Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ

Professional

Both

$736.00

Service Code	HCPCS 26641
Min. Negotiated Rate	$253.90
Max. Negotiated Rate	$597.97
Rate for Payer: Aetna Commercial	$505.26
Rate for Payer: BCBS Complete	$266.60
Rate for Payer: BCBS Trust/PPO	$525.66
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Mclaren Medicaid	$253.90
Rate for Payer: Meridian Medicaid	$266.60
Rate for Payer: Priority Health Choice Medicaid	$253.90
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$597.97
Rate for Payer: Priority Health Narrow Network	$597.97
Rate for Payer: Priority Health SBD	$597.97

PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ

Professional

Both

$998.00

Service Code	HCPCS 26645
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$698.60
Rate for Payer: Aetna Commercial	$526.41
Rate for Payer: BCBS Complete	$274.87
Rate for Payer: BCBS Trust/PPO	$23.25
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Mclaren Medicaid	$261.78
Rate for Payer: Meridian Medicaid	$274.87
Rate for Payer: Priority Health Choice Medicaid	$261.78
Rate for Payer: Priority Health Cigna Priority Health	$698.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$617.89
Rate for Payer: Priority Health Narrow Network	$617.89
Rate for Payer: Priority Health SBD	$617.89

PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES

Professional

Both

$593.00

Service Code	HCPCS 26670
Min. Negotiated Rate	$57.73
Max. Negotiated Rate	$489.20
Rate for Payer: Aetna Commercial	$415.80
Rate for Payer: BCBS Complete	$219.18
Rate for Payer: BCBS Trust/PPO	$57.73
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Mclaren Medicaid	$208.74
Rate for Payer: Meridian Medicaid	$219.18
Rate for Payer: Priority Health Choice Medicaid	$208.74
Rate for Payer: Priority Health Cigna Priority Health	$415.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$489.20
Rate for Payer: Priority Health Narrow Network	$489.20
Rate for Payer: Priority Health SBD	$489.20

PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES

Professional

Both

$1,240.00

Service Code	HCPCS 26675
Min. Negotiated Rate	$46.70
Max. Negotiated Rate	$868.00
Rate for Payer: Aetna Commercial	$561.06
Rate for Payer: BCBS Complete	$293.65
Rate for Payer: BCBS Trust/PPO	$46.70
Rate for Payer: Cash Price	$992.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: Mclaren Medicaid	$279.67
Rate for Payer: Meridian Medicaid	$293.65
Rate for Payer: Priority Health Choice Medicaid	$279.67
Rate for Payer: Priority Health Cigna Priority Health	$868.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$660.27
Rate for Payer: Priority Health Narrow Network	$660.27
Rate for Payer: Priority Health SBD	$660.27

PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ

Professional

Both

$1,280.00

Service Code	HCPCS 27516
Min. Negotiated Rate	$319.71
Max. Negotiated Rate	$1,829.50
Rate for Payer: Aetna Commercial	$641.97
Rate for Payer: BCBS Complete	$335.70
Rate for Payer: BCBS Trust/PPO	$1,829.50
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Mclaren Medicaid	$319.71
Rate for Payer: Meridian Medicaid	$335.70
Rate for Payer: Priority Health Choice Medicaid	$319.71
Rate for Payer: Priority Health Cigna Priority Health	$896.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$755.25
Rate for Payer: Priority Health Narrow Network	$755.25
Rate for Payer: Priority Health SBD	$755.25

PR CLTX DSTL FIBULAR FX LAT MALLS W/MANJ

Professional

Both

$1,330.00

Service Code	HCPCS 27788
Min. Negotiated Rate	$254.54
Max. Negotiated Rate	$931.00
Rate for Payer: Aetna Commercial	$512.28
Rate for Payer: BCBS Complete	$267.27
Rate for Payer: BCBS Trust/PPO	$677.10
Rate for Payer: Cash Price	$1,064.00
Rate for Payer: Cash Price	$1,064.00
Rate for Payer: Mclaren Medicaid	$254.54
Rate for Payer: Meridian Medicaid	$267.27
Rate for Payer: Priority Health Choice Medicaid	$254.54
Rate for Payer: Priority Health Cigna Priority Health	$931.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$602.06
Rate for Payer: Priority Health Narrow Network	$602.06
Rate for Payer: Priority Health SBD	$602.06

