Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MODAFINIL 200 MG TABLET

Facility

$300.68

Service Code	NDC 62332038690
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$189.43
Max. Negotiated Rate	$270.61
Rate for Payer: Aetna Commercial	$255.58
Rate for Payer: Aetna New Business (MI Preferred)	$195.44
Rate for Payer: Cash Price	$240.54
Rate for Payer: Cofinity Commercial	$210.48
Rate for Payer: Cofinity Commercial	$258.58
Rate for Payer: Cofinity Medicare Advantage	$210.48
Rate for Payer: Encore Health Key Benefits Commercial	$240.54
Rate for Payer: Healthscope Commercial	$270.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$255.58
Rate for Payer: PHP Commercial	$255.58
Rate for Payer: Priority Health Cigna Priority Health	$195.44
Rate for Payer: Priority Health SBD	$189.43

MOLASSES

Facility

$23.94

Service Code	NDC 00990000075
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$9.58
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$20.35
Rate for Payer: Aetna Medicare	$11.97
Rate for Payer: Aetna New Business (MI Preferred)	$15.56
Rate for Payer: BCBS Complete	$9.58
Rate for Payer: Cash Price	$19.15
Rate for Payer: Cofinity Commercial	$16.76
Rate for Payer: Cofinity Commercial	$20.59
Rate for Payer: Cofinity Medicare Advantage	$16.76
Rate for Payer: Encore Health Key Benefits Commercial	$19.15
Rate for Payer: Healthscope Commercial	$21.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.35
Rate for Payer: PHP Commercial	$20.35
Rate for Payer: Priority Health Cigna Priority Health	$15.56
Rate for Payer: Priority Health SBD	$15.08

MOLASSES

Facility

$6.48

Service Code	NDC 09900001118
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna New Business (MI Preferred)	$4.21
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Commercial	$5.57
Rate for Payer: Cofinity Medicare Advantage	$4.54
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: PHP Commercial	$5.51
Rate for Payer: Priority Health Cigna Priority Health	$4.21
Rate for Payer: Priority Health SBD	$4.08

MOLASSES

Facility

$6.48

Service Code	NDC 09900001118
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$5.83
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna Medicare	$3.24
Rate for Payer: Aetna New Business (MI Preferred)	$4.21
Rate for Payer: BCBS Complete	$2.59
Rate for Payer: Cash Price	$5.18
Rate for Payer: Cofinity Commercial	$4.54
Rate for Payer: Cofinity Commercial	$5.57
Rate for Payer: Cofinity Medicare Advantage	$4.54
Rate for Payer: Encore Health Key Benefits Commercial	$5.18
Rate for Payer: Healthscope Commercial	$5.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.51
Rate for Payer: PHP Commercial	$5.51
Rate for Payer: Priority Health Cigna Priority Health	$4.21
Rate for Payer: Priority Health SBD	$4.08

MOLASSES

Facility

$23.94

Service Code	NDC 00990000075
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$20.35
Rate for Payer: Aetna New Business (MI Preferred)	$15.56
Rate for Payer: Cash Price	$19.15
Rate for Payer: Cofinity Commercial	$16.76
Rate for Payer: Cofinity Commercial	$20.59
Rate for Payer: Cofinity Medicare Advantage	$16.76
Rate for Payer: Encore Health Key Benefits Commercial	$19.15
Rate for Payer: Healthscope Commercial	$21.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.35
Rate for Payer: PHP Commercial	$20.35
Rate for Payer: Priority Health Cigna Priority Health	$15.56
Rate for Payer: Priority Health SBD	$15.08

MONALISA TOUCH, SERIES, UP TO 3 VISITS

Professional

Both

$1,836.00

Service Code	HCPCS 00561
Hospital Revenue Code	990
Min. Negotiated Rate	$734.40
Max. Negotiated Rate	$1,193.40
Rate for Payer: Aetna Medicare	$918.00
Rate for Payer: BCBS Complete	$734.40
Rate for Payer: Cash Price	$1,468.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,193.40
Rate for Payer: Priority Health Cigna Priority Health	$1,193.40

MONALISA TOUCH, SINGLE TREATMENT FOLLOWING A SERIES

Professional

Both

$612.00

Service Code	HCPCS 00562
Hospital Revenue Code	990
Min. Negotiated Rate	$244.80
Max. Negotiated Rate	$397.80
Rate for Payer: Aetna Medicare	$306.00
Rate for Payer: BCBS Complete	$244.80
Rate for Payer: Cash Price	$489.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.80
Rate for Payer: Priority Health Cigna Priority Health	$397.80

MONTELUKAST 10 MG TABLET

Facility

$183.83

Service Code	NDC 50268057515
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$73.53
Max. Negotiated Rate	$165.45
Rate for Payer: Aetna Commercial	$156.26
Rate for Payer: Aetna Medicare	$91.92
Rate for Payer: Aetna New Business (MI Preferred)	$119.49
Rate for Payer: BCBS Complete	$73.53
Rate for Payer: Cash Price	$147.06
Rate for Payer: Cofinity Commercial	$128.68
Rate for Payer: Cofinity Commercial	$158.09
Rate for Payer: Cofinity Medicare Advantage	$128.68
Rate for Payer: Encore Health Key Benefits Commercial	$147.06
Rate for Payer: Healthscope Commercial	$165.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.26
Rate for Payer: PHP Commercial	$156.26
Rate for Payer: Priority Health Cigna Priority Health	$119.49
Rate for Payer: Priority Health SBD	$115.81

