Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES

Professional

Both

$200.00

Service Code	HCPCS 99243
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$1,523.62
Rate for Payer: Aetna Commercial	$98.89
Rate for Payer: BCBS Complete	$58.60
Rate for Payer: BCBS Trust/PPO	$1,523.62
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Mclaren Medicaid	$55.81
Rate for Payer: Meridian Medicaid	$58.60
Rate for Payer: Priority Health Choice Medicaid	$55.81
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$112.21
Rate for Payer: Priority Health Narrow Network	$112.21
Rate for Payer: Priority Health SBD	$112.21

PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES

Professional

Both

$293.00

Service Code	HCPCS 99244
Min. Negotiated Rate	$84.99
Max. Negotiated Rate	$722.19
Rate for Payer: Aetna Commercial	$159.16
Rate for Payer: BCBS Complete	$89.24
Rate for Payer: BCBS Trust/PPO	$722.19
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Mclaren Medicaid	$84.99
Rate for Payer: Meridian Medicaid	$89.24
Rate for Payer: Priority Health Choice Medicaid	$84.99
Rate for Payer: Priority Health Cigna Priority Health	$205.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$171.33
Rate for Payer: Priority Health Narrow Network	$171.33
Rate for Payer: Priority Health SBD	$171.33

PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES

Professional

Both

$148.00

Service Code	HCPCS 99242
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$158.49
Rate for Payer: Aetna Commercial	$70.73
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCBS Trust/PPO	$158.49
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Mclaren Medicaid	$35.36
Rate for Payer: Meridian Medicaid	$37.13
Rate for Payer: Priority Health Choice Medicaid	$35.36
Rate for Payer: Priority Health Cigna Priority Health	$103.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.10
Rate for Payer: Priority Health Narrow Network	$71.10
Rate for Payer: Priority Health SBD	$71.10

PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN

Professional

Both

$212.00

Service Code	HCPCS 99215
Min. Negotiated Rate	$123.62
Max. Negotiated Rate	$1,816.82
Rate for Payer: Aetna Commercial	$145.41
Rate for Payer: BCBS Complete	$129.80
Rate for Payer: BCBS Trust/PPO	$1,816.82
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Mclaren Medicaid	$123.62
Rate for Payer: Meridian Medicaid	$129.80
Rate for Payer: Priority Health Choice Medicaid	$123.62
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.20
Rate for Payer: Priority Health Narrow Network	$147.20
Rate for Payer: Priority Health SBD	$147.20

PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN

Professional

Both

$110.00

Service Code	HCPCS 99213
Min. Negotiated Rate	$56.48
Max. Negotiated Rate	$1,305.96
Rate for Payer: Aetna Commercial	$66.92
Rate for Payer: BCBS Complete	$59.30
Rate for Payer: BCBS Trust/PPO	$1,305.96
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Mclaren Medicaid	$56.48
Rate for Payer: Meridian Medicaid	$59.30
Rate for Payer: Priority Health Choice Medicaid	$56.48
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.86
Rate for Payer: Priority Health Narrow Network	$67.86
Rate for Payer: Priority Health SBD	$67.86

PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN

Professional

Both

$160.00

Service Code	HCPCS 99214
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$1,340.83
Rate for Payer: Aetna Commercial	$98.82
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,340.83
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Mclaren Medicaid	$83.28
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.23
Rate for Payer: Priority Health Narrow Network	$100.23
Rate for Payer: Priority Health SBD	$100.23

PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN

Professional

Both

$62.00

Service Code	HCPCS 99212
Min. Negotiated Rate	$30.26
Max. Negotiated Rate	$2,731.31
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: BCBS Complete	$31.77
Rate for Payer: BCBS Trust/PPO	$2,731.31
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Mclaren Medicaid	$30.26
Rate for Payer: Meridian Medicaid	$31.77
Rate for Payer: Priority Health Choice Medicaid	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.54
Rate for Payer: Priority Health Narrow Network	$36.54
Rate for Payer: Priority Health SBD	$36.54

PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP

Professional

Both

$40.00

Service Code	HCPCS 99211
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$2,495.16
Rate for Payer: Aetna Commercial	$8.94
Rate for Payer: BCBS Complete	$7.86
Rate for Payer: BCBS Trust/PPO	$2,495.16
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Mclaren Medicaid	$7.49
Rate for Payer: Meridian Medicaid	$7.86
Rate for Payer: Priority Health Choice Medicaid	$7.49
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.05
Rate for Payer: Priority Health Narrow Network	$9.05
Rate for Payer: Priority Health SBD	$9.05

PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES

Professional

Both

$310.00

Service Code	HCPCS 99205
Min. Negotiated Rate	$155.60
Max. Negotiated Rate	$2,028.67
Rate for Payer: Aetna Commercial	$183.49
Rate for Payer: BCBS Complete	$163.38
Rate for Payer: BCBS Trust/PPO	$2,028.67
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Mclaren Medicaid	$155.60
Rate for Payer: Meridian Medicaid	$163.38
Rate for Payer: Priority Health Choice Medicaid	$155.60
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$186.19
Rate for Payer: Priority Health Narrow Network	$186.19
Rate for Payer: Priority Health SBD	$186.19

PR OFFICE OUTPATIENT NEW LEVL I

Professional

Both

$70.00

Service Code	HCPCS 99201
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$49.00
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00

PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES

Professional

Both

$160.00

Service Code	HCPCS 99203
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$931.39
Rate for Payer: Aetna Commercial	$83.07
Rate for Payer: BCBS Complete	$73.83
Rate for Payer: BCBS Trust/PPO	$931.39
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Mclaren Medicaid	$70.31
Rate for Payer: Meridian Medicaid	$73.83
Rate for Payer: Priority Health Choice Medicaid	$70.31
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$85.26
Rate for Payer: Priority Health Narrow Network	$85.26
Rate for Payer: Priority Health SBD	$85.26

PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES

Professional

Both

$250.00

Service Code	HCPCS 99204
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$1,704.30
Rate for Payer: Aetna Commercial	$135.20
Rate for Payer: BCBS Complete	$120.12
Rate for Payer: BCBS Trust/PPO	$1,704.30
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Mclaren Medicaid	$114.40
Rate for Payer: Meridian Medicaid	$120.12
Rate for Payer: Priority Health Choice Medicaid	$114.40
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.12
Rate for Payer: Priority Health Narrow Network	$137.12
Rate for Payer: Priority Health SBD	$137.12

PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES

Professional

Both

$110.00

Service Code	HCPCS 99202
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$706.34
Rate for Payer: Aetna Commercial	$49.04
Rate for Payer: BCBS Complete	$42.66
Rate for Payer: BCBS Trust/PPO	$706.34
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Mclaren Medicaid	$40.63
Rate for Payer: Meridian Medicaid	$42.66
Rate for Payer: Priority Health Choice Medicaid	$40.63
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.42
Rate for Payer: Priority Health Narrow Network	$49.42
Rate for Payer: Priority Health SBD	$49.42

PROGESTERONE MICRONIZED 100 MG CAPSULE

Facility

$487.68

Service Code	NDC 43598-349-01
Hospital Charge Code	23122
Hospital Revenue Code	637
Min. Negotiated Rate	$307.24
Max. Negotiated Rate	$438.91
Rate for Payer: Aetna Commercial	$414.53
Rate for Payer: Aetna New Business (MI Preferred)	$316.99
Rate for Payer: Cash Price	$390.14
Rate for Payer: Cofinity Commercial	$341.38
Rate for Payer: Cofinity Commercial	$419.40
Rate for Payer: Healthscope Commercial	$438.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$414.53
Rate for Payer: PHP Commercial	$414.53
Rate for Payer: Priority Health Cigna Priority Health	$341.38
Rate for Payer: Priority Health SBD	$307.24

PROGESTERONE MICRONIZED 100 MG CAPSULE

Facility

$437.10

Service Code	NDC 59651-152-01
Hospital Charge Code	23122
Hospital Revenue Code	637
Min. Negotiated Rate	$275.37
Max. Negotiated Rate	$393.39
Rate for Payer: Aetna Commercial	$371.54
Rate for Payer: Aetna New Business (MI Preferred)	$284.12
Rate for Payer: Cash Price	$349.68
Rate for Payer: Cofinity Commercial	$305.97
Rate for Payer: Cofinity Commercial	$375.91
Rate for Payer: Healthscope Commercial	$393.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$371.54
Rate for Payer: PHP Commercial	$371.54
Rate for Payer: Priority Health Cigna Priority Health	$305.97
Rate for Payer: Priority Health SBD	$275.37

