Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT

Professional

Both

$7,151.00

Service Code	HCPCS 61582
Min. Negotiated Rate	$893.36
Max. Negotiated Rate	$5,392.15
Rate for Payer: Aetna Commercial	$3,893.94
Rate for Payer: BCBS Complete	$2,033.65
Rate for Payer: BCBS Trust/PPO	$893.36
Rate for Payer: Cash Price	$5,720.80
Rate for Payer: Cash Price	$5,720.80
Rate for Payer: Meridian Medicaid	$2,033.65
Rate for Payer: Priority Health Choice Medicaid	$1,936.81
Rate for Payer: Priority Health Cigna Priority Health	$5,005.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,392.15
Rate for Payer: Priority Health Narrow Network	$5,392.15
Rate for Payer: Priority Health SBD	$5,392.15
Rate for Payer: UMR Bronson Commercial	$3,289.46

PR CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE

Professional

Both

$7,812.00

Service Code	HCPCS 61583
Min. Negotiated Rate	$841.58
Max. Negotiated Rate	$5,468.40
Rate for Payer: Aetna Commercial	$3,781.58
Rate for Payer: BCBS Complete	$1,978.63
Rate for Payer: BCBS Trust/PPO	$841.58
Rate for Payer: Cash Price	$6,249.60
Rate for Payer: Cash Price	$6,249.60
Rate for Payer: Meridian Medicaid	$1,978.63
Rate for Payer: Priority Health Choice Medicaid	$1,884.41
Rate for Payer: Priority Health Cigna Priority Health	$5,468.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,012.77
Rate for Payer: Priority Health Narrow Network	$5,012.77
Rate for Payer: Priority Health SBD	$5,012.77
Rate for Payer: UMR Bronson Commercial	$3,593.52

PR CRANIECT/CRANIOT W/WO DURAPLASTY W/LOBECTOMY

Professional

Both

$8,634.00

Service Code	HCPCS 61323
Min. Negotiated Rate	$679.39
Max. Negotiated Rate	$6,043.80
Rate for Payer: Aetna Commercial	$3,089.39
Rate for Payer: BCBS Complete	$1,625.94
Rate for Payer: BCBS Trust/PPO	$679.39
Rate for Payer: Cash Price	$6,907.20
Rate for Payer: Cash Price	$6,907.20
Rate for Payer: Meridian Medicaid	$1,625.94
Rate for Payer: Priority Health Choice Medicaid	$1,548.51
Rate for Payer: Priority Health Cigna Priority Health	$6,043.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,081.91
Rate for Payer: Priority Health Narrow Network	$4,081.91
Rate for Payer: Priority Health SBD	$4,081.91
Rate for Payer: UMR Bronson Commercial	$3,971.64

PR CRANIECT/CRANIOT W/WO DURAPLASTY W/O LOBECTOMY

Professional

Both

$4,919.58

Service Code	HCPCS 61322
Min. Negotiated Rate	$569.51
Max. Negotiated Rate	$4,067.19
Rate for Payer: Aetna Commercial	$3,074.11
Rate for Payer: BCBS Complete	$1,622.13
Rate for Payer: BCBS Trust/PPO	$569.51
Rate for Payer: Cash Price	$3,935.66
Rate for Payer: Cash Price	$3,935.66
Rate for Payer: Meridian Medicaid	$1,622.13
Rate for Payer: Priority Health Choice Medicaid	$1,544.89
Rate for Payer: Priority Health Cigna Priority Health	$3,443.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,067.19
Rate for Payer: Priority Health Narrow Network	$4,067.19
Rate for Payer: Priority Health SBD	$4,067.19
Rate for Payer: UMR Bronson Commercial	$2,263.01

PR CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP

Professional

Both

$3,321.00

Service Code	HCPCS 61557
Min. Negotiated Rate	$1,097.80
Max. Negotiated Rate	$2,890.57
Rate for Payer: Aetna Commercial	$2,174.94
Rate for Payer: BCBS Complete	$1,152.69
Rate for Payer: BCBS Trust/PPO	$2,068.29
Rate for Payer: Cash Price	$2,656.80
Rate for Payer: Cash Price	$2,656.80
Rate for Payer: Meridian Medicaid	$1,152.69
Rate for Payer: Priority Health Choice Medicaid	$1,097.80
Rate for Payer: Priority Health Cigna Priority Health	$2,324.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,890.57
Rate for Payer: Priority Health Narrow Network	$2,890.57
Rate for Payer: Priority Health SBD	$2,890.57
Rate for Payer: UMR Bronson Commercial	$1,527.66

