Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN

Professional

Both

$475.00

Service Code	HCPCS 43756
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$332.50
Rate for Payer: Aetna Commercial	$67.03
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCBS Trust/PPO	$194.41
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Mclaren Medicaid	$32.38
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health	$332.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88.78
Rate for Payer: Priority Health Narrow Network	$88.78
Rate for Payer: Priority Health SBD	$88.78

PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL

Professional

Both

$2,878.00

Service Code	HCPCS 44010
Min. Negotiated Rate	$542.30
Max. Negotiated Rate	$2,014.60
Rate for Payer: Aetna Commercial	$1,155.16
Rate for Payer: BCBS Complete	$569.42
Rate for Payer: BCBS Trust/PPO	$1,969.50
Rate for Payer: Cash Price	$2,302.40
Rate for Payer: Cash Price	$2,302.40
Rate for Payer: Mclaren Medicaid	$542.30
Rate for Payer: Meridian Medicaid	$569.42
Rate for Payer: Priority Health Choice Medicaid	$542.30
Rate for Payer: Priority Health Cigna Priority Health	$2,014.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,488.74
Rate for Payer: Priority Health Narrow Network	$1,488.74
Rate for Payer: Priority Health SBD	$1,488.74

PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ

Professional

Both

$6,158.00

Service Code	HCPCS 48547
Min. Negotiated Rate	$749.66
Max. Negotiated Rate	$4,310.60
Rate for Payer: Aetna Commercial	$2,429.46
Rate for Payer: BCBS Complete	$1,200.11
Rate for Payer: BCBS Trust/PPO	$749.66
Rate for Payer: Cash Price	$4,926.40
Rate for Payer: Cash Price	$4,926.40
Rate for Payer: Mclaren Medicaid	$1,142.96
Rate for Payer: Meridian Medicaid	$1,200.11
Rate for Payer: Priority Health Choice Medicaid	$1,142.96
Rate for Payer: Priority Health Cigna Priority Health	$4,310.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,143.30
Rate for Payer: Priority Health Narrow Network	$3,143.30
Rate for Payer: Priority Health SBD	$3,143.30

PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD

Professional

Both

$76.00

Service Code	HCPCS 93985
Min. Negotiated Rate	$30.40
Max. Negotiated Rate	$334.16
Rate for Payer: Aetna Commercial	$282.30
Rate for Payer: BCBS Complete	$30.40
Rate for Payer: BCBS Trust/PPO	$243.55
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Priority Health Cigna Priority Health	$53.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health SBD	$334.16

PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD

Professional

Both

$47.00

Service Code	HCPCS 93986
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$198.97
Rate for Payer: Aetna Commercial	$137.95
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS Trust/PPO	$61.81
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Priority Health Cigna Priority Health	$32.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.44
Rate for Payer: Priority Health Narrow Network	$31.44
Rate for Payer: Priority Health SBD	$198.97

PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY

Professional

Both

$435.00

Service Code	HCPCS 93880
Min. Negotiated Rate	$50.75
Max. Negotiated Rate	$304.50
Rate for Payer: Aetna Commercial	$211.27
Rate for Payer: BCBS Complete	$174.00
Rate for Payer: BCBS Trust/PPO	$80.30
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Priority Health Cigna Priority Health	$304.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.75
Rate for Payer: Priority Health Narrow Network	$50.75
Rate for Payer: Priority Health SBD	$257.35

PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY

Professional

Both

$312.00

Service Code	HCPCS 93882
Min. Negotiated Rate	$31.89
Max. Negotiated Rate	$310.64
Rate for Payer: Aetna Commercial	$137.60
Rate for Payer: BCBS Complete	$124.80
Rate for Payer: BCBS Trust/PPO	$310.64
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Priority Health Cigna Priority Health	$218.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31.89
Rate for Payer: Priority Health Narrow Network	$31.89
Rate for Payer: Priority Health SBD	$167.08

PR DUPLEX SCAN HEMODIALYSIS ACCESS

Professional

Both

$340.00

Service Code	HCPCS 93990
Min. Negotiated Rate	$16.91
Max. Negotiated Rate	$238.00
Rate for Payer: Aetna Commercial	$138.39
Rate for Payer: Aetna Commercial	$138.39
Rate for Payer: BCBS Complete	$136.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$16.91
Rate for Payer: BCBS Trust/PPO	$16.91
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$238.00
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.99
Rate for Payer: Priority Health Narrow Network	$30.99
Rate for Payer: Priority Health Narrow Network	$30.99
Rate for Payer: Priority Health SBD	$197.17
Rate for Payer: Priority Health SBD	$197.17

PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE

Professional

Both

$390.00

Service Code	HCPCS 93978
Min. Negotiated Rate	$50.30
Max. Negotiated Rate	$430.56
Rate for Payer: Aetna Commercial	$199.98
Rate for Payer: Aetna Commercial	$199.98
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: BCBS Complete	$156.00
Rate for Payer: BCBS Trust/PPO	$430.56
Rate for Payer: BCBS Trust/PPO	$430.56
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$55.30
Rate for Payer: Priority Health Cigna Priority Health	$273.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health SBD	$242.99
Rate for Payer: Priority Health SBD	$242.99

PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD

Professional

Both

$270.00

Service Code	HCPCS 93979
Min. Negotiated Rate	$30.54
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$129.02
Rate for Payer: Aetna Commercial	$129.02
Rate for Payer: BCBS Complete	$108.00
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS Trust/PPO	$84.00
Rate for Payer: BCBS Trust/PPO	$84.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$189.00
Rate for Payer: Priority Health Cigna Priority Health	$35.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.54
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.54
Rate for Payer: Priority Health Narrow Network	$30.54
Rate for Payer: Priority Health Narrow Network	$30.54
Rate for Payer: Priority Health SBD	$157.64
Rate for Payer: Priority Health SBD	$157.64

PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM

Professional

Both

$253.00

Service Code	HCPCS 93975
Min. Negotiated Rate	$57.58
Max. Negotiated Rate	$358.42
Rate for Payer: Aetna Commercial	$294.18
Rate for Payer: Aetna Commercial	$294.18
Rate for Payer: BCBS Complete	$242.80
Rate for Payer: BCBS Complete	$101.20
Rate for Payer: BCBS Trust/PPO	$57.58
Rate for Payer: BCBS Trust/PPO	$57.58
Rate for Payer: Cash Price	$485.60
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$485.60
Rate for Payer: Priority Health Cigna Priority Health	$424.90
Rate for Payer: Priority Health Cigna Priority Health	$177.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.67
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.67
Rate for Payer: Priority Health Narrow Network	$73.67
Rate for Payer: Priority Health Narrow Network	$73.67
Rate for Payer: Priority Health SBD	$358.42
Rate for Payer: Priority Health SBD	$358.42

PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT

Professional

Both

$630.00

Service Code	HCPCS 93976
Min. Negotiated Rate	$50.30
Max. Negotiated Rate	$547.85
Rate for Payer: Aetna Commercial	$154.25
Rate for Payer: Aetna Commercial	$154.25
Rate for Payer: BCBS Complete	$252.00
Rate for Payer: BCBS Complete	$70.80
Rate for Payer: BCBS Trust/PPO	$547.85
Rate for Payer: BCBS Trust/PPO	$547.85
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Priority Health Cigna Priority Health	$123.90
Rate for Payer: Priority Health Cigna Priority Health	$441.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health SBD	$213.34
Rate for Payer: Priority Health SBD	$213.34

PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY

Professional

Both

$100.00

Service Code	HCPCS 93925
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$323.39
Rate for Payer: Aetna Commercial	$268.26
Rate for Payer: Aetna Commercial	$268.26
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: BCBS Trust/PPO	$160.60
Rate for Payer: BCBS Trust/PPO	$160.60
Rate for Payer: Cash Price	$336.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health Cigna Priority Health	$294.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.41
Rate for Payer: Priority Health Narrow Network	$49.41
Rate for Payer: Priority Health Narrow Network	$49.41
Rate for Payer: Priority Health SBD	$323.39
Rate for Payer: Priority Health SBD	$323.39

PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$327.00

Service Code	HCPCS 93926
Min. Negotiated Rate	$30.09
Max. Negotiated Rate	$416.83
Rate for Payer: Aetna Commercial	$137.57
Rate for Payer: Aetna Commercial	$137.57
Rate for Payer: BCBS Complete	$130.80
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$416.83
Rate for Payer: BCBS Trust/PPO	$416.83
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$228.90
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.09
Rate for Payer: Priority Health Narrow Network	$30.09
Rate for Payer: Priority Health Narrow Network	$30.09
Rate for Payer: Priority Health SBD	$192.24
Rate for Payer: Priority Health SBD	$192.24

PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY

Professional

Both

$398.00

Service Code	HCPCS 93930
Min. Negotiated Rate	$21.13
Max. Negotiated Rate	$278.60
Rate for Payer: Aetna Commercial	$218.52
Rate for Payer: Aetna Commercial	$218.52
Rate for Payer: BCBS Complete	$159.20
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCBS Trust/PPO	$21.13
Rate for Payer: BCBS Trust/PPO	$21.13
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Priority Health Cigna Priority Health	$44.10
Rate for Payer: Priority Health Cigna Priority Health	$278.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health Narrow Network	$50.30
Rate for Payer: Priority Health SBD	$263.65
Rate for Payer: Priority Health SBD	$263.65

PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$267.00

Service Code	HCPCS 93931
Min. Negotiated Rate	$12.68
Max. Negotiated Rate	$186.90
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: Aetna Commercial	$136.50
Rate for Payer: BCBS Complete	$106.80
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$12.68
Rate for Payer: BCBS Trust/PPO	$12.68
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health Cigna Priority Health	$22.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.54
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.54
Rate for Payer: Priority Health Narrow Network	$30.54
Rate for Payer: Priority Health Narrow Network	$30.54
Rate for Payer: Priority Health SBD	$166.18
Rate for Payer: Priority Health SBD	$166.18

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$414.00

Service Code	HCPCS 93970
Min. Negotiated Rate	$8.98
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna Commercial	$206.98
Rate for Payer: Aetna Commercial	$206.98
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: BCBS Complete	$165.60
Rate for Payer: BCBS Trust/PPO	$8.98
Rate for Payer: BCBS Trust/PPO	$8.98
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$92.00
Rate for Payer: Priority Health Cigna Priority Health	$289.80
Rate for Payer: Priority Health Cigna Priority Health	$80.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.02
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.02
Rate for Payer: Priority Health Narrow Network	$44.02
Rate for Payer: Priority Health Narrow Network	$44.02
Rate for Payer: Priority Health SBD	$253.76
Rate for Payer: Priority Health SBD	$253.76

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$274.00

Service Code	HCPCS 93971
Min. Negotiated Rate	$28.30
Max. Negotiated Rate	$191.80
Rate for Payer: Aetna Commercial	$130.22
Rate for Payer: Aetna Commercial	$130.22
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: BCBS Complete	$109.60
Rate for Payer: BCBS Trust/PPO	$100.91
Rate for Payer: BCBS Trust/PPO	$100.91
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Priority Health Cigna Priority Health	$51.10
Rate for Payer: Priority Health Cigna Priority Health	$191.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.30
Rate for Payer: Priority Health Narrow Network	$28.30
Rate for Payer: Priority Health Narrow Network	$28.30
Rate for Payer: Priority Health SBD	$160.80
Rate for Payer: Priority Health SBD	$160.80

PR DURAL GRAFT SPINAL

Professional

Both

$4,992.00

Service Code	HCPCS 63710
Min. Negotiated Rate	$172.75
Max. Negotiated Rate	$3,494.40
Rate for Payer: Aetna Commercial	$1,398.53
Rate for Payer: BCBS Complete	$736.03
Rate for Payer: BCBS Trust/PPO	$172.75
Rate for Payer: Cash Price	$3,993.60
Rate for Payer: Cash Price	$3,993.60
Rate for Payer: Mclaren Medicaid	$700.98
Rate for Payer: Meridian Medicaid	$736.03
Rate for Payer: Priority Health Choice Medicaid	$700.98
Rate for Payer: Priority Health Cigna Priority Health	$3,494.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,841.36
Rate for Payer: Priority Health Narrow Network	$1,841.36
Rate for Payer: Priority Health SBD	$1,841.36

PR DYSPORT

Professional

Both

$12.00

Service Code	HCPCS 00385
Hospital Revenue Code	990
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$8.40
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$8.40

PR EAR MOLD/INSERT

Professional

Both

$70.00

Service Code	HCPCS V5264
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$57.45
Rate for Payer: Aetna Commercial	$57.45
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00

PR EAR PIERCING

Professional

Both

$70.00

Service Code	HCPCS 69090
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$248.83
Rate for Payer: Aetna Commercial	$35.41
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: BCBS Trust/PPO	$248.83
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.85
Rate for Payer: Priority Health Narrow Network	$43.85
Rate for Payer: Priority Health SBD	$43.85

PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY

Professional

Both

$23.00

Service Code	HCPCS 93010
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$2,320.82
Rate for Payer: Aetna Commercial	$11.04
Rate for Payer: BCBS Complete	$5.37
Rate for Payer: BCBS Trust/PPO	$2,320.82
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Mclaren Medicaid	$5.11
Rate for Payer: Meridian Medicaid	$5.37
Rate for Payer: Priority Health Choice Medicaid	$5.11
Rate for Payer: Priority Health Cigna Priority Health	$16.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.34
Rate for Payer: Priority Health Narrow Network	$11.34
Rate for Payer: Priority Health SBD	$11.34

PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R

Professional

Both

$42.00

Service Code	HCPCS 93005
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$1,832.67
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCBS Trust/PPO	$1,832.67
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$29.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.99
Rate for Payer: Priority Health Narrow Network	$8.99
Rate for Payer: Priority Health SBD	$8.99

PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R

Professional

Both

$77.00

Service Code	HCPCS 93000
Min. Negotiated Rate	$19.23
Max. Negotiated Rate	$1,966.86
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCBS Trust/PPO	$1,966.86
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$53.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.33
Rate for Payer: Priority Health Narrow Network	$20.33
Rate for Payer: Priority Health SBD	$20.33

Know your out-of-pocket cost for care.

All Charges