Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR INJECTION KNEE ARTHROGRAPHY

Professional

Both

$280.00

Service Code	HCPCS 27370
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$196.00
Rate for Payer: BCBS Complete	$112.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Priority Health Cigna Priority Health	$196.00

PR INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM

Professional

Both

$324.00

Service Code	HCPCS 19030
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$82.84
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$13.78
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Mclaren Medicaid	$47.50
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$226.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.90
Rate for Payer: Priority Health Narrow Network	$92.90
Rate for Payer: Priority Health SBD	$92.90

PR INJECTION,ONABOTULINUMTOXINA

Professional

Both

$8.00

Service Code	HCPCS J0585
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$6.35
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60

PR INJECTION PEYRONIE DISEASE

Professional

Both

$217.00

Service Code	HCPCS 54200
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$189.66
Rate for Payer: Aetna Commercial	$107.78
Rate for Payer: BCBS Complete	$59.04
Rate for Payer: BCBS Trust/PPO	$189.66
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Mclaren Medicaid	$56.23
Rate for Payer: Meridian Medicaid	$59.04
Rate for Payer: Priority Health Choice Medicaid	$56.23
Rate for Payer: Priority Health Cigna Priority Health	$151.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.87
Rate for Payer: Priority Health Narrow Network	$138.87
Rate for Payer: Priority Health SBD	$138.87

PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED

Professional

Both

$600.00

Service Code	HCPCS 00671
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00

PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY

Professional

Both

$281.00

Service Code	HCPCS 24220
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$196.70
Rate for Payer: Aetna Commercial	$90.48
Rate for Payer: BCBS Complete	$43.84
Rate for Payer: BCBS Trust/PPO	$70.79
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Mclaren Medicaid	$41.75
Rate for Payer: Meridian Medicaid	$43.84
Rate for Payer: Priority Health Choice Medicaid	$41.75
Rate for Payer: Priority Health Cigna Priority Health	$196.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.60
Rate for Payer: Priority Health Narrow Network	$100.60
Rate for Payer: Priority Health SBD	$100.60

PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR

Professional

Both

$590.00

Service Code	HCPCS 62284
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$499.24
Rate for Payer: Aetna Commercial	$109.22
Rate for Payer: BCBS Complete	$55.02
Rate for Payer: BCBS Trust/PPO	$499.24
Rate for Payer: Cash Price	$472.00
Rate for Payer: Cash Price	$472.00
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Meridian Medicaid	$55.02
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health	$413.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.99
Rate for Payer: Priority Health Narrow Network	$140.99
Rate for Payer: Priority Health SBD	$140.99

PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR

Professional

Both

$1,412.00

Service Code	HCPCS 62290
Min. Negotiated Rate	$98.62
Max. Negotiated Rate	$988.40
Rate for Payer: Aetna Commercial	$210.47
Rate for Payer: BCBS Complete	$103.55
Rate for Payer: BCBS Trust/PPO	$675.17
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$98.62
Rate for Payer: Meridian Medicaid	$103.55
Rate for Payer: Priority Health Choice Medicaid	$98.62
Rate for Payer: Priority Health Cigna Priority Health	$988.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$263.30
Rate for Payer: Priority Health Narrow Network	$263.30
Rate for Payer: Priority Health SBD	$263.30

PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM

Professional

Both

$447.00

Service Code	HCPCS 36002
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$797.73
Rate for Payer: Aetna Commercial	$138.71
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCBS Trust/PPO	$797.73
Rate for Payer: Cash Price	$357.60
Rate for Payer: Cash Price	$357.60
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health	$312.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.77
Rate for Payer: Priority Health Narrow Network	$162.77
Rate for Payer: Priority Health SBD	$162.77

PR INJECTION, REMDESIVIR, 1 MG

Professional

Both

$16.32

Service Code	HCPCS J0248
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$11.42
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: BCBS Complete	$6.53
Rate for Payer: BCBS Trust/PPO	$6.17
Rate for Payer: Cash Price	$13.06
Rate for Payer: Cash Price	$13.06
Rate for Payer: Priority Health Cigna Priority Health	$11.42

