Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Professional

Both

$875.00

Service Code	HCPCS 55250
Hospital Charge Code	55250
Min. Negotiated Rate	$147.61
Max. Negotiated Rate	$1,543.69
Rate for Payer: Aetna Commercial	$290.03
Rate for Payer: BCBS Complete	$154.99
Rate for Payer: BCBS Trust/PPO	$1,543.69
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Mclaren Medicaid	$147.61
Rate for Payer: Meridian Medicaid	$154.99
Rate for Payer: Priority Health Choice Medicaid	$147.61
Rate for Payer: Priority Health Cigna Priority Health	$612.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$367.44
Rate for Payer: Priority Health Narrow Network	$367.44
Rate for Payer: Priority Health SBD	$367.44

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Facility

$875.00

Service Code	CPT 55250
Hospital Charge Code	55250
Hospital Revenue Code	960
Min. Negotiated Rate	$226.92
Max. Negotiated Rate	$5,575.00
Rate for Payer: Aetna Commercial	$743.75
Rate for Payer: Aetna Medicare	$1,884.83
Rate for Payer: Aetna New Business (MI Preferred)	$568.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,265.42
Rate for Payer: Amish Plain Church Group Commercial	$2,265.42
Rate for Payer: BCBS Complete	$1,041.01
Rate for Payer: BCBS MAPPO	$1,812.34
Rate for Payer: BCBS Trust/PPO	$763.47
Rate for Payer: BCN Medicare Advantage	$1,812.34
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cofinity Commercial	$612.50
Rate for Payer: Cofinity Commercial	$752.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,812.34
Rate for Payer: Healthscope Commercial	$787.50
Rate for Payer: Mclaren Medicaid	$991.35
Rate for Payer: Mclaren Medicare	$1,812.34
Rate for Payer: Meridian Medicaid	$1,041.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,902.96
Rate for Payer: MI Amish Medical Board Commercial	$2,084.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$743.75
Rate for Payer: PACE Medicare	$1,721.72
Rate for Payer: PACE SWMI	$1,812.34
Rate for Payer: PHP Commercial	$743.75
Rate for Payer: PHP Medicare Advantage	$1,812.34
Rate for Payer: Priority Health Choice Medicaid	$991.35
Rate for Payer: Priority Health Cigna Priority Health	$612.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,575.00
Rate for Payer: Priority Health Medicare	$1,812.34
Rate for Payer: Priority Health Narrow Network	$4,460.00
Rate for Payer: Priority Health SBD	$551.25
Rate for Payer: Railroad Medicare Medicare	$1,812.34
Rate for Payer: UHC All Payor (Choice/PPO)	$249.61
Rate for Payer: UHC Dual Complete DSNP	$1,812.34
Rate for Payer: UHC Exchange	$226.92
Rate for Payer: UHC Medicare Advantage	$1,866.71
Rate for Payer: VA VA	$1,812.34

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Facility

$875.00

Service Code	CPT 55250
Hospital Charge Code	55250
Hospital Revenue Code	960
Min. Negotiated Rate	$551.25
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$743.75
Rate for Payer: Aetna New Business (MI Preferred)	$568.75
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cofinity Commercial	$612.50
Rate for Payer: Cofinity Commercial	$752.50
Rate for Payer: Healthscope Commercial	$787.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$743.75
Rate for Payer: PHP Commercial	$743.75
Rate for Payer: Priority Health Cigna Priority Health	$612.50
Rate for Payer: Priority Health SBD	$551.25

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Professional

Both

$875.00

Service Code	HCPCS 55250
Min. Negotiated Rate	$147.61
Max. Negotiated Rate	$1,543.69
Rate for Payer: Aetna Commercial	$290.03
Rate for Payer: BCBS Complete	$154.99
Rate for Payer: BCBS Trust/PPO	$1,543.69
Rate for Payer: Cash Price	$700.00
Rate for Payer: Cash Price	$700.00
Rate for Payer: Mclaren Medicaid	$147.61
Rate for Payer: Meridian Medicaid	$154.99
Rate for Payer: Priority Health Choice Medicaid	$147.61
Rate for Payer: Priority Health Cigna Priority Health	$612.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$367.44
Rate for Payer: Priority Health Narrow Network	$367.44
Rate for Payer: Priority Health SBD	$367.44

