Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL

Professional

Both

$385.00

Service Code	HCPCS 51784
Min. Negotiated Rate	$44.31
Max. Negotiated Rate	$3,642.10
Rate for Payer: Aetna Commercial	$83.00
Rate for Payer: BCBS Complete	$154.00
Rate for Payer: BCBS Trust/PPO	$3,642.10
Rate for Payer: Cash Price	$308.00
Rate for Payer: Cash Price	$308.00
Rate for Payer: Priority Health Cigna Priority Health	$269.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.31
Rate for Payer: Priority Health Narrow Network	$44.31
Rate for Payer: Priority Health SBD	$103.20
Rate for Payer: UMR Bronson Commercial	$177.10

PRENATAL VIT 14-FERROUS FUM 29 MG IRON-FOLIC ACID 1 MG CHEWABLE TABLET

Facility

$222.05

Service Code	NDC 1381101490
Hospital Charge Code	115087
Hospital Revenue Code	637
Min. Negotiated Rate	$97.70
Max. Negotiated Rate	$199.84
Rate for Payer: Aetna American Axle	$144.33
Rate for Payer: Aetna Commercial	$188.74
Rate for Payer: Aetna New Business (MI Preferred)	$144.33
Rate for Payer: Cash Price	$177.64
Rate for Payer: Cofinity Commercial	$155.44
Rate for Payer: Cofinity Commercial	$190.96
Rate for Payer: Encore Health Key Benefits Commercial	$177.64
Rate for Payer: Healthscope Commercial	$199.84
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$155.44
Rate for Payer: Lakeland Regional Health Systems Commercial	$166.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$188.74
Rate for Payer: PHP Commercial	$188.74
Rate for Payer: Priority Health Cigna Priority Health	$155.44
Rate for Payer: Priority Health SBD	$139.89
Rate for Payer: UMR Bronson Commercial	$97.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$166.54

PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER

Facility

$96.35

Service Code	NDC 5789657501
Hospital Charge Code	300610
Hospital Revenue Code	637
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$86.72
Rate for Payer: Aetna American Axle	$62.63
Rate for Payer: Aetna Commercial	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$62.63
Rate for Payer: Cash Price	$77.08
Rate for Payer: Cofinity Commercial	$67.44
Rate for Payer: Cofinity Commercial	$82.86
Rate for Payer: Encore Health Key Benefits Commercial	$77.08
Rate for Payer: Healthscope Commercial	$86.72
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$67.44
Rate for Payer: Lakeland Regional Health Systems Commercial	$72.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$81.90
Rate for Payer: PHP Commercial	$81.90
Rate for Payer: Priority Health Cigna Priority Health	$67.44
Rate for Payer: Priority Health SBD	$60.70
Rate for Payer: UMR Bronson Commercial	$42.39
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$72.26

PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER

Facility

$317.25

Service Code	NDC 7733371510
Hospital Charge Code	300610
Hospital Revenue Code	637
Min. Negotiated Rate	$139.59
Max. Negotiated Rate	$285.52
Rate for Payer: Aetna American Axle	$206.21
Rate for Payer: Aetna Commercial	$269.66
Rate for Payer: Aetna New Business (MI Preferred)	$206.21
Rate for Payer: Cash Price	$253.80
Rate for Payer: Cofinity Commercial	$222.08
Rate for Payer: Cofinity Commercial	$272.84
Rate for Payer: Encore Health Key Benefits Commercial	$253.80
Rate for Payer: Healthscope Commercial	$285.52
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$222.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$237.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$269.66
Rate for Payer: PHP Commercial	$269.66
Rate for Payer: Priority Health Cigna Priority Health	$222.08
Rate for Payer: Priority Health SBD	$199.87
Rate for Payer: UMR Bronson Commercial	$139.59
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$237.94

PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER

Facility

$3.18

Service Code	NDC 7733371525
Hospital Charge Code	300610
Hospital Revenue Code	637
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.86
Rate for Payer: Aetna American Axle	$2.07
Rate for Payer: Aetna Commercial	$2.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.07
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Commercial	$2.23
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.86
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2.23
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.70
Rate for Payer: PHP Commercial	$2.70
Rate for Payer: Priority Health Cigna Priority Health	$2.23
Rate for Payer: Priority Health SBD	$2.00
Rate for Payer: UMR Bronson Commercial	$1.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.38

PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER

Facility

$31.73

Service Code	NDC 904531346
Hospital Charge Code	300610
Hospital Revenue Code	637
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna American Axle	$20.62
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Commercial	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$22.21
Rate for Payer: Lakeland Regional Health Systems Commercial	$23.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.97
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health Cigna Priority Health	$22.21
Rate for Payer: Priority Health SBD	$19.99
Rate for Payer: UMR Bronson Commercial	$13.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$23.80

PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER

Facility

$65.80

Service Code	NDC 904531360
Hospital Charge Code	300610
Hospital Revenue Code	637
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$59.22
Rate for Payer: Aetna American Axle	$42.77
Rate for Payer: Aetna Commercial	$55.93
Rate for Payer: Aetna New Business (MI Preferred)	$42.77
Rate for Payer: Cash Price	$52.64
Rate for Payer: Cofinity Commercial	$46.06
Rate for Payer: Cofinity Commercial	$56.59
Rate for Payer: Encore Health Key Benefits Commercial	$52.64
Rate for Payer: Healthscope Commercial	$59.22
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$46.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$49.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$55.93
Rate for Payer: PHP Commercial	$55.93
Rate for Payer: Priority Health Cigna Priority Health	$46.06
Rate for Payer: Priority Health SBD	$41.45
Rate for Payer: UMR Bronson Commercial	$28.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$49.35

PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET

Facility

$179.78

Service Code	NDC 761010418
Hospital Charge Code	177116
Hospital Revenue Code	637
Min. Negotiated Rate	$79.10
Max. Negotiated Rate	$161.80
Rate for Payer: Aetna American Axle	$116.86
Rate for Payer: Aetna Commercial	$152.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.86
Rate for Payer: Cash Price	$143.82
Rate for Payer: Cofinity Commercial	$125.85
Rate for Payer: Cofinity Commercial	$154.61
Rate for Payer: Encore Health Key Benefits Commercial	$143.82
Rate for Payer: Healthscope Commercial	$161.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$125.85
Rate for Payer: Lakeland Regional Health Systems Commercial	$134.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$152.81
Rate for Payer: PHP Commercial	$152.81
Rate for Payer: Priority Health Cigna Priority Health	$125.85
Rate for Payer: Priority Health SBD	$113.26
Rate for Payer: UMR Bronson Commercial	$79.10
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$134.84

PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET

Facility

$31.73

Service Code	NDC 904531346
Hospital Charge Code	177116
Hospital Revenue Code	637
Min. Negotiated Rate	$13.96
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna American Axle	$20.62
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Commercial	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$22.21
Rate for Payer: Lakeland Regional Health Systems Commercial	$23.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.97
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health Cigna Priority Health	$22.21
Rate for Payer: Priority Health SBD	$19.99
Rate for Payer: UMR Bronson Commercial	$13.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$23.80

PR ENDOBRONCHIAL U/S ADD-ON

Professional

Both

$455.00

Service Code	HCPCS 31620
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$318.50
Rate for Payer: BCBS Complete	$182.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Priority Health Cigna Priority Health	$318.50
Rate for Payer: UMR Bronson Commercial	$209.30

PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C

Professional

Both

$306.00

Service Code	HCPCS 57505
Min. Negotiated Rate	$70.72
Max. Negotiated Rate	$232.98
Rate for Payer: Aetna Commercial	$124.37
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: BCBS Trust/PPO	$232.98
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Meridian Medicaid	$74.26
Rate for Payer: Priority Health Choice Medicaid	$70.72
Rate for Payer: Priority Health Cigna Priority Health	$214.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.76
Rate for Payer: Priority Health Narrow Network	$155.76
Rate for Payer: Priority Health SBD	$155.76
Rate for Payer: UMR Bronson Commercial	$140.76

PR END OF LIFE COUNSELING

Professional

Both

$50.00

Service Code	HCPCS S0257
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$206.57
Rate for Payer: Aetna Commercial	$3.85
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$206.57
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.64
Rate for Payer: Priority Health Narrow Network	$47.64
Rate for Payer: Priority Health SBD	$47.64
Rate for Payer: UMR Bronson Commercial	$23.00

PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL

Professional

Both

$301.00

Service Code	HCPCS 92979
Min. Negotiated Rate	$104.03
Max. Negotiated Rate	$230.34
Rate for Payer: Aetna Commercial	$212.41
Rate for Payer: BCBS Complete	$120.40
Rate for Payer: BCBS Trust/PPO	$230.34
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Priority Health Cigna Priority Health	$210.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$104.03
Rate for Payer: Priority Health Narrow Network	$104.03
Rate for Payer: Priority Health SBD	$226.03
Rate for Payer: UMR Bronson Commercial	$138.46

PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL

Professional

Both

$491.00

Service Code	HCPCS 92978
Min. Negotiated Rate	$130.51
Max. Negotiated Rate	$373.09
Rate for Payer: Aetna Commercial	$348.91
Rate for Payer: BCBS Complete	$196.40
Rate for Payer: BCBS Trust/PPO	$154.26
Rate for Payer: Cash Price	$392.80
Rate for Payer: Cash Price	$392.80
Rate for Payer: Priority Health Cigna Priority Health	$343.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.51
Rate for Payer: Priority Health Narrow Network	$130.51
Rate for Payer: Priority Health SBD	$373.09
Rate for Payer: UMR Bronson Commercial	$225.86

PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID

Professional

Both

$2,003.00

Service Code	HCPCS 58353
Min. Negotiated Rate	$148.46
Max. Negotiated Rate	$1,402.10
Rate for Payer: Aetna Commercial	$274.07
Rate for Payer: BCBS Complete	$155.88
Rate for Payer: BCBS Trust/PPO	$572.15
Rate for Payer: Cash Price	$1,602.40
Rate for Payer: Cash Price	$1,602.40
Rate for Payer: Meridian Medicaid	$155.88
Rate for Payer: Priority Health Choice Medicaid	$148.46
Rate for Payer: Priority Health Cigna Priority Health	$1,402.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$329.50
Rate for Payer: Priority Health Narrow Network	$329.50
Rate for Payer: Priority Health SBD	$329.50
Rate for Payer: UMR Bronson Commercial	$921.38

PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY

Professional

Both

$130.00

Service Code	HCPCS 58110
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$1,845.88
Rate for Payer: Aetna Commercial	$49.01
Rate for Payer: BCBS Complete	$26.84
Rate for Payer: BCBS Trust/PPO	$1,845.88
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Meridian Medicaid	$26.84
Rate for Payer: Priority Health Choice Medicaid	$25.56
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.34
Rate for Payer: Priority Health Narrow Network	$56.34
Rate for Payer: Priority Health SBD	$56.34
Rate for Payer: UMR Bronson Commercial	$59.80

PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Professional

Both

$211.00

Service Code	HCPCS 58100
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$1,579.09
Rate for Payer: Aetna Commercial	$76.79
Rate for Payer: BCBS Complete	$42.27
Rate for Payer: BCBS Trust/PPO	$1,579.09
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Meridian Medicaid	$42.27
Rate for Payer: Priority Health Choice Medicaid	$40.26
Rate for Payer: Priority Health Cigna Priority Health	$147.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.01
Rate for Payer: Priority Health Narrow Network	$89.01
Rate for Payer: Priority Health SBD	$89.01
Rate for Payer: UMR Bronson Commercial	$97.06

PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR

Professional

Both

$2,758.00

Service Code	HCPCS 58356
Min. Negotiated Rate	$226.42
Max. Negotiated Rate	$1,930.60
Rate for Payer: Aetna Commercial	$426.17
Rate for Payer: BCBS Complete	$237.74
Rate for Payer: BCBS Trust/PPO	$503.47
Rate for Payer: Cash Price	$2,206.40
Rate for Payer: Cash Price	$2,206.40
Rate for Payer: Meridian Medicaid	$237.74
Rate for Payer: Priority Health Choice Medicaid	$226.42
Rate for Payer: Priority Health Cigna Priority Health	$1,930.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$502.77
Rate for Payer: Priority Health Narrow Network	$502.77
Rate for Payer: Priority Health SBD	$502.77
Rate for Payer: UMR Bronson Commercial	$1,268.68

PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC

Professional

Both

$459.00

Service Code	HCPCS 43273
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$786.11
Rate for Payer: Aetna Commercial	$159.96
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: BCBS Trust/PPO	$786.11
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Meridian Medicaid	$78.28
Rate for Payer: Priority Health Choice Medicaid	$74.55
Rate for Payer: Priority Health Cigna Priority Health	$321.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.03
Rate for Payer: Priority Health Narrow Network	$204.03
Rate for Payer: Priority Health SBD	$204.03
Rate for Payer: UMR Bronson Commercial	$211.14

PR ENDOSCOPY UPPER SMALL INTESTINE

Professional

Both

$917.00

Service Code	HCPCS 44360
Min. Negotiated Rate	$90.53
Max. Negotiated Rate	$641.90
Rate for Payer: Aetna Commercial	$190.22
Rate for Payer: BCBS Complete	$95.06
Rate for Payer: BCBS Trust/PPO	$381.96
Rate for Payer: Cash Price	$733.60
Rate for Payer: Cash Price	$733.60
Rate for Payer: Meridian Medicaid	$95.06
Rate for Payer: Priority Health Choice Medicaid	$90.53
Rate for Payer: Priority Health Cigna Priority Health	$641.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$247.55
Rate for Payer: Priority Health Narrow Network	$247.55
Rate for Payer: Priority Health SBD	$247.55
Rate for Payer: UMR Bronson Commercial	$421.82

PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY

Professional

Both

$969.00

Service Code	HCPCS 44361
Min. Negotiated Rate	$99.68
Max. Negotiated Rate	$678.30
Rate for Payer: Aetna Commercial	$210.83
Rate for Payer: BCBS Complete	$104.66
Rate for Payer: BCBS Trust/PPO	$508.22
Rate for Payer: Cash Price	$775.20
Rate for Payer: Cash Price	$775.20
Rate for Payer: Meridian Medicaid	$104.66
Rate for Payer: Priority Health Choice Medicaid	$99.68
Rate for Payer: Priority Health Cigna Priority Health	$678.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$272.83
Rate for Payer: Priority Health Narrow Network	$272.83
Rate for Payer: Priority Health SBD	$272.83
Rate for Payer: UMR Bronson Commercial	$445.74

PR ENDOVASC ABDO REPAIR W/PROS

Professional

Both

$5,228.00

Service Code	HCPCS 34805
Min. Negotiated Rate	$2,091.20
Max. Negotiated Rate	$3,659.60
Rate for Payer: BCBS Complete	$2,091.20
Rate for Payer: Cash Price	$4,182.40
Rate for Payer: Priority Health Cigna Priority Health	$3,659.60
Rate for Payer: UMR Bronson Commercial	$2,404.88

PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS

Professional

Both

$1,731.00

Service Code	HCPCS 34900
Min. Negotiated Rate	$692.40
Max. Negotiated Rate	$1,211.70
Rate for Payer: BCBS Complete	$692.40
Rate for Payer: Cash Price	$1,384.80
Rate for Payer: Priority Health Cigna Priority Health	$1,211.70
Rate for Payer: UMR Bronson Commercial	$796.26

PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN

Professional

Both

$2,687.00

Service Code	HCPCS 36478
Hospital Charge Code	36478
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$1,880.90
Rate for Payer: Aetna Commercial	$372.23
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCBS Trust/PPO	$288.45
Rate for Payer: Cash Price	$2,149.60
Rate for Payer: Cash Price	$2,149.60
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health	$1,880.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$431.94
Rate for Payer: Priority Health Narrow Network	$431.94
Rate for Payer: Priority Health SBD	$431.94
Rate for Payer: UMR Bronson Commercial	$1,236.02

PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN

Professional

Both

$2,687.00

Service Code	HCPCS 36478
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$1,880.90
Rate for Payer: Aetna Commercial	$372.23
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCBS Trust/PPO	$288.45
Rate for Payer: Cash Price	$2,149.60
Rate for Payer: Cash Price	$2,149.60
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health	$1,880.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$431.94
Rate for Payer: Priority Health Narrow Network	$431.94
Rate for Payer: Priority Health SBD	$431.94
Rate for Payer: UMR Bronson Commercial	$1,236.02

Know your out-of-pocket cost for care.

All Charges