PR CRANIECTOMY/CRANIOTMY DRG ABSCESS INFRATENTORIAL

Professional

Both

$4,272.00

Service Code	HCPCS 61321
Min. Negotiated Rate	$431.09
Max. Negotiated Rate	$3,631.20
Rate for Payer: Aetna Commercial	$2,747.11
Rate for Payer: BCBS Complete	$1,446.56
Rate for Payer: BCBS Trust/PPO	$431.09
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Cash Price	$3,417.60
Rate for Payer: Meridian Medicaid	$1,446.56
Rate for Payer: Priority Health Choice Medicaid	$1,377.68
Rate for Payer: Priority Health Cigna Priority Health	$2,990.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,631.20
Rate for Payer: Priority Health Narrow Network	$3,631.20
Rate for Payer: Priority Health SBD	$3,631.20
Rate for Payer: UMR Bronson Commercial	$1,965.12

PR CRANIECTOMY/CRANIOTMY DRG ABSCESS SUPRATENTORIAL

Professional

Both

$6,708.00

Service Code	HCPCS 61320
Min. Negotiated Rate	$495.02
Max. Negotiated Rate	$4,695.60
Rate for Payer: Aetna Commercial	$2,452.91
Rate for Payer: BCBS Complete	$1,289.12
Rate for Payer: BCBS Trust/PPO	$495.02
Rate for Payer: Cash Price	$5,366.40
Rate for Payer: Cash Price	$5,366.40
Rate for Payer: Meridian Medicaid	$1,289.12
Rate for Payer: Priority Health Choice Medicaid	$1,227.73
Rate for Payer: Priority Health Cigna Priority Health	$4,695.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,233.14
Rate for Payer: Priority Health Narrow Network	$3,233.14
Rate for Payer: Priority Health SBD	$3,233.14
Rate for Payer: UMR Bronson Commercial	$3,085.68

PR CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN

Professional

Both

$9,210.00

Service Code	HCPCS 61570
Min. Negotiated Rate	$610.19
Max. Negotiated Rate	$6,447.00
Rate for Payer: Aetna Commercial	$2,417.18
Rate for Payer: BCBS Complete	$1,276.59
Rate for Payer: BCBS Trust/PPO	$610.19
Rate for Payer: Cash Price	$7,368.00
Rate for Payer: Cash Price	$7,368.00
Rate for Payer: Meridian Medicaid	$1,276.59
Rate for Payer: Priority Health Choice Medicaid	$1,215.80
Rate for Payer: Priority Health Cigna Priority Health	$6,447.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,203.13
Rate for Payer: Priority Health Narrow Network	$3,203.13
Rate for Payer: Priority Health SBD	$3,203.13
Rate for Payer: UMR Bronson Commercial	$4,236.60

PR CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL

Professional

Both

$4,106.00

Service Code	HCPCS 61305
Min. Negotiated Rate	$1,101.51
Max. Negotiated Rate	$3,429.05
Rate for Payer: Aetna Commercial	$2,593.13
Rate for Payer: BCBS Complete	$1,366.28
Rate for Payer: BCBS Trust/PPO	$1,101.51
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Meridian Medicaid	$1,366.28
Rate for Payer: Priority Health Choice Medicaid	$1,301.22
Rate for Payer: Priority Health Cigna Priority Health	$2,874.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,429.05
Rate for Payer: Priority Health Narrow Network	$3,429.05
Rate for Payer: Priority Health SBD	$3,429.05
Rate for Payer: UMR Bronson Commercial	$1,888.76

PR CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL

Professional

Both

$5,356.00

Service Code	HCPCS 61304
Min. Negotiated Rate	$797.20
Max. Negotiated Rate	$3,749.20
Rate for Payer: Aetna Commercial	$2,122.58
Rate for Payer: BCBS Complete	$1,118.03
Rate for Payer: BCBS Trust/PPO	$797.20
Rate for Payer: Cash Price	$4,284.80
Rate for Payer: Cash Price	$4,284.80
Rate for Payer: Meridian Medicaid	$1,118.03
Rate for Payer: Priority Health Choice Medicaid	$1,064.79
Rate for Payer: Priority Health Cigna Priority Health	$3,749.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,798.28
Rate for Payer: Priority Health Narrow Network	$2,798.28
Rate for Payer: Priority Health SBD	$2,798.28
Rate for Payer: UMR Bronson Commercial	$2,463.76