PR CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ

Professional

Both

$760.00

Service Code	HCPCS 27786
Min. Negotiated Rate	$191.06
Max. Negotiated Rate	$2,764.24
Rate for Payer: Aetna Commercial	$381.27
Rate for Payer: BCBS Complete	$200.61
Rate for Payer: BCBS Trust/PPO	$2,764.24
Rate for Payer: Cash Price	$608.00
Rate for Payer: Cash Price	$608.00
Rate for Payer: Mclaren Medicaid	$191.06
Rate for Payer: Meridian Medicaid	$200.61
Rate for Payer: Priority Health Choice Medicaid	$191.06
Rate for Payer: Priority Health Cigna Priority Health	$532.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$450.90
Rate for Payer: Priority Health Narrow Network	$450.90
Rate for Payer: Priority Health SBD	$450.90

PR CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA

Professional

Both

$539.00

Service Code	HCPCS 26755
Min. Negotiated Rate	$182.54
Max. Negotiated Rate	$1,776.67
Rate for Payer: Aetna Commercial	$366.59
Rate for Payer: BCBS Complete	$191.67
Rate for Payer: BCBS Trust/PPO	$1,776.67
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Mclaren Medicaid	$182.54
Rate for Payer: Meridian Medicaid	$191.67
Rate for Payer: Priority Health Choice Medicaid	$182.54
Rate for Payer: Priority Health Cigna Priority Health	$377.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$432.51
Rate for Payer: Priority Health Narrow Network	$432.51
Rate for Payer: Priority Health SBD	$432.51

PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA

Professional

Both

$404.00

Service Code	HCPCS 26750
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$945.13
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: BCBS Complete	$134.19
Rate for Payer: BCBS Trust/PPO	$945.13
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Mclaren Medicaid	$127.80
Rate for Payer: Meridian Medicaid	$134.19
Rate for Payer: Priority Health Choice Medicaid	$127.80
Rate for Payer: Priority Health Cigna Priority Health	$282.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$299.24
Rate for Payer: Priority Health Narrow Network	$299.24
Rate for Payer: Priority Health SBD	$299.24

PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ

Professional

Both

$739.00

Service Code	HCPCS 25600
Min. Negotiated Rate	$216.83
Max. Negotiated Rate	$579.96
Rate for Payer: Aetna Commercial	$422.71
Rate for Payer: BCBS Complete	$227.67
Rate for Payer: BCBS Trust/PPO	$579.96
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Mclaren Medicaid	$216.83
Rate for Payer: Meridian Medicaid	$227.67
Rate for Payer: Priority Health Choice Medicaid	$216.83
Rate for Payer: Priority Health Cigna Priority Health	$517.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$510.13
Rate for Payer: Priority Health Narrow Network	$510.13
Rate for Payer: Priority Health SBD	$510.13

PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF

Professional

Both

$1,361.00

Service Code	HCPCS 25605
Min. Negotiated Rate	$101.96
Max. Negotiated Rate	$952.70
Rate for Payer: Aetna Commercial	$681.17
Rate for Payer: BCBS Complete	$353.82
Rate for Payer: BCBS Trust/PPO	$101.96
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Mclaren Medicaid	$336.97
Rate for Payer: Meridian Medicaid	$353.82
Rate for Payer: Priority Health Choice Medicaid	$336.97
Rate for Payer: Priority Health Cigna Priority Health	$952.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$798.15
Rate for Payer: Priority Health Narrow Network	$798.15
Rate for Payer: Priority Health SBD	$798.15

PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING

Professional

Both

$1,026.00

Service Code	HCPCS 26432
Min. Negotiated Rate	$257.28
Max. Negotiated Rate	$849.20
Rate for Payer: Aetna Commercial	$712.43
Rate for Payer: BCBS Complete	$370.59
Rate for Payer: BCBS Trust/PPO	$257.28
Rate for Payer: Cash Price	$820.80
Rate for Payer: Cash Price	$820.80
Rate for Payer: Mclaren Medicaid	$352.94
Rate for Payer: Meridian Medicaid	$370.59
Rate for Payer: Priority Health Choice Medicaid	$352.94
Rate for Payer: Priority Health Cigna Priority Health	$718.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$849.20
Rate for Payer: Priority Health Narrow Network	$849.20
Rate for Payer: Priority Health SBD	$849.20

PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ

Professional

Both

$1,389.00

Service Code	HCPCS 27510
Min. Negotiated Rate	$442.19
Max. Negotiated Rate	$1,050.92
Rate for Payer: Aetna Commercial	$911.08
Rate for Payer: BCBS Complete	$464.30
Rate for Payer: BCBS Trust/PPO	$768.68
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Mclaren Medicaid	$442.19
Rate for Payer: Meridian Medicaid	$464.30
Rate for Payer: Priority Health Choice Medicaid	$442.19
Rate for Payer: Priority Health Cigna Priority Health	$972.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,050.92
Rate for Payer: Priority Health Narrow Network	$1,050.92
Rate for Payer: Priority Health SBD	$1,050.92

PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ

Professional

Both

$1,078.00

Service Code	HCPCS 27508
Min. Negotiated Rate	$326.53
Max. Negotiated Rate	$773.63
Rate for Payer: Aetna Commercial	$663.27
Rate for Payer: BCBS Complete	$342.86
Rate for Payer: BCBS Trust/PPO	$738.04
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Mclaren Medicaid	$326.53
Rate for Payer: Meridian Medicaid	$342.86
Rate for Payer: Priority Health Choice Medicaid	$326.53
Rate for Payer: Priority Health Cigna Priority Health	$754.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.63
Rate for Payer: Priority Health Narrow Network	$773.63
Rate for Payer: Priority Health SBD	$773.63

PR CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ

Professional

Both

$1,346.00

Service Code	HCPCS 27232
Min. Negotiated Rate	$467.75
Max. Negotiated Rate	$1,113.73
Rate for Payer: Aetna Commercial	$995.08
Rate for Payer: BCBS Complete	$491.14
Rate for Payer: BCBS Trust/PPO	$835.77
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Mclaren Medicaid	$467.75
Rate for Payer: Meridian Medicaid	$491.14
Rate for Payer: Priority Health Choice Medicaid	$467.75
Rate for Payer: Priority Health Cigna Priority Health	$942.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,113.73
Rate for Payer: Priority Health Narrow Network	$1,113.73
Rate for Payer: Priority Health SBD	$1,113.73

PR CLTX FEM FX PROX END NCK W/O MANJ

Professional

Both

$979.00

Service Code	HCPCS 27230
Min. Negotiated Rate	$313.75
Max. Negotiated Rate	$806.71
Rate for Payer: Aetna Commercial	$634.41
Rate for Payer: BCBS Complete	$329.44
Rate for Payer: BCBS Trust/PPO	$806.71
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Mclaren Medicaid	$313.75
Rate for Payer: Meridian Medicaid	$329.44
Rate for Payer: Priority Health Choice Medicaid	$313.75
Rate for Payer: Priority Health Cigna Priority Health	$685.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$741.46
Rate for Payer: Priority Health Narrow Network	$741.46
Rate for Payer: Priority Health SBD	$741.46

PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ

Professional

Both

$1,796.00

Service Code	HCPCS 27502
Min. Negotiated Rate	$486.71
Max. Negotiated Rate	$1,257.20
Rate for Payer: Aetna Commercial	$1,013.42
Rate for Payer: BCBS Complete	$511.05
Rate for Payer: BCBS Trust/PPO	$878.56
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Mclaren Medicaid	$486.71
Rate for Payer: Meridian Medicaid	$511.05
Rate for Payer: Priority Health Choice Medicaid	$486.71
Rate for Payer: Priority Health Cigna Priority Health	$1,257.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,161.72
Rate for Payer: Priority Health Narrow Network	$1,161.72
Rate for Payer: Priority Health SBD	$1,161.72

PR CLTX FX GRT TOE PHLX/PHLG W/MANJ

Professional

Both

$224.00

Service Code	HCPCS 28495
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$413.04
Rate for Payer: Aetna Commercial	$192.97
Rate for Payer: BCBS Complete	$103.33
Rate for Payer: BCBS Trust/PPO	$413.04
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Mclaren Medicaid	$98.41
Rate for Payer: Meridian Medicaid	$103.33
Rate for Payer: Priority Health Choice Medicaid	$98.41
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$229.79
Rate for Payer: Priority Health Narrow Network	$229.79
Rate for Payer: Priority Health SBD	$229.79