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$331.00

Service Code	CPT 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$73.02
Max. Negotiated Rate	$1,118.65
Rate for Payer: Aetna Commercial	$281.35
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$215.15
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: BCBS Trust/PPO	$172.35
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cofinity Commercial	$284.66
Rate for Payer: Cofinity Commercial	$231.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$297.90
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	$281.35
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$281.35
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	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.65
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$894.92
Rate for Payer: Priority Health SBD	$208.53
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$80.32
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$73.02
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$331.00

Service Code	HCPCS 36471
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$751.77
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$751.77
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Mclaren Medicaid	$47.50
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.63
Rate for Payer: Priority Health Narrow Network	$118.63
Rate for Payer: Priority Health SBD	$118.63

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$331.00

Service Code	CPT 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$208.53
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna Commercial	$281.35
Rate for Payer: Aetna New Business (MI Preferred)	$215.15
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cofinity Commercial	$231.70
Rate for Payer: Cofinity Commercial	$284.66
Rate for Payer: Healthscope Commercial	$297.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.35
Rate for Payer: PHP Commercial	$281.35
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health SBD	$208.53

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$331.00

Service Code	HCPCS 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$751.77
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$751.77
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Mclaren Medicaid	$47.50
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.63
Rate for Payer: Priority Health Narrow Network	$118.63
Rate for Payer: Priority Health SBD	$118.63

PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

Professional

Both

$265.00

Service Code	HCPCS 36470
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$701.05
Rate for Payer: Aetna Commercial	$51.69
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCBS Trust/PPO	$701.05
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Mclaren Medicaid	$23.86
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Cigna Priority Health	$185.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.64
Rate for Payer: Priority Health Narrow Network	$60.64
Rate for Payer: Priority Health SBD	$60.64

PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS

Professional

Both

$342.00

Service Code	HCPCS 46500
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$3,628.89
Rate for Payer: Aetna Commercial	$245.44
Rate for Payer: BCBS Complete	$123.90
Rate for Payer: BCBS Trust/PPO	$3,628.89
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Mclaren Medicaid	$118.00
Rate for Payer: Meridian Medicaid	$123.90
Rate for Payer: Priority Health Choice Medicaid	$118.00
Rate for Payer: Priority Health Cigna Priority Health	$239.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.32
Rate for Payer: Priority Health Narrow Network	$326.32
Rate for Payer: Priority Health SBD	$326.32

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Facility

$118.00

Service Code	CPT 20552
Hospital Charge Code	20552
Hospital Revenue Code	521
Min. Negotiated Rate	$74.34
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health SBD	$74.34

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Facility

$118.00

Service Code	CPT 20552
Hospital Charge Code	20552
Hospital Revenue Code	521
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$329.42
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna Medicare	$274.08
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.42
Rate for Payer: Amish Plain Church Group Commercial	$329.42
Rate for Payer: BCBS Complete	$151.38
Rate for Payer: BCBS MAPPO	$263.54
Rate for Payer: BCBS Trust/PPO	$169.96
Rate for Payer: BCN Medicare Advantage	$263.54
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.54
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Mclaren Medicaid	$144.16
Rate for Payer: Mclaren Medicare	$263.54
Rate for Payer: Meridian Medicaid	$151.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.72
Rate for Payer: MI Amish Medical Board Commercial	$303.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PACE Medicare	$250.36
Rate for Payer: PACE SWMI	$263.54
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: PHP Medicare Advantage	$263.54
Rate for Payer: Priority Health Choice Medicaid	$144.16
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health Medicare	$263.54
Rate for Payer: Priority Health SBD	$74.34
Rate for Payer: Railroad Medicare Medicare	$263.54
Rate for Payer: UHC All Payor (Choice/PPO)	$39.62
Rate for Payer: UHC Dual Complete DSNP	$263.54
Rate for Payer: UHC Exchange	$36.02
Rate for Payer: UHC Medicare Advantage	$271.45
Rate for Payer: VA VA	$263.54