PR CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN

Professional

Both

$8,807.00

Service Code	HCPCS 61571
Min. Negotiated Rate	$723.24
Max. Negotiated Rate	$6,164.90
Rate for Payer: Aetna Commercial	$2,572.96
Rate for Payer: BCBS Complete	$1,357.34
Rate for Payer: BCBS Trust/PPO	$723.24
Rate for Payer: Cash Price	$7,045.60
Rate for Payer: Cash Price	$7,045.60
Rate for Payer: Meridian Medicaid	$1,357.34
Rate for Payer: Priority Health Choice Medicaid	$1,292.70
Rate for Payer: Priority Health Cigna Priority Health	$6,164.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,405.84
Rate for Payer: Priority Health Narrow Network	$3,405.84
Rate for Payer: Priority Health SBD	$3,405.84
Rate for Payer: UMR Bronson Commercial	$4,051.22

PR CRANIECTOMY HMTMA INFRATENTORIAL EXTRA/SUBDURAL

Professional

Both

$5,502.00

Service Code	HCPCS 61314
Min. Negotiated Rate	$1,064.00
Max. Negotiated Rate	$3,851.40
Rate for Payer: Aetna Commercial	$2,364.24
Rate for Payer: BCBS Complete	$1,244.17
Rate for Payer: BCBS Trust/PPO	$1,064.00
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Meridian Medicaid	$1,244.17
Rate for Payer: Priority Health Choice Medicaid	$1,184.92
Rate for Payer: Priority Health Cigna Priority Health	$3,851.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,115.92
Rate for Payer: Priority Health Narrow Network	$3,115.92
Rate for Payer: Priority Health SBD	$3,115.92
Rate for Payer: UMR Bronson Commercial	$2,530.92

PR CRANIECTOMY HMTMA SUPRATENTORIAL EXTRA/SUBDURAL

Professional

Both

$6,989.00

Service Code	HCPCS 61312
Min. Negotiated Rate	$831.54
Max. Negotiated Rate	$4,892.30
Rate for Payer: Aetna Commercial	$2,679.75
Rate for Payer: BCBS Complete	$1,408.77
Rate for Payer: BCBS Trust/PPO	$831.54
Rate for Payer: Cash Price	$5,591.20
Rate for Payer: Cash Price	$5,591.20
Rate for Payer: Meridian Medicaid	$1,408.77
Rate for Payer: Priority Health Choice Medicaid	$1,341.69
Rate for Payer: Priority Health Cigna Priority Health	$4,892.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,536.07
Rate for Payer: Priority Health Narrow Network	$3,536.07
Rate for Payer: Priority Health SBD	$3,536.07
Rate for Payer: UMR Bronson Commercial	$3,214.94

PR CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL

Professional

Both

$6,902.00

Service Code	HCPCS 61315
Min. Negotiated Rate	$1,127.39
Max. Negotiated Rate	$4,831.40
Rate for Payer: Aetna Commercial	$2,670.81
Rate for Payer: BCBS Complete	$1,409.67
Rate for Payer: BCBS Trust/PPO	$1,127.39
Rate for Payer: Cash Price	$5,521.60
Rate for Payer: Cash Price	$5,521.60
Rate for Payer: Meridian Medicaid	$1,409.67
Rate for Payer: Priority Health Choice Medicaid	$1,342.54
Rate for Payer: Priority Health Cigna Priority Health	$4,831.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,534.94
Rate for Payer: Priority Health Narrow Network	$3,534.94
Rate for Payer: Priority Health SBD	$3,534.94
Rate for Payer: UMR Bronson Commercial	$3,174.92

PR CRANIECTOMY HMTMA SUPRATENTORIAL INTRACEREBRAL

Professional

Both

$4,088.98

Service Code	HCPCS 61313
Min. Negotiated Rate	$1,065.58
Max. Negotiated Rate	$3,390.55
Rate for Payer: Aetna Commercial	$2,561.06
Rate for Payer: BCBS Complete	$1,353.53
Rate for Payer: BCBS Trust/PPO	$1,065.58
Rate for Payer: Cash Price	$3,271.18
Rate for Payer: Cash Price	$3,271.18
Rate for Payer: Meridian Medicaid	$1,353.53
Rate for Payer: Priority Health Choice Medicaid	$1,289.08
Rate for Payer: Priority Health Cigna Priority Health	$2,862.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,390.55
Rate for Payer: Priority Health Narrow Network	$3,390.55
Rate for Payer: Priority Health SBD	$3,390.55
Rate for Payer: UMR Bronson Commercial	$1,880.93