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Professional

Both

$297.00

Service Code	HCPCS 28490
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$1,548.98
Rate for Payer: Aetna Commercial	$160.73
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$1,548.98
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Mclaren Medicaid	$82.43
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.04
Rate for Payer: Priority Health Narrow Network	$194.04
Rate for Payer: Priority Health SBD	$194.04

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Facility

$297.00

Service Code	CPT 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$187.11
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: Aetna New Business (MI Preferred)	$193.05
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$207.90
Rate for Payer: Cofinity Commercial	$255.42
Rate for Payer: Healthscope Commercial	$267.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: PHP Commercial	$252.45
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health SBD	$187.11

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Professional

Both

$297.00

Service Code	HCPCS 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$1,548.98
Rate for Payer: Aetna Commercial	$160.73
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$1,548.98
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Mclaren Medicaid	$82.43
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.04
Rate for Payer: Priority Health Narrow Network	$194.04
Rate for Payer: Priority Health SBD	$194.04

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Facility

$297.00

Service Code	CPT 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$67.40
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: Aetna Medicare	$218.22
Rate for Payer: Aetna New Business (MI Preferred)	$193.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$262.29
Rate for Payer: Amish Plain Church Group Commercial	$262.29
Rate for Payer: BCBS Complete	$120.53
Rate for Payer: BCBS MAPPO	$209.83
Rate for Payer: BCBS Trust/PPO	$67.40
Rate for Payer: BCN Medicare Advantage	$209.83
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$207.90
Rate for Payer: Cofinity Commercial	$255.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$209.83
Rate for Payer: Healthscope Commercial	$267.30
Rate for Payer: Mclaren Medicaid	$114.78
Rate for Payer: Mclaren Medicare	$209.83
Rate for Payer: Meridian Medicaid	$120.53
Rate for Payer: Meridian Wellcare - Medicare Advantage	$220.32
Rate for Payer: MI Amish Medical Board Commercial	$241.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: PACE Medicare	$199.34
Rate for Payer: PACE SWMI	$209.83
Rate for Payer: PHP Commercial	$252.45
Rate for Payer: PHP Medicare Advantage	$209.83
Rate for Payer: Priority Health Choice Medicaid	$114.78
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health Medicare	$209.83
Rate for Payer: Priority Health SBD	$187.11
Rate for Payer: Railroad Medicare Medicare	$209.83
Rate for Payer: UHC All Payor (Choice/PPO)	$139.39
Rate for Payer: UHC Dual Complete DSNP	$209.83
Rate for Payer: UHC Exchange	$126.72
Rate for Payer: UHC Medicare Advantage	$216.12
Rate for Payer: VA VA	$209.83

PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ

Professional

Both

$363.00

Service Code	HCPCS 28515
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$423.70
Rate for Payer: Aetna Commercial	$184.71
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$423.70
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Mclaren Medicaid	$94.79
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$254.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.62
Rate for Payer: Priority Health Narrow Network	$221.62
Rate for Payer: Priority Health SBD	$221.62

PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ

Professional

Both

$286.00

Service Code	HCPCS 28510
Min. Negotiated Rate	$79.88
Max. Negotiated Rate	$1,955.77
Rate for Payer: Aetna Commercial	$155.55
Rate for Payer: BCBS Complete	$83.87
Rate for Payer: BCBS Trust/PPO	$1,955.77
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Mclaren Medicaid	$79.88
Rate for Payer: Meridian Medicaid	$83.87
Rate for Payer: Priority Health Choice Medicaid	$79.88
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$186.39
Rate for Payer: Priority Health Narrow Network	$186.39
Rate for Payer: Priority Health SBD	$186.39

PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ

Professional

Both

$855.00

Service Code	HCPCS 27824
Min. Negotiated Rate	$202.56
Max. Negotiated Rate	$3,163.99
Rate for Payer: Aetna Commercial	$405.52
Rate for Payer: BCBS Complete	$212.69
Rate for Payer: BCBS Trust/PPO	$3,163.99
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Mclaren Medicaid	$202.56
Rate for Payer: Meridian Medicaid	$212.69
Rate for Payer: Priority Health Choice Medicaid	$202.56
Rate for Payer: Priority Health Cigna Priority Health	$598.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$478.99
Rate for Payer: Priority Health Narrow Network	$478.99
Rate for Payer: Priority Health SBD	$478.99

Know your out-of-pocket cost for care.

All Charges