PROGESTERONE MICRONIZED 100 MG CAPSULE

Facility

$256.80

Service Code	NDC 17478-766-10
Hospital Charge Code	23122
Hospital Revenue Code	637
Min. Negotiated Rate	$161.78
Max. Negotiated Rate	$231.12
Rate for Payer: Aetna Commercial	$218.28
Rate for Payer: Aetna New Business (MI Preferred)	$166.92
Rate for Payer: Cash Price	$205.44
Rate for Payer: Cofinity Commercial	$179.76
Rate for Payer: Cofinity Commercial	$220.85
Rate for Payer: Healthscope Commercial	$231.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$218.28
Rate for Payer: PHP Commercial	$218.28
Rate for Payer: Priority Health Cigna Priority Health	$179.76
Rate for Payer: Priority Health SBD	$161.78

PR OMALIZUMAB INJECTION

Professional

Both

$30.00

Service Code	HCPCS J2357
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$40.64
Rate for Payer: Aetna Commercial	$40.64
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$40.20
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$21.00

PR OMENTAL FLAP INTRA-ABDOMINAL

Professional

Both

$629.00

Service Code	HCPCS 49905
Min. Negotiated Rate	$223.01
Max. Negotiated Rate	$4,973.94
Rate for Payer: Aetna Commercial	$477.01
Rate for Payer: BCBS Complete	$234.16
Rate for Payer: BCBS Trust/PPO	$4,973.94
Rate for Payer: Cash Price	$503.20
Rate for Payer: Cash Price	$503.20
Rate for Payer: Mclaren Medicaid	$223.01
Rate for Payer: Meridian Medicaid	$234.16
Rate for Payer: Priority Health Choice Medicaid	$223.01
Rate for Payer: Priority Health Cigna Priority Health	$440.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$614.43
Rate for Payer: Priority Health Narrow Network	$614.43
Rate for Payer: Priority Health SBD	$614.43

PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY

Facility

$181.02

Service Code	NDC 0713-0536-12
Hospital Charge Code	11143
Hospital Revenue Code	637
Min. Negotiated Rate	$114.04
Max. Negotiated Rate	$162.92
Rate for Payer: Aetna Commercial	$153.87
Rate for Payer: Aetna New Business (MI Preferred)	$117.66
Rate for Payer: Cash Price	$144.82
Rate for Payer: Cofinity Commercial	$126.71
Rate for Payer: Cofinity Commercial	$155.68
Rate for Payer: Healthscope Commercial	$162.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$153.87
Rate for Payer: PHP Commercial	$153.87
Rate for Payer: Priority Health Cigna Priority Health	$126.71
Rate for Payer: Priority Health SBD	$114.04

PROMETHAZINE 25 MG/ML INJECTION SOLUTION

Facility

$22.23

Service Code	HCPCS J2550
Hospital Charge Code	6618
Hospital Revenue Code	636
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$20.01
Rate for Payer: Aetna Commercial	$18.90
Rate for Payer: Aetna Commercial	$14.32
Rate for Payer: Aetna Commercial	$13.87
Rate for Payer: Aetna Commercial	$18.93
Rate for Payer: Aetna Commercial	$18.91
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna New Business (MI Preferred)	$14.46
Rate for Payer: Aetna New Business (MI Preferred)	$10.61
Rate for Payer: Aetna New Business (MI Preferred)	$10.95
Rate for Payer: Aetna New Business (MI Preferred)	$14.33
Rate for Payer: Aetna New Business (MI Preferred)	$14.45
Rate for Payer: Aetna New Business (MI Preferred)	$14.48
Rate for Payer: Cash Price	$17.78
Rate for Payer: Cash Price	$17.82
Rate for Payer: Cash Price	$13.48
Rate for Payer: Cash Price	$13.06
Rate for Payer: Cash Price	$17.64
Rate for Payer: Cash Price	$17.80
Rate for Payer: Cofinity Commercial	$14.49
Rate for Payer: Cofinity Commercial	$15.44
Rate for Payer: Cofinity Commercial	$18.96
Rate for Payer: Cofinity Commercial	$11.42
Rate for Payer: Cofinity Commercial	$14.04
Rate for Payer: Cofinity Commercial	$11.80
Rate for Payer: Cofinity Commercial	$19.14
Rate for Payer: Cofinity Commercial	$15.58
Rate for Payer: Cofinity Commercial	$15.56
Rate for Payer: Cofinity Commercial	$19.12
Rate for Payer: Cofinity Commercial	$19.15
Rate for Payer: Cofinity Commercial	$15.59
Rate for Payer: Healthscope Commercial	$20.01
Rate for Payer: Healthscope Commercial	$20.04
Rate for Payer: Healthscope Commercial	$19.84
Rate for Payer: Healthscope Commercial	$20.02
Rate for Payer: Healthscope Commercial	$14.69
Rate for Payer: Healthscope Commercial	$15.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.93
Rate for Payer: PHP Commercial	$18.90
Rate for Payer: PHP Commercial	$13.87
Rate for Payer: PHP Commercial	$18.91
Rate for Payer: PHP Commercial	$18.74
Rate for Payer: PHP Commercial	$14.32
Rate for Payer: PHP Commercial	$18.93
Rate for Payer: Priority Health Cigna Priority Health	$15.58
Rate for Payer: Priority Health Cigna Priority Health	$11.80
Rate for Payer: Priority Health Cigna Priority Health	$15.56
Rate for Payer: Priority Health Cigna Priority Health	$15.59
Rate for Payer: Priority Health Cigna Priority Health	$15.44
Rate for Payer: Priority Health Cigna Priority Health	$11.42
Rate for Payer: Priority Health SBD	$14.02
Rate for Payer: Priority Health SBD	$14.00
Rate for Payer: Priority Health SBD	$10.62
Rate for Payer: Priority Health SBD	$13.89
Rate for Payer: Priority Health SBD	$10.28
Rate for Payer: Priority Health SBD	$14.03