PR CRANIECTOMY OSTEOMYELITIS

Professional

Both

$5,255.00

Service Code	HCPCS 61501
Min. Negotiated Rate	$264.68
Max. Negotiated Rate	$3,678.50
Rate for Payer: Aetna Commercial	$1,448.08
Rate for Payer: BCBS Complete	$767.57
Rate for Payer: BCBS Trust/PPO	$264.68
Rate for Payer: Cash Price	$4,204.00
Rate for Payer: Cash Price	$4,204.00
Rate for Payer: Meridian Medicaid	$767.57
Rate for Payer: Priority Health Choice Medicaid	$731.02
Rate for Payer: Priority Health Cigna Priority Health	$3,678.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,934.79
Rate for Payer: Priority Health Narrow Network	$1,934.79
Rate for Payer: Priority Health SBD	$1,934.79
Rate for Payer: UMR Bronson Commercial	$2,417.30

PR CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NR

Professional

Both

$6,177.00

Service Code	HCPCS 61460
Min. Negotiated Rate	$1,018.03
Max. Negotiated Rate	$4,323.90
Rate for Payer: Aetna Commercial	$2,721.64
Rate for Payer: BCBS Complete	$1,434.49
Rate for Payer: BCBS Trust/PPO	$1,018.03
Rate for Payer: Cash Price	$4,941.60
Rate for Payer: Cash Price	$4,941.60
Rate for Payer: Meridian Medicaid	$1,434.49
Rate for Payer: Priority Health Choice Medicaid	$1,366.18
Rate for Payer: Priority Health Cigna Priority Health	$4,323.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,600.62
Rate for Payer: Priority Health Narrow Network	$3,600.62
Rate for Payer: Priority Health SBD	$3,600.62
Rate for Payer: UMR Bronson Commercial	$2,841.42

PR CRANIECTOMY W/EXCISION TUMOR/LESION SKULL

Professional

Both

$2,685.32

Service Code	HCPCS 61500
Min. Negotiated Rate	$534.64
Max. Negotiated Rate	$2,220.74
Rate for Payer: Aetna Commercial	$1,684.10
Rate for Payer: BCBS Complete	$882.07
Rate for Payer: BCBS Trust/PPO	$534.64
Rate for Payer: Cash Price	$2,148.26
Rate for Payer: Cash Price	$2,148.26
Rate for Payer: Meridian Medicaid	$882.07
Rate for Payer: Priority Health Choice Medicaid	$840.07
Rate for Payer: Priority Health Cigna Priority Health	$1,879.72
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,220.74
Rate for Payer: Priority Health Narrow Network	$2,220.74
Rate for Payer: Priority Health SBD	$2,220.74
Rate for Payer: UMR Bronson Commercial	$1,235.25

PR CRANIEC TREPHINE BONE FLP BRAIN TUMOR SUPRTENTOR

Professional

Both

$4,513.72

Service Code	HCPCS 61510
Min. Negotiated Rate	$455.92
Max. Negotiated Rate	$3,763.68
Rate for Payer: Aetna Commercial	$2,837.36
Rate for Payer: BCBS Complete	$1,500.91
Rate for Payer: BCBS Trust/PPO	$455.92
Rate for Payer: Cash Price	$3,610.98
Rate for Payer: Cash Price	$3,610.98
Rate for Payer: Meridian Medicaid	$1,500.91
Rate for Payer: Priority Health Choice Medicaid	$1,429.44
Rate for Payer: Priority Health Cigna Priority Health	$3,159.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,763.68
Rate for Payer: Priority Health Narrow Network	$3,763.68
Rate for Payer: Priority Health SBD	$3,763.68
Rate for Payer: UMR Bronson Commercial	$2,076.31

PR CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ

Professional

Both

$5,208.00

Service Code	HCPCS 61580
Min. Negotiated Rate	$901.81
Max. Negotiated Rate	$4,233.66
Rate for Payer: Aetna Commercial	$3,215.20
Rate for Payer: BCBS Complete	$1,673.12
Rate for Payer: BCBS Trust/PPO	$901.81
Rate for Payer: Cash Price	$4,166.40
Rate for Payer: Cash Price	$4,166.40
Rate for Payer: Meridian Medicaid	$1,673.12
Rate for Payer: Priority Health Choice Medicaid	$1,593.45
Rate for Payer: Priority Health Cigna Priority Health	$3,645.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,233.66
Rate for Payer: Priority Health Narrow Network	$4,233.66
Rate for Payer: Priority Health SBD	$4,233.66
Rate for Payer: UMR Bronson Commercial	$2,395.68