PR VASOVASOSTOMY VASOVASORRHAPHY

Professional

Both

$933.00

Service Code	HCPCS 55400
Min. Negotiated Rate	$373.20
Max. Negotiated Rate	$2,224.67
Rate for Payer: Aetna Commercial	$641.17
Rate for Payer: BCBS Complete	$373.20
Rate for Payer: BCBS Trust/PPO	$2,224.67
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Priority Health Cigna Priority Health	$653.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$798.64
Rate for Payer: Priority Health Narrow Network	$798.64
Rate for Payer: Priority Health SBD	$798.64

PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG

Professional

Both

$2,716.00

Service Code	HCPCS 63103
Min. Negotiated Rate	$187.01
Max. Negotiated Rate	$4,342.63
Rate for Payer: Aetna Commercial	$381.03
Rate for Payer: BCBS Complete	$196.36
Rate for Payer: BCBS Trust/PPO	$4,342.63
Rate for Payer: Cash Price	$2,172.80
Rate for Payer: Cash Price	$2,172.80
Rate for Payer: Mclaren Medicaid	$187.01
Rate for Payer: Meridian Medicaid	$196.36
Rate for Payer: Priority Health Choice Medicaid	$187.01
Rate for Payer: Priority Health Cigna Priority Health	$1,901.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$497.14
Rate for Payer: Priority Health Narrow Network	$497.14
Rate for Payer: Priority Health SBD	$497.14

PR VCRPEC LES 1 SGM XDRL CERVICAL

Professional

Both

$4,613.00

Service Code	HCPCS 63300
Min. Negotiated Rate	$519.85
Max. Negotiated Rate	$3,229.10
Rate for Payer: Aetna Commercial	$2,360.58
Rate for Payer: BCBS Complete	$1,228.96
Rate for Payer: BCBS Trust/PPO	$519.85
Rate for Payer: Cash Price	$3,690.40
Rate for Payer: Cash Price	$3,690.40
Rate for Payer: Mclaren Medicaid	$1,170.44
Rate for Payer: Meridian Medicaid	$1,228.96
Rate for Payer: Priority Health Choice Medicaid	$1,170.44
Rate for Payer: Priority Health Cigna Priority Health	$3,229.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,094.97
Rate for Payer: Priority Health Narrow Network	$3,094.97
Rate for Payer: Priority Health SBD	$3,094.97

PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC

Professional

Both

$4,564.00

Service Code	HCPCS 63301
Min. Negotiated Rate	$1,431.79
Max. Negotiated Rate	$3,772.74
Rate for Payer: Aetna Commercial	$2,850.87
Rate for Payer: BCBS Complete	$1,503.38
Rate for Payer: BCBS Trust/PPO	$1,593.88
Rate for Payer: Cash Price	$3,651.20
Rate for Payer: Cash Price	$3,651.20
Rate for Payer: Mclaren Medicaid	$1,431.79
Rate for Payer: Meridian Medicaid	$1,503.38
Rate for Payer: Priority Health Choice Medicaid	$1,431.79
Rate for Payer: Priority Health Cigna Priority Health	$3,194.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,772.74
Rate for Payer: Priority Health Narrow Network	$3,772.74
Rate for Payer: Priority Health SBD	$3,772.74

PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG

Professional

Both

$9,042.00

Service Code	HCPCS 63087
Min. Negotiated Rate	$232.45
Max. Negotiated Rate	$6,329.40
Rate for Payer: Aetna Commercial	$3,114.02
Rate for Payer: BCBS Complete	$1,635.10
Rate for Payer: BCBS Trust/PPO	$232.45
Rate for Payer: Cash Price	$7,233.60
Rate for Payer: Cash Price	$7,233.60
Rate for Payer: Mclaren Medicaid	$1,557.24
Rate for Payer: Meridian Medicaid	$1,635.10
Rate for Payer: Priority Health Choice Medicaid	$1,557.24
Rate for Payer: Priority Health Cigna Priority Health	$6,329.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,095.49
Rate for Payer: Priority Health Narrow Network	$4,095.49
Rate for Payer: Priority Health SBD	$4,095.49

PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG

Professional

Both

$3,100.00

Service Code	HCPCS 63088
Min. Negotiated Rate	$165.08
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$335.33
Rate for Payer: BCBS Complete	$173.33
Rate for Payer: BCBS Trust/PPO	$342.34
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Mclaren Medicaid	$165.08
Rate for Payer: Meridian Medicaid	$173.33
Rate for Payer: Priority Health Choice Medicaid	$165.08
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$435.42
Rate for Payer: Priority Health Narrow Network	$435.42
Rate for Payer: Priority Health SBD	$435.42

PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG

Professional

Both

$7,131.00

Service Code	HCPCS 63090
Min. Negotiated Rate	$1,249.46
Max. Negotiated Rate	$4,991.70
Rate for Payer: Aetna Commercial	$2,534.05
Rate for Payer: BCBS Complete	$1,311.93
Rate for Payer: BCBS Trust/PPO	$1,683.69
Rate for Payer: Cash Price	$5,704.80
Rate for Payer: Cash Price	$5,704.80
Rate for Payer: Mclaren Medicaid	$1,249.46
Rate for Payer: Meridian Medicaid	$1,311.93
Rate for Payer: Priority Health Choice Medicaid	$1,249.46
Rate for Payer: Priority Health Cigna Priority Health	$4,991.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,297.12
Rate for Payer: Priority Health Narrow Network	$3,297.12
Rate for Payer: Priority Health SBD	$3,297.12

PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG

Professional

Both

$2,429.00

Service Code	HCPCS 63091
Min. Negotiated Rate	$111.40
Max. Negotiated Rate	$2,079.39
Rate for Payer: Aetna Commercial	$230.26
Rate for Payer: BCBS Complete	$116.97
Rate for Payer: BCBS Trust/PPO	$2,079.39
Rate for Payer: Cash Price	$1,943.20
Rate for Payer: Cash Price	$1,943.20
Rate for Payer: Mclaren Medicaid	$111.40
Rate for Payer: Meridian Medicaid	$116.97
Rate for Payer: Priority Health Choice Medicaid	$111.40
Rate for Payer: Priority Health Cigna Priority Health	$1,700.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$296.13
Rate for Payer: Priority Health Narrow Network	$296.13
Rate for Payer: Priority Health SBD	$296.13

PR VEIN SCREEN

Professional

Both

$20.00

Service Code	HCPCS 00515
Hospital Revenue Code	990
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$14.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR VEN CATHJ SLCTV ORGAN BLD SAMPLING

Professional

Both

$342.00

Service Code	HCPCS 36500
Min. Negotiated Rate	$113.53
Max. Negotiated Rate	$428.45
Rate for Payer: Aetna Commercial	$244.57
Rate for Payer: BCBS Complete	$119.21
Rate for Payer: BCBS Trust/PPO	$428.45
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Mclaren Medicaid	$113.53
Rate for Payer: Meridian Medicaid	$119.21
Rate for Payer: Priority Health Choice Medicaid	$113.53
Rate for Payer: Priority Health Cigna Priority Health	$239.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$282.47
Rate for Payer: Priority Health Narrow Network	$282.47
Rate for Payer: Priority Health SBD	$282.47

PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL

Professional

Both

$4,281.00

Service Code	HCPCS 37180
Min. Negotiated Rate	$1,352.34
Max. Negotiated Rate	$3,361.97
Rate for Payer: Aetna Commercial	$2,874.90
Rate for Payer: BCBS Complete	$1,419.96
Rate for Payer: BCBS Trust/PPO	$1,647.77
Rate for Payer: Cash Price	$3,424.80
Rate for Payer: Cash Price	$3,424.80
Rate for Payer: Mclaren Medicaid	$1,352.34
Rate for Payer: Meridian Medicaid	$1,419.96
Rate for Payer: Priority Health Choice Medicaid	$1,352.34
Rate for Payer: Priority Health Cigna Priority Health	$2,996.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,361.97
Rate for Payer: Priority Health Narrow Network	$3,361.97
Rate for Payer: Priority Health SBD	$3,361.97

PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES

Professional

Both

$601.00

Service Code	HCPCS 69424
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$2,176.60
Rate for Payer: Aetna Commercial	$67.67
Rate for Payer: BCBS Complete	$40.71
Rate for Payer: BCBS Trust/PPO	$2,176.60
Rate for Payer: Cash Price	$480.80
Rate for Payer: Cash Price	$480.80
Rate for Payer: Mclaren Medicaid	$38.77
Rate for Payer: Meridian Medicaid	$40.71
Rate for Payer: Priority Health Choice Medicaid	$38.77
Rate for Payer: Priority Health Cigna Priority Health	$420.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.87
Rate for Payer: Priority Health Narrow Network	$84.87
Rate for Payer: Priority Health SBD	$84.87

PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY

Professional

Both

$169.00

Service Code	HCPCS 94002
Min. Negotiated Rate	$57.51
Max. Negotiated Rate	$1,687.92
Rate for Payer: Aetna Commercial	$102.02
Rate for Payer: BCBS Complete	$60.39
Rate for Payer: BCBS Trust/PPO	$1,687.92
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Mclaren Medicaid	$57.51
Rate for Payer: Meridian Medicaid	$60.39
Rate for Payer: Priority Health Choice Medicaid	$57.51
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121.27
Rate for Payer: Priority Health Narrow Network	$121.27
Rate for Payer: Priority Health SBD	$121.27

PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA

Professional

Both

$124.00

Service Code	HCPCS 94003
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$1,092.52
Rate for Payer: Aetna Commercial	$72.70
Rate for Payer: BCBS Complete	$42.49
Rate for Payer: BCBS Trust/PPO	$1,092.52
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$40.47
Rate for Payer: Meridian Medicaid	$42.49
Rate for Payer: Priority Health Choice Medicaid	$40.47
Rate for Payer: Priority Health Cigna Priority Health	$86.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.89
Rate for Payer: Priority Health Narrow Network	$84.89
Rate for Payer: Priority Health SBD	$84.89

PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ

Professional

Both

$552.00

Service Code	HCPCS 61026
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$593.81
Rate for Payer: Aetna Commercial	$135.98
Rate for Payer: BCBS Complete	$74.02
Rate for Payer: BCBS Trust/PPO	$593.81
Rate for Payer: Cash Price	$441.60
Rate for Payer: Cash Price	$441.60
Rate for Payer: Mclaren Medicaid	$70.50
Rate for Payer: Meridian Medicaid	$74.02
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health	$386.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.63
Rate for Payer: Priority Health Narrow Network	$180.63
Rate for Payer: Priority Health SBD	$180.63

PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX

Professional

Both

$449.00

Service Code	HCPCS 61020
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$330.19
Rate for Payer: Aetna Commercial	$134.44
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCBS Trust/PPO	$330.19
Rate for Payer: Cash Price	$359.20
Rate for Payer: Cash Price	$359.20
Rate for Payer: Mclaren Medicaid	$69.01
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health	$314.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.06
Rate for Payer: Priority Health Narrow Network	$180.06
Rate for Payer: Priority Health SBD	$180.06

