Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR REVJ/RMVL INTRACRANIAL NEUROSTIMULATOR ELTRDS

Professional

Both

$3,122.00

Service Code	HCPCS 61880
Min. Negotiated Rate	$384.25
Max. Negotiated Rate	$2,185.40
Rate for Payer: Aetna Commercial	$745.42
Rate for Payer: BCBS Complete	$403.46
Rate for Payer: BCBS Trust/PPO	$1,107.32
Rate for Payer: Cash Price	$2,497.60
Rate for Payer: Cash Price	$2,497.60
Rate for Payer: Meridian Medicaid	$403.46
Rate for Payer: Priority Health Choice Medicaid	$384.25
Rate for Payer: Priority Health Cigna Priority Health	$2,185.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.58
Rate for Payer: Priority Health Narrow Network	$1,009.58
Rate for Payer: Priority Health SBD	$1,009.58
Rate for Payer: UMR Bronson Commercial	$1,436.12

PR REVJ/RMVL NEUROSTIMULATOR PULSE GENERATOR

Professional

Both

$1,027.00

Service Code	HCPCS 61888
Min. Negotiated Rate	$259.22
Max. Negotiated Rate	$1,422.71
Rate for Payer: Aetna Commercial	$512.47
Rate for Payer: BCBS Complete	$272.18
Rate for Payer: BCBS Trust/PPO	$1,422.71
Rate for Payer: Cash Price	$821.60
Rate for Payer: Cash Price	$821.60
Rate for Payer: Meridian Medicaid	$272.18
Rate for Payer: Priority Health Choice Medicaid	$259.22
Rate for Payer: Priority Health Cigna Priority Health	$718.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$683.43
Rate for Payer: Priority Health Narrow Network	$683.43
Rate for Payer: Priority Health SBD	$683.43
Rate for Payer: UMR Bronson Commercial	$472.42

PR REVJ/RMVL PERIPHERAL NEUROSTIMULATOR ELECTRODE

Professional

Both

$1,312.00

Service Code	HCPCS 64585
Min. Negotiated Rate	$92.23
Max. Negotiated Rate	$918.40
Rate for Payer: Aetna Commercial	$182.91
Rate for Payer: BCBS Complete	$96.84
Rate for Payer: BCBS Trust/PPO	$390.41
Rate for Payer: Cash Price	$1,049.60
Rate for Payer: Cash Price	$1,049.60
Rate for Payer: Meridian Medicaid	$96.84
Rate for Payer: Priority Health Choice Medicaid	$92.23
Rate for Payer: Priority Health Cigna Priority Health	$918.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$241.21
Rate for Payer: Priority Health Narrow Network	$241.21
Rate for Payer: Priority Health SBD	$241.21
Rate for Payer: UMR Bronson Commercial	$603.52

PR REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP

Professional

Both

$1,392.00

Service Code	HCPCS 57295
Min. Negotiated Rate	$322.91
Max. Negotiated Rate	$1,461.28
Rate for Payer: Aetna Commercial	$593.12
Rate for Payer: BCBS Complete	$339.06
Rate for Payer: BCBS Trust/PPO	$1,461.28
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Cash Price	$1,113.60
Rate for Payer: Meridian Medicaid	$339.06
Rate for Payer: Priority Health Choice Medicaid	$322.91
Rate for Payer: Priority Health Cigna Priority Health	$974.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$713.45
Rate for Payer: Priority Health Narrow Network	$713.45
Rate for Payer: Priority Health SBD	$713.45
Rate for Payer: UMR Bronson Commercial	$640.32

PR REVJ/RPLCMT HPGLSL NERVE NSTIM RA PG&RESPIR SNR

Professional

Both

$1,720.00

Service Code	HCPCS 64583
Min. Negotiated Rate	$315.92
Max. Negotiated Rate	$1,462.56
Rate for Payer: Aetna Commercial	$1,017.89
Rate for Payer: BCBS Complete	$580.15
Rate for Payer: BCBS Trust/PPO	$315.92
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Meridian Medicaid	$580.15
Rate for Payer: Priority Health Choice Medicaid	$552.52
Rate for Payer: Priority Health Cigna Priority Health	$1,204.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,462.56
Rate for Payer: Priority Health Narrow Network	$1,462.56
Rate for Payer: Priority Health SBD	$1,462.56
Rate for Payer: UMR Bronson Commercial	$791.20