PR CRANIOPLASTY SKULL DEFECT </5 CM DIAMETER

Professional

Both

$5,237.00

Service Code	HCPCS 62140
Min. Negotiated Rate	$330.72
Max. Negotiated Rate	$3,665.90
Rate for Payer: Aetna Commercial	$1,313.67
Rate for Payer: BCBS Complete	$696.68
Rate for Payer: BCBS Trust/PPO	$330.72
Rate for Payer: Cash Price	$4,189.60
Rate for Payer: Cash Price	$4,189.60
Rate for Payer: Meridian Medicaid	$696.68
Rate for Payer: Priority Health Choice Medicaid	$663.50
Rate for Payer: Priority Health Cigna Priority Health	$3,665.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,747.37
Rate for Payer: Priority Health Narrow Network	$1,747.37
Rate for Payer: Priority Health SBD	$1,747.37
Rate for Payer: UMR Bronson Commercial	$2,409.02

PR CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER

Professional

Both

$6,237.00

Service Code	HCPCS 62141
Min. Negotiated Rate	$415.77
Max. Negotiated Rate	$4,365.90
Rate for Payer: Aetna Commercial	$1,476.78
Rate for Payer: BCBS Complete	$780.09
Rate for Payer: BCBS Trust/PPO	$415.77
Rate for Payer: Cash Price	$4,989.60
Rate for Payer: Cash Price	$4,989.60
Rate for Payer: Meridian Medicaid	$780.09
Rate for Payer: Priority Health Choice Medicaid	$742.94
Rate for Payer: Priority Health Cigna Priority Health	$4,365.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,954.04
Rate for Payer: Priority Health Narrow Network	$1,954.04
Rate for Payer: Priority Health SBD	$1,954.04
Rate for Payer: UMR Bronson Commercial	$2,869.02

PR CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG

Professional

Both

$5,869.00

Service Code	HCPCS 62145
Min. Negotiated Rate	$923.57
Max. Negotiated Rate	$4,108.30
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: BCBS Complete	$969.75
Rate for Payer: BCBS Trust/PPO	$1,261.58
Rate for Payer: Cash Price	$4,695.20
Rate for Payer: Cash Price	$4,695.20
Rate for Payer: Meridian Medicaid	$969.75
Rate for Payer: Priority Health Choice Medicaid	$923.57
Rate for Payer: Priority Health Cigna Priority Health	$4,108.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,424.00
Rate for Payer: Priority Health Narrow Network	$2,424.00
Rate for Payer: Priority Health SBD	$2,424.00
Rate for Payer: UMR Bronson Commercial	$2,699.74

PR CRANIOPLASTY W/AUTOGRAFT </ 5 CM DIAMETER

Professional

Both

$6,252.00

Service Code	HCPCS 62146
Min. Negotiated Rate	$814.51
Max. Negotiated Rate	$4,376.40
Rate for Payer: Aetna Commercial	$1,615.24
Rate for Payer: BCBS Complete	$855.24
Rate for Payer: BCBS Trust/PPO	$1,636.15
Rate for Payer: Cash Price	$5,001.60
Rate for Payer: Cash Price	$5,001.60
Rate for Payer: Meridian Medicaid	$855.24
Rate for Payer: Priority Health Choice Medicaid	$814.51
Rate for Payer: Priority Health Cigna Priority Health	$4,376.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,144.29
Rate for Payer: Priority Health Narrow Network	$2,144.29
Rate for Payer: Priority Health SBD	$2,144.29
Rate for Payer: UMR Bronson Commercial	$2,875.92

PR CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER

Professional

Both

$7,153.00

Service Code	HCPCS 62147
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$5,007.10
Rate for Payer: Aetna Commercial	$1,834.50
Rate for Payer: BCBS Complete	$964.82
Rate for Payer: BCBS Trust/PPO	$128.38
Rate for Payer: Cash Price	$5,722.40
Rate for Payer: Cash Price	$5,722.40
Rate for Payer: Meridian Medicaid	$964.82
Rate for Payer: Priority Health Choice Medicaid	$918.88
Rate for Payer: Priority Health Cigna Priority Health	$5,007.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,421.18
Rate for Payer: Priority Health Narrow Network	$2,421.18
Rate for Payer: Priority Health SBD	$2,421.18
Rate for Payer: UMR Bronson Commercial	$3,290.38

Know your out-of-pocket cost for care.

All Charges