price	$158.86
Rate for Payer: Cofinity Commercial	$139.01
Rate for Payer: Cofinity Commercial	$170.78
Rate for Payer: Healthscope Commercial	$178.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.79
Rate for Payer: PHP Commercial	$168.79
Rate for Payer: Priority Health Cigna Priority Health	$139.01
Rate for Payer: Priority Health SBD	$125.11

HC NEG PRES WND THRPY DSG SET LAR

Facility

$198.58

Hospital Charge Code	27200138
Hospital Revenue Code	272
Min. Negotiated Rate	$125.11
Max. Negotiated Rate	$178.72
Rate for Payer: Aetna Commercial	$168.79
Rate for Payer: Aetna New Business (MI Preferred)	$129.08
Rate for Payer: Cash Price	$158.86
Rate for Payer: Cofinity Commercial	$139.01
Rate for Payer: Cofinity Commercial	$170.78
Rate for Payer: Healthscope Commercial	$178.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.79
Rate for Payer: PHP Commercial	$168.79
Rate for Payer: Priority Health Cigna Priority Health	$139.01
Rate for Payer: Priority Health SBD	$125.11

HC NEG PRES WND THRPY DSG SET MED

Facility

$143.06

Hospital Charge Code	27200139
Hospital Revenue Code	272
Min. Negotiated Rate	$57.22
Max. Negotiated Rate	$128.75
Rate for Payer: Aetna Commercial	$121.60
Rate for Payer: Aetna New Business (MI Preferred)	$92.99
Rate for Payer: BCBS Complete	$57.22
Rate for Payer: Cash Price	$114.45
Rate for Payer: Cofinity Commercial	$100.14
Rate for Payer: Cofinity Commercial	$123.03
Rate for Payer: Healthscope Commercial	$128.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$121.60
Rate for Payer: PHP Commercial	$121.60
Rate for Payer: Priority Health Cigna Priority Health	$100.14
Rate for Payer: Priority Health SBD	$90.13

Know your out-of-pocket cost for care.

All Charges