PROMETHAZINE 25 MG RECTAL SUPPOSITORY

Facility

$153.98

Service Code	NDC 0713-0526-12
Hospital Charge Code	11144
Hospital Revenue Code	637
Min. Negotiated Rate	$97.01
Max. Negotiated Rate	$138.58
Rate for Payer: Aetna Commercial	$130.88
Rate for Payer: Aetna New Business (MI Preferred)	$100.09
Rate for Payer: Cash Price	$123.18
Rate for Payer: Cofinity Commercial	$107.79
Rate for Payer: Cofinity Commercial	$132.42
Rate for Payer: Healthscope Commercial	$138.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$130.88
Rate for Payer: PHP Commercial	$130.88
Rate for Payer: Priority Health Cigna Priority Health	$107.79
Rate for Payer: Priority Health SBD	$97.01

PROMETHAZINE 25 MG TABLET

Facility

$251.45

Service Code	NDC 0904-6461-61
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$213.73
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$176.02
Rate for Payer: Priority Health SBD	$158.41

PROMETHAZINE 25 MG TABLET

Facility

$108.10

Service Code	NDC 10702-003-01
Hospital Charge Code	6622
Hospital Revenue Code	637
Min. Negotiated Rate	$68.10
Max. Negotiated Rate	$97.29
Rate for Payer: Aetna Commercial	$91.88
Rate for Payer: Aetna New Business (MI Preferred)	$70.26
Rate for Payer: Cash Price	$86.48
Rate for Payer: Cofinity Commercial	$75.67
Rate for Payer: Cofinity Commercial	$92.97
Rate for Payer: Healthscope Commercial	$97.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$91.88
Rate for Payer: PHP Commercial	$91.88
Rate for Payer: Priority Health Cigna Priority Health	$75.67
Rate for Payer: Priority Health SBD	$68.10

PROMETHAZINE 50 MG RECTAL SUPPOSITORY

Facility

$988.70

Service Code	NDC 0713-0132-12
Hospital Charge Code	6624
Hospital Revenue Code	637
Min. Negotiated Rate	$622.88
Max. Negotiated Rate	$889.83
Rate for Payer: Aetna Commercial	$840.40
Rate for Payer: Aetna New Business (MI Preferred)	$642.66
Rate for Payer: Cash Price	$790.96
Rate for Payer: Cofinity Commercial	$692.09
Rate for Payer: Cofinity Commercial	$850.28
Rate for Payer: Healthscope Commercial	$889.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$840.40
Rate for Payer: PHP Commercial	$840.40
Rate for Payer: Priority Health Cigna Priority Health	$692.09
Rate for Payer: Priority Health SBD	$622.88

PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP

Facility

$198.66

Service Code	NDC 0121-0927-16
Hospital Charge Code	6620
Hospital Revenue Code	637
Min. Negotiated Rate	$125.16
Max. Negotiated Rate	$178.79
Rate for Payer: Aetna Commercial	$168.86
Rate for Payer: Aetna New Business (MI Preferred)	$129.13
Rate for Payer: Cash Price	$158.93
Rate for Payer: Cofinity Commercial	$139.06
Rate for Payer: Cofinity Commercial	$170.85
Rate for Payer: Healthscope Commercial	$178.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$168.86
Rate for Payer: PHP Commercial	$168.86
Rate for Payer: Priority Health Cigna Priority Health	$139.06
Rate for Payer: Priority Health SBD	$125.16

Know your out-of-pocket cost for care.

All Charges