PR REVJ/RPLMNT CH WAL RESPIR ELTRD & CONJ PULSE GEN

Professional

Both

$800.00

Service Code	HCPCS 0467T
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$560.00
Rate for Payer: BCBS Complete	$320.00
Rate for Payer: Cash Price	$640.00
Rate for Payer: Priority Health Cigna Priority Health	$560.00
Rate for Payer: UMR Bronson Commercial	$368.00

PR REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT

Professional

Both

$4,478.00

Service Code	HCPCS 27486
Min. Negotiated Rate	$899.71
Max. Negotiated Rate	$3,134.60
Rate for Payer: Aetna Commercial	$1,879.07
Rate for Payer: BCBS Complete	$944.70
Rate for Payer: BCBS Trust/PPO	$1,429.05
Rate for Payer: Cash Price	$3,582.40
Rate for Payer: Cash Price	$3,582.40
Rate for Payer: Meridian Medicaid	$944.70
Rate for Payer: Priority Health Choice Medicaid	$899.71
Rate for Payer: Priority Health Cigna Priority Health	$3,134.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,142.69
Rate for Payer: Priority Health Narrow Network	$2,142.69
Rate for Payer: Priority Health SBD	$2,142.69
Rate for Payer: UMR Bronson Commercial	$2,059.88

PR REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT

Professional

Both

$2,978.08

Service Code	HCPCS 27137
Min. Negotiated Rate	$936.99
Max. Negotiated Rate	$2,232.56
Rate for Payer: Aetna Commercial	$1,964.36
Rate for Payer: BCBS Complete	$983.84
Rate for Payer: BCBS Trust/PPO	$1,779.31
Rate for Payer: Cash Price	$2,382.46
Rate for Payer: Cash Price	$2,382.46
Rate for Payer: Meridian Medicaid	$983.84
Rate for Payer: Priority Health Choice Medicaid	$936.99
Rate for Payer: Priority Health Cigna Priority Health	$2,084.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,232.56
Rate for Payer: Priority Health Narrow Network	$2,232.56
Rate for Payer: Priority Health SBD	$2,232.56
Rate for Payer: UMR Bronson Commercial	$1,369.92

PR REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT

Professional

Both

$3,880.62

Service Code	HCPCS 27134
Min. Negotiated Rate	$409.96
Max. Negotiated Rate	$2,898.45
Rate for Payer: Aetna Commercial	$2,555.78
Rate for Payer: BCBS Complete	$1,275.70
Rate for Payer: BCBS Trust/PPO	$409.96
Rate for Payer: Cash Price	$3,104.50
Rate for Payer: Cash Price	$3,104.50
Rate for Payer: Meridian Medicaid	$1,275.70
Rate for Payer: Priority Health Choice Medicaid	$1,214.95
Rate for Payer: Priority Health Cigna Priority Health	$2,716.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,898.45
Rate for Payer: Priority Health Narrow Network	$2,898.45
Rate for Payer: Priority Health SBD	$2,898.45
Rate for Payer: UMR Bronson Commercial	$1,785.09

PR REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT

Professional

Both

$3,095.16

Service Code	HCPCS 27138
Min. Negotiated Rate	$573.73
Max. Negotiated Rate	$2,318.86
Rate for Payer: Aetna Commercial	$2,041.22
Rate for Payer: BCBS Complete	$1,021.63
Rate for Payer: BCBS Trust/PPO	$573.73
Rate for Payer: Cash Price	$2,476.13
Rate for Payer: Cash Price	$2,476.13
Rate for Payer: Meridian Medicaid	$1,021.63
Rate for Payer: Priority Health Choice Medicaid	$972.98
Rate for Payer: Priority Health Cigna Priority Health	$2,166.61
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,318.86
Rate for Payer: Priority Health Narrow Network	$2,318.86
Rate for Payer: Priority Health SBD	$2,318.86
Rate for Payer: UMR Bronson Commercial	$1,423.77

PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE

Facility

$5,885.00

Service Code	CPT 27487
Hospital Charge Code	27487
Min. Negotiated Rate	$2,589.40
Max. Negotiated Rate	$5,296.50
Rate for Payer: Aetna American Axle	$3,825.25
Rate for Payer: Aetna Commercial	$5,002.25
Rate for Payer: Aetna New Business (MI Preferred)	$3,825.25
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Cofinity Commercial	$4,119.50
Rate for Payer: Cofinity Commercial	$5,061.10
Rate for Payer: Encore Health Key Benefits Commercial	$4,708.00
Rate for Payer: Healthscope Commercial	$5,296.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$4,119.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$4,413.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,002.25
Rate for Payer: PHP Commercial	$5,002.25
Rate for Payer: Priority Health Cigna Priority Health	$4,119.50
Rate for Payer: Priority Health SBD	$3,707.55
Rate for Payer: UMR Bronson Commercial	$2,589.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$4,413.75

PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE

Professional

Both

$5,885.00

Service Code	HCPCS 27487
Hospital Charge Code	27487
Min. Negotiated Rate	$861.66
Max. Negotiated Rate	$4,119.50
Rate for Payer: Aetna Commercial	$2,348.25
Rate for Payer: BCBS Complete	$1,176.62
Rate for Payer: BCBS Trust/PPO	$861.66
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Meridian Medicaid	$1,176.62
Rate for Payer: Priority Health Choice Medicaid	$1,120.59
Rate for Payer: Priority Health Cigna Priority Health	$4,119.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,670.19
Rate for Payer: Priority Health Narrow Network	$2,670.19
Rate for Payer: Priority Health SBD	$2,670.19
Rate for Payer: UMR Bronson Commercial	$2,707.10

PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE

Professional

Both

$5,885.00

Service Code	HCPCS 27487
Min. Negotiated Rate	$861.66
Max. Negotiated Rate	$4,119.50
Rate for Payer: Aetna Commercial	$2,348.25
Rate for Payer: BCBS Complete	$1,176.62
Rate for Payer: BCBS Trust/PPO	$861.66
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Meridian Medicaid	$1,176.62
Rate for Payer: Priority Health Choice Medicaid	$1,120.59
Rate for Payer: Priority Health Cigna Priority Health	$4,119.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,670.19
Rate for Payer: Priority Health Narrow Network	$2,670.19
Rate for Payer: Priority Health SBD	$2,670.19
Rate for Payer: UMR Bronson Commercial	$2,707.10

PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE

Facility

$5,885.00

Service Code	CPT 27487
Hospital Charge Code	27487
Min. Negotiated Rate	$1,722.67
Max. Negotiated Rate	$13,036.87
Rate for Payer: Aetna American Axle	$3,825.25
Rate for Payer: Aetna Commercial	$5,002.25
Rate for Payer: Aetna New Business (MI Preferred)	$3,825.25
Rate for Payer: BCBS Complete	$2,354.00
Rate for Payer: BCBS Trust/PPO	$13,036.87
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Cash Price	$4,708.00
Rate for Payer: Cofinity Commercial	$4,119.50
Rate for Payer: Cofinity Commercial	$5,061.10
Rate for Payer: Encore Health Key Benefits Commercial	$4,708.00
Rate for Payer: Healthscope Commercial	$5,296.50
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$4,119.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$4,413.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,002.25
Rate for Payer: PHP Commercial	$5,002.25
Rate for Payer: Priority Health Cigna Priority Health	$4,119.50
Rate for Payer: Priority Health SBD	$3,707.55
Rate for Payer: UHC All Payor (Choice/PPO)	$1,894.94
Rate for Payer: UHC Exchange	$1,722.67
Rate for Payer: UMR Bronson Commercial	$2,177.45
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$4,413.75

PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA

Professional

Both

$1,407.00

Service Code	HCPCS 50728
Min. Negotiated Rate	$356.07
Max. Negotiated Rate	$1,116.92
Rate for Payer: Aetna Commercial	$942.32
Rate for Payer: BCBS Complete	$468.77
Rate for Payer: BCBS Trust/PPO	$356.07
Rate for Payer: Cash Price	$1,125.60
Rate for Payer: Cash Price	$1,125.60
Rate for Payer: Meridian Medicaid	$468.77
Rate for Payer: Priority Health Choice Medicaid	$446.45
Rate for Payer: Priority Health Cigna Priority Health	$984.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,116.92
Rate for Payer: Priority Health Narrow Network	$1,116.92
Rate for Payer: Priority Health SBD	$1,116.92
Rate for Payer: UMR Bronson Commercial	$647.22