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$118.00

Service Code	HCPCS 20552
Hospital Charge Code	20552
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$82.60
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: BCBS Complete	$24.60
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Mclaren Medicaid	$23.43
Rate for Payer: Meridian Medicaid	$24.60
Rate for Payer: Priority Health Choice Medicaid	$23.43
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.18
Rate for Payer: Priority Health Narrow Network	$56.18
Rate for Payer: Priority Health SBD	$56.18

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$118.00

Service Code	HCPCS 20552
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$82.60
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: BCBS Complete	$24.60
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Mclaren Medicaid	$23.43
Rate for Payer: Meridian Medicaid	$24.60
Rate for Payer: Priority Health Choice Medicaid	$23.43
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.18
Rate for Payer: Priority Health Narrow Network	$56.18
Rate for Payer: Priority Health SBD	$56.18

PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES

Professional

Both

$139.00

Service Code	HCPCS 20553
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$97.30
Rate for Payer: Aetna Commercial	$57.07
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Mclaren Medicaid	$26.63
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$97.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.35
Rate for Payer: Priority Health Narrow Network	$64.35
Rate for Payer: Priority Health SBD	$64.35

PR INJECTION SINGLE TENDON ORIGIN/INSERTION

Professional

Both

$92.00

Service Code	HCPCS 20551
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$64.40
Rate for Payer: Aetna Commercial	$52.78
Rate for Payer: BCBS Complete	$25.72
Rate for Payer: BCBS Trust/PPO	$24.96
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Mclaren Medicaid	$24.50
Rate for Payer: Meridian Medicaid	$25.72
Rate for Payer: Priority Health Choice Medicaid	$24.50
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.24
Rate for Payer: Priority Health Narrow Network	$59.24
Rate for Payer: Priority Health SBD	$59.24

PR INJECTION SINUS TRACT DIAGNOSTIC

Professional

Both

$277.00

Service Code	HCPCS 20501
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$193.90
Rate for Payer: Aetna Commercial	$49.72
Rate for Payer: BCBS Complete	$23.93
Rate for Payer: BCBS Trust/PPO	$86.88
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Mclaren Medicaid	$22.79
Rate for Payer: Meridian Medicaid	$23.93
Rate for Payer: Priority Health Choice Medicaid	$22.79
Rate for Payer: Priority Health Cigna Priority Health	$193.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.15
Rate for Payer: Priority Health Narrow Network	$55.15
Rate for Payer: Priority Health SBD	$55.15

PR INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC

Professional

Both

$242.00

Service Code	HCPCS 20500
Min. Negotiated Rate	$57.30
Max. Negotiated Rate	$556.70
Rate for Payer: Aetna Commercial	$115.24
Rate for Payer: BCBS Complete	$60.16
Rate for Payer: BCBS Trust/PPO	$556.70
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Mclaren Medicaid	$57.30
Rate for Payer: Meridian Medicaid	$60.16
Rate for Payer: Priority Health Choice Medicaid	$57.30
Rate for Payer: Priority Health Cigna Priority Health	$169.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.83
Rate for Payer: Priority Health Narrow Network	$135.83
Rate for Payer: Priority Health SBD	$135.83

PR INJECTIONS SCLEROSANT FOR SPIDER VEINS LIM/TRNK

Professional

Both

$250.00

Service Code	HCPCS 36468
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$1,096.22
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: Aetna Commercial	$51.00
Rate for Payer: BCBS Complete	$98.27
Rate for Payer: BCBS Complete	$98.27
Rate for Payer: BCBS Trust/PPO	$1,096.22
Rate for Payer: BCBS Trust/PPO	$1,096.22
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Mclaren Medicaid	$93.59
Rate for Payer: Mclaren Medicaid	$93.59
Rate for Payer: Meridian Medicaid	$98.27
Rate for Payer: Meridian Medicaid	$98.27
Rate for Payer: Priority Health Choice Medicaid	$93.59
Rate for Payer: Priority Health Choice Medicaid	$93.59
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$80.75
Rate for Payer: Priority Health Narrow Network	$80.75
Rate for Payer: Priority Health Narrow Network	$80.75
Rate for Payer: Priority Health SBD	$80.75
Rate for Payer: Priority Health SBD	$80.75

Know your out-of-pocket cost for care.

All Charges