MONTELUKAST 10 MG TABLET

Facility

$183.83

Service Code	NDC 50268057515
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$115.81
Max. Negotiated Rate	$165.45
Rate for Payer: Aetna Commercial	$156.26
Rate for Payer: Aetna New Business (MI Preferred)	$119.49
Rate for Payer: Cash Price	$147.06
Rate for Payer: Cofinity Commercial	$128.68
Rate for Payer: Cofinity Commercial	$158.09
Rate for Payer: Cofinity Medicare Advantage	$128.68
Rate for Payer: Encore Health Key Benefits Commercial	$147.06
Rate for Payer: Healthscope Commercial	$165.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.26
Rate for Payer: PHP Commercial	$156.26
Rate for Payer: Priority Health Cigna Priority Health	$119.49
Rate for Payer: Priority Health SBD	$115.81

MONTELUKAST 10 MG TABLET

Facility

$3.68

Service Code	NDC 50268057511
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna Medicare	$1.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: BCBS Complete	$1.47
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.13
Rate for Payer: PHP Commercial	$3.13
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.32

MONTELUKAST 10 MG TABLET

Facility

$3.68

Service Code	NDC 50268057511
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.31
Rate for Payer: Aetna Commercial	$3.13
Rate for Payer: Aetna New Business (MI Preferred)	$2.39
Rate for Payer: Cash Price	$2.94
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.16
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.94
Rate for Payer: Healthscope Commercial	$3.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.13
Rate for Payer: PHP Commercial	$3.13
Rate for Payer: Priority Health Cigna Priority Health	$2.39
Rate for Payer: Priority Health SBD	$2.32

MONTELUKAST 10 MG TABLET

Facility

$240.35

Service Code	NDC 00904680861
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$151.42
Max. Negotiated Rate	$216.31
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Commercial	$168.25
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Cofinity Medicare Advantage	$168.25
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health Cigna Priority Health	$156.23
Rate for Payer: Priority Health SBD	$151.42

MONTELUKAST 10 MG TABLET

Facility

$240.35

Service Code	NDC 00904680861
Hospital Charge Code	22509
Hospital Revenue Code	637
Min. Negotiated Rate	$96.14
Max. Negotiated Rate	$216.31
Rate for Payer: Aetna Commercial	$204.30
Rate for Payer: Aetna Medicare	$120.17
Rate for Payer: Aetna New Business (MI Preferred)	$156.23
Rate for Payer: BCBS Complete	$96.14
Rate for Payer: Cash Price	$192.28
Rate for Payer: Cofinity Commercial	$168.25
Rate for Payer: Cofinity Commercial	$206.70
Rate for Payer: Cofinity Medicare Advantage	$168.25
Rate for Payer: Encore Health Key Benefits Commercial	$192.28
Rate for Payer: Healthscope Commercial	$216.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$204.30
Rate for Payer: PHP Commercial	$204.30
Rate for Payer: Priority Health Cigna Priority Health	$156.23
Rate for Payer: Priority Health SBD	$151.42

MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION

Facility

$0.59

Service Code	NDC 09900000720
Hospital Charge Code	165001
Hospital Revenue Code	637
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: Aetna New Business (MI Preferred)	$0.38
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cofinity Commercial	$0.41
Rate for Payer: Cofinity Commercial	$0.51
Rate for Payer: Cofinity Medicare Advantage	$0.41
Rate for Payer: Encore Health Key Benefits Commercial	$0.47
Rate for Payer: Healthscope Commercial	$0.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.50
Rate for Payer: PHP Commercial	$0.50
Rate for Payer: Priority Health Cigna Priority Health	$0.38
Rate for Payer: Priority Health SBD	$0.37

MORPHINE 0.2 MG/ML 1 ML ORAL SOLUTION

Facility

$0.59

Service Code	NDC 09900000720
Hospital Charge Code	165001
Hospital Revenue Code	637
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna Commercial	$0.50
Rate for Payer: Aetna Medicare	$0.30
Rate for Payer: Aetna New Business (MI Preferred)	$0.38
Rate for Payer: BCBS Complete	$0.24
Rate for Payer: Cash Price	$0.47
Rate for Payer: Cofinity Commercial	$0.41
Rate for Payer: Cofinity Commercial	$0.51
Rate for Payer: Cofinity Medicare Advantage	$0.41
Rate for Payer: Encore Health Key Benefits Commercial	$0.47
Rate for Payer: Healthscope Commercial	$0.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$0.50
Rate for Payer: PHP Commercial	$0.50
Rate for Payer: Priority Health Cigna Priority Health	$0.38
Rate for Payer: Priority Health SBD	$0.37

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	190319
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	190319
Hospital Revenue Code	636
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna Medicare	$113.75
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: BCBS Complete	$91.00
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION (BBC)