PR REVJ URINARY-CUTANEOUS ANASTAMOSIS

Professional

Both

$1,271.00

Service Code	HCPCS 50727
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$4,557.12
Rate for Payer: Aetna Commercial	$652.33
Rate for Payer: BCBS Complete	$344.42
Rate for Payer: BCBS Trust/PPO	$4,557.12
Rate for Payer: Cash Price	$1,016.80
Rate for Payer: Cash Price	$1,016.80
Rate for Payer: Meridian Medicaid	$344.42
Rate for Payer: Priority Health Choice Medicaid	$328.02
Rate for Payer: Priority Health Cigna Priority Health	$889.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$817.56
Rate for Payer: Priority Health Narrow Network	$817.56
Rate for Payer: Priority Health SBD	$817.56
Rate for Payer: UMR Bronson Commercial	$584.66

PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI

Professional

Both

$1,045.00

Service Code	HCPCS 37224
Min. Negotiated Rate	$275.62
Max. Negotiated Rate	$731.50
Rate for Payer: Aetna Commercial	$598.07
Rate for Payer: BCBS Complete	$289.40
Rate for Payer: BCBS Trust/PPO	$622.87
Rate for Payer: Cash Price	$836.00
Rate for Payer: Cash Price	$836.00
Rate for Payer: Meridian Medicaid	$289.40
Rate for Payer: Priority Health Choice Medicaid	$275.62
Rate for Payer: Priority Health Cigna Priority Health	$731.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$687.29
Rate for Payer: Priority Health Narrow Network	$687.29
Rate for Payer: Priority Health SBD	$687.29
Rate for Payer: UMR Bronson Commercial	$480.70

PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL

Professional

Both

$2,272.00

Service Code	HCPCS 37225
Min. Negotiated Rate	$370.83
Max. Negotiated Rate	$1,590.40
Rate for Payer: Aetna Commercial	$809.21
Rate for Payer: BCBS Complete	$389.37
Rate for Payer: BCBS Trust/PPO	$1,131.41
Rate for Payer: Cash Price	$1,817.60
Rate for Payer: Cash Price	$1,817.60
Rate for Payer: Meridian Medicaid	$389.37
Rate for Payer: Priority Health Choice Medicaid	$370.83
Rate for Payer: Priority Health Cigna Priority Health	$1,590.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$924.54
Rate for Payer: Priority Health Narrow Network	$924.54
Rate for Payer: Priority Health SBD	$924.54
Rate for Payer: UMR Bronson Commercial	$1,045.12

PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL

Professional

Both

$1,132.00

Service Code	HCPCS 37226
Min. Negotiated Rate	$321.42
Max. Negotiated Rate	$802.73
Rate for Payer: Aetna Commercial	$699.45
Rate for Payer: BCBS Complete	$337.49
Rate for Payer: BCBS Trust/PPO	$496.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Meridian Medicaid	$337.49
Rate for Payer: Priority Health Choice Medicaid	$321.42
Rate for Payer: Priority Health Cigna Priority Health	$792.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$802.73
Rate for Payer: Priority Health Narrow Network	$802.73
Rate for Payer: Priority Health SBD	$802.73
Rate for Payer: UMR Bronson Commercial	$520.72

PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL

Professional

Both

$1,928.00

Service Code	HCPCS 37227
Min. Negotiated Rate	$443.68
Max. Negotiated Rate	$1,349.60
Rate for Payer: Aetna Commercial	$970.23
Rate for Payer: BCBS Complete	$465.86
Rate for Payer: BCBS Trust/PPO	$690.49
Rate for Payer: Cash Price	$1,542.40
Rate for Payer: Cash Price	$1,542.40
Rate for Payer: Meridian Medicaid	$465.86
Rate for Payer: Priority Health Choice Medicaid	$443.68
Rate for Payer: Priority Health Cigna Priority Health	$1,349.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,109.13
Rate for Payer: Priority Health Narrow Network	$1,109.13
Rate for Payer: Priority Health SBD	$1,109.13
Rate for Payer: UMR Bronson Commercial	$886.88

PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL

Professional

Both

$489.00

Service Code	HCPCS 37223
Min. Negotiated Rate	$131.21
Max. Negotiated Rate	$374.83
Rate for Payer: Aetna Commercial	$286.46
Rate for Payer: BCBS Complete	$137.77
Rate for Payer: BCBS Trust/PPO	$374.83
Rate for Payer: Cash Price	$391.20
Rate for Payer: Cash Price	$391.20
Rate for Payer: Meridian Medicaid	$137.77
Rate for Payer: Priority Health Choice Medicaid	$131.21
Rate for Payer: Priority Health Cigna Priority Health	$342.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.16
Rate for Payer: Priority Health Narrow Network	$327.16
Rate for Payer: Priority Health SBD	$327.16
Rate for Payer: UMR Bronson Commercial	$224.94

PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY

Professional

Both

$1,982.00

Service Code	HCPCS 37221
Min. Negotiated Rate	$305.44
Max. Negotiated Rate	$1,387.40
Rate for Payer: Aetna Commercial	$664.33
Rate for Payer: BCBS Complete	$320.71
Rate for Payer: BCBS Trust/PPO	$652.45
Rate for Payer: Cash Price	$1,585.60
Rate for Payer: Cash Price	$1,585.60
Rate for Payer: Meridian Medicaid	$320.71
Rate for Payer: Priority Health Choice Medicaid	$305.44
Rate for Payer: Priority Health Cigna Priority Health	$1,387.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$762.29
Rate for Payer: Priority Health Narrow Network	$762.29
Rate for Payer: Priority Health SBD	$762.29
Rate for Payer: UMR Bronson Commercial	$911.72

PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI

Professional

Both

$1,279.00

Service Code	HCPCS 37228
Min. Negotiated Rate	$335.05
Max. Negotiated Rate	$1,216.15
Rate for Payer: Aetna Commercial	$728.29
Rate for Payer: BCBS Complete	$351.80
Rate for Payer: BCBS Trust/PPO	$1,216.15
Rate for Payer: Cash Price	$1,023.20
Rate for Payer: Cash Price	$1,023.20
Rate for Payer: Meridian Medicaid	$351.80
Rate for Payer: Priority Health Choice Medicaid	$335.05
Rate for Payer: Priority Health Cigna Priority Health	$895.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$837.29
Rate for Payer: Priority Health Narrow Network	$837.29
Rate for Payer: Priority Health SBD	$837.29
Rate for Payer: UMR Bronson Commercial	$588.34

PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL

Professional

Both

$4,266.00

Service Code	HCPCS 37232
Min. Negotiated Rate	$123.33
Max. Negotiated Rate	$2,986.20
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: BCBS Complete	$129.50
Rate for Payer: BCBS Trust/PPO	$1,565.35
Rate for Payer: Cash Price	$3,412.80
Rate for Payer: Cash Price	$3,412.80
Rate for Payer: Meridian Medicaid	$129.50
Rate for Payer: Priority Health Choice Medicaid	$123.33
Rate for Payer: Priority Health Cigna Priority Health	$2,986.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$307.47
Rate for Payer: Priority Health Narrow Network	$307.47
Rate for Payer: Priority Health SBD	$307.47
Rate for Payer: UMR Bronson Commercial	$1,962.36

PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL

Professional

Both

$2,679.00

Service Code	HCPCS 37229
Min. Negotiated Rate	$429.20
Max. Negotiated Rate	$1,875.30
Rate for Payer: Aetna Commercial	$937.57
Rate for Payer: BCBS Complete	$450.66
Rate for Payer: BCBS Trust/PPO	$476.53
Rate for Payer: Cash Price	$2,143.20
Rate for Payer: Cash Price	$2,143.20
Rate for Payer: Meridian Medicaid	$450.66
Rate for Payer: Priority Health Choice Medicaid	$429.20
Rate for Payer: Priority Health Cigna Priority Health	$1,875.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,072.95
Rate for Payer: Priority Health Narrow Network	$1,072.95
Rate for Payer: Priority Health SBD	$1,072.95
Rate for Payer: UMR Bronson Commercial	$1,232.34

Know your out-of-pocket cost for care.

All Charges