PR VENTRICULOCISTERNOSTOMY

Professional

Both

$4,660.00

Service Code	HCPCS 62180
Min. Negotiated Rate	$1,040.08
Max. Negotiated Rate	$3,262.00
Rate for Payer: Aetna Commercial	$2,066.64
Rate for Payer: BCBS Complete	$1,092.08
Rate for Payer: BCBS Trust/PPO	$1,771.92
Rate for Payer: Cash Price	$3,728.00
Rate for Payer: Cash Price	$3,728.00
Rate for Payer: Mclaren Medicaid	$1,040.08
Rate for Payer: Meridian Medicaid	$1,092.08
Rate for Payer: Priority Health Choice Medicaid	$1,040.08
Rate for Payer: Priority Health Cigna Priority Health	$3,262.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,738.25
Rate for Payer: Priority Health Narrow Network	$2,738.25
Rate for Payer: Priority Health SBD	$2,738.25

PR VENTRICULOCISTERNOSTOMY 3RD VENTRICLE

Professional

Both

$6,420.00

Service Code	HCPCS 62200
Min. Negotiated Rate	$895.67
Max. Negotiated Rate	$4,494.00
Rate for Payer: Aetna Commercial	$1,779.36
Rate for Payer: BCBS Complete	$940.45
Rate for Payer: BCBS Trust/PPO	$1,335.01
Rate for Payer: Cash Price	$5,136.00
Rate for Payer: Cash Price	$5,136.00
Rate for Payer: Mclaren Medicaid	$895.67
Rate for Payer: Meridian Medicaid	$940.45
Rate for Payer: Priority Health Choice Medicaid	$895.67
Rate for Payer: Priority Health Cigna Priority Health	$4,494.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,358.89
Rate for Payer: Priority Health Narrow Network	$2,358.89
Rate for Payer: Priority Health SBD	$2,358.89

PR VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC

Professional

Both

$5,833.00

Service Code	HCPCS 62201
Min. Negotiated Rate	$792.36
Max. Negotiated Rate	$9,012.27
Rate for Payer: Aetna Commercial	$1,562.86
Rate for Payer: BCBS Complete	$831.98
Rate for Payer: BCBS Trust/PPO	$9,012.27
Rate for Payer: Cash Price	$4,666.40
Rate for Payer: Cash Price	$4,666.40
Rate for Payer: Mclaren Medicaid	$792.36
Rate for Payer: Meridian Medicaid	$831.98
Rate for Payer: Priority Health Choice Medicaid	$792.36
Rate for Payer: Priority Health Cigna Priority Health	$4,083.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,088.80
Rate for Payer: Priority Health Narrow Network	$2,088.80
Rate for Payer: Priority Health SBD	$2,088.80

PR VENTRICULOMYOTOMY-MYECTOMY

Professional

Both

$8,920.00

Service Code	HCPCS 33416
Min. Negotiated Rate	$718.49
Max. Negotiated Rate	$6,244.00
Rate for Payer: Aetna Commercial	$2,713.83
Rate for Payer: BCBS Complete	$1,331.84
Rate for Payer: BCBS Trust/PPO	$718.49
Rate for Payer: Cash Price	$7,136.00
Rate for Payer: Cash Price	$7,136.00
Rate for Payer: Mclaren Medicaid	$1,268.42
Rate for Payer: Meridian Medicaid	$1,331.84
Rate for Payer: Priority Health Choice Medicaid	$1,268.42
Rate for Payer: Priority Health Cigna Priority Health	$6,244.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,156.64
Rate for Payer: Priority Health Narrow Network	$3,156.64
Rate for Payer: Priority Health SBD	$3,156.64

PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT

Professional

Both

$734.00

Service Code	HCPCS 40500
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$652.65
Rate for Payer: Aetna Commercial	$478.94
Rate for Payer: BCBS Complete	$251.16
Rate for Payer: BCBS Trust/PPO	$449.06
Rate for Payer: Cash Price	$587.20
Rate for Payer: Cash Price	$587.20
Rate for Payer: Mclaren Medicaid	$239.20
Rate for Payer: Meridian Medicaid	$251.16
Rate for Payer: Priority Health Choice Medicaid	$239.20
Rate for Payer: Priority Health Cigna Priority Health	$513.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$652.65
Rate for Payer: Priority Health Narrow Network	$652.65
Rate for Payer: Priority Health SBD	$652.65

Know your out-of-pocket cost for care.

All Charges