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	301224
Hospital Revenue Code	636
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna Medicare	$113.75
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: BCBS Complete	$91.00
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML AVERAGE PCA IV SOLUTION (BBC)

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	301224
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	150918
Hospital Revenue Code	636
Min. Negotiated Rate	$143.32
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 100MG/100ML PCA IV SOLUTION

Facility

$227.49

Service Code	HCPCS J2274
Hospital Charge Code	150918
Hospital Revenue Code	636
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$204.74
Rate for Payer: Aetna Commercial	$193.37
Rate for Payer: Aetna Medicare	$113.75
Rate for Payer: Aetna New Business (MI Preferred)	$147.87
Rate for Payer: BCBS Complete	$91.00
Rate for Payer: Cash Price	$181.99
Rate for Payer: Cofinity Commercial	$159.24
Rate for Payer: Cofinity Commercial	$195.64
Rate for Payer: Cofinity Medicare Advantage	$159.24
Rate for Payer: Encore Health Key Benefits Commercial	$181.99
Rate for Payer: Healthscope Commercial	$204.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.37
Rate for Payer: PHP Commercial	$193.37
Rate for Payer: Priority Health Cigna Priority Health	$147.87
Rate for Payer: Priority Health SBD	$143.32

MORPHINE 10 MG/ML INJECTION SOLUTION

Facility

$33.73

Service Code	HCPCS J2272
Hospital Charge Code	5168
Hospital Revenue Code	636
Min. Negotiated Rate	$13.49
Max. Negotiated Rate	$30.36
Rate for Payer: Aetna Commercial	$28.67
Rate for Payer: Aetna Medicare	$16.86
Rate for Payer: Aetna New Business (MI Preferred)	$21.92
Rate for Payer: BCBS Complete	$13.49
Rate for Payer: Cash Price	$26.98
Rate for Payer: Cofinity Commercial	$23.61
Rate for Payer: Cofinity Commercial	$29.01
Rate for Payer: Cofinity Medicare Advantage	$23.61
Rate for Payer: Encore Health Key Benefits Commercial	$26.98
Rate for Payer: Healthscope Commercial	$30.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.67
Rate for Payer: PHP Commercial	$28.67
Rate for Payer: Priority Health Cigna Priority Health	$21.92
Rate for Payer: Priority Health SBD	$21.25

MORPHINE 10 MG/ML INJECTION SOLUTION

Facility

$33.73

Service Code	HCPCS J2272
Hospital Charge Code	5168
Hospital Revenue Code	636
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$30.36
Rate for Payer: Aetna Commercial	$28.67
Rate for Payer: Aetna New Business (MI Preferred)	$21.92
Rate for Payer: Cash Price	$26.98
Rate for Payer: Cofinity Commercial	$23.61
Rate for Payer: Cofinity Commercial	$29.01
Rate for Payer: Cofinity Medicare Advantage	$23.61
Rate for Payer: Encore Health Key Benefits Commercial	$26.98
Rate for Payer: Healthscope Commercial	$30.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28.67
Rate for Payer: PHP Commercial	$28.67
Rate for Payer: Priority Health Cigna Priority Health	$21.92
Rate for Payer: Priority Health SBD	$21.25

MORPHINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.47

Service Code	HCPCS J2270
Hospital Charge Code	27390
Hospital Revenue Code	636
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$15.72
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: Aetna Medicare	$8.73
Rate for Payer: Aetna New Business (MI Preferred)	$11.36
Rate for Payer: BCBS Complete	$6.99
Rate for Payer: Cash Price	$13.98
Rate for Payer: Cofinity Commercial	$12.23
Rate for Payer: Cofinity Commercial	$15.02
Rate for Payer: Cofinity Medicare Advantage	$12.23
Rate for Payer: Encore Health Key Benefits Commercial	$13.98
Rate for Payer: Healthscope Commercial	$15.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.85
Rate for Payer: PHP Commercial	$14.85
Rate for Payer: Priority Health Cigna Priority Health	$11.36
Rate for Payer: Priority Health SBD	$11.01

MORPHINE 10 MG/ML INTRAVENOUS SOLUTION

Facility

$17.47

Service Code	HCPCS J2270
Hospital Charge Code	27390
Hospital Revenue Code	636
Min. Negotiated Rate	$11.01
Max. Negotiated Rate	$15.72
Rate for Payer: Aetna Commercial	$14.85
Rate for Payer: Aetna New Business (MI Preferred)	$11.36
Rate for Payer: Cash Price	$13.98
Rate for Payer: Cofinity Commercial	$12.23
Rate for Payer: Cofinity Commercial	$15.02
Rate for Payer: Cofinity Medicare Advantage	$12.23
Rate for Payer: Encore Health Key Benefits Commercial	$13.98
Rate for Payer: Healthscope Commercial	$15.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.85
Rate for Payer: PHP Commercial	$14.85
Rate for Payer: Priority Health Cigna Priority Health	$11.36
Rate for Payer: Priority Health SBD	$11.01

Know your out-of-pocket cost for care.

All Charges