Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR AAA REPAIR,UNIBODY BIFURCATED PROSTH

Professional

Both

$5,512.00

Service Code	HCPCS 34804
Min. Negotiated Rate	$2,204.80
Max. Negotiated Rate	$3,582.80
Rate for Payer: Aetna Medicare	$2,756.00
Rate for Payer: BCBS Complete	$2,204.80
Rate for Payer: Cash Price	$4,409.60
Rate for Payer: Priority Health Cigna Priority Health	$3,582.80

PR AAA REPR,1ST VESSEL,EXTENSION PROSTH

Professional

Both

$2,698.00

Service Code	HCPCS 34825
Min. Negotiated Rate	$1,079.20
Max. Negotiated Rate	$1,753.70
Rate for Payer: Aetna Medicare	$1,349.00
Rate for Payer: BCBS Complete	$1,079.20
Rate for Payer: Cash Price	$2,158.40
Rate for Payer: Priority Health Cigna Priority Health	$1,753.70

PR AAA REPR,ADD VESSEL,EXTENSION PROSTH

Professional

Both

$436.00

Service Code	HCPCS 34826
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$283.40
Rate for Payer: Aetna Medicare	$218.00
Rate for Payer: BCBS Complete	$174.40
Rate for Payer: Cash Price	$348.80
Rate for Payer: Priority Health Cigna Priority Health	$283.40

PR ABATACEPT INJECTION

Professional

Both

$41.00

Service Code	HCPCS J0129
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$52.16
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$52.16
Rate for Payer: BCN Commercial	$50.93
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$26.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$43.73
Rate for Payer: UHC Exchange	$43.73

PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC

Professional

Both

$483.00

Service Code	HCPCS 38747
Min. Negotiated Rate	$168.91
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: Aetna Medicare	$241.50
Rate for Payer: BCBS Complete	$177.36
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: BCN Commercial	$384.59
Rate for Payer: Cash Price	$386.40
Rate for Payer: Cash Price	$386.40
Rate for Payer: Meridian Medicaid	$177.36
Rate for Payer: Priority Health Choice Medicaid	$168.91
Rate for Payer: Priority Health Cigna Priority Health	$313.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$527.28
Rate for Payer: Priority Health Narrow Network	$527.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$305.06
Rate for Payer: UHC Exchange	$305.06
Rate for Payer: UHCCP Medicaid	$168.91

PR ABDOMINOPLASTY (2HRS)

Professional

Both

$2,652.00

Service Code	HCPCS 00364
Hospital Revenue Code	990
Min. Negotiated Rate	$1,060.80
Max. Negotiated Rate	$1,723.80
Rate for Payer: Aetna Medicare	$1,326.00
Rate for Payer: BCBS Complete	$1,060.80
Rate for Payer: Cash Price	$2,121.60
Rate for Payer: Priority Health Cigna Priority Health	$1,723.80

PR ABDOMINOPLASTY (3HRS)

Professional

Both

$4,284.00

Service Code	HCPCS 00365
Hospital Revenue Code	990
Min. Negotiated Rate	$1,713.60
Max. Negotiated Rate	$2,784.60
Rate for Payer: Aetna Medicare	$2,142.00
Rate for Payer: BCBS Complete	$1,713.60
Rate for Payer: Cash Price	$3,427.20
Rate for Payer: Priority Health Cigna Priority Health	$2,784.60

PR ABDOMINOPLASTY W/ BREAST AUGMENT

Professional

Both

$7,446.00

Service Code	HCPCS 00256
Hospital Revenue Code	990
Min. Negotiated Rate	$2,978.40
Max. Negotiated Rate	$4,839.90
Rate for Payer: Aetna Medicare	$3,723.00
Rate for Payer: BCBS Complete	$2,978.40
Rate for Payer: Cash Price	$5,956.80
Rate for Payer: Priority Health Cigna Priority Health	$4,839.90

PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL

Professional

Both

$2,628.00

Service Code	HCPCS 51845
Min. Negotiated Rate	$374.45
Max. Negotiated Rate	$3,525.87
Rate for Payer: Aetna Commercial	$747.51
Rate for Payer: Aetna Medicare	$1,314.00
Rate for Payer: BCBS Complete	$393.17
Rate for Payer: BCBS Trust/PPO	$3,525.87
Rate for Payer: BCN Commercial	$841.50
Rate for Payer: Cash Price	$2,102.40
Rate for Payer: Cash Price	$2,102.40
Rate for Payer: Meridian Medicaid	$393.17
Rate for Payer: Priority Health Choice Medicaid	$374.45
Rate for Payer: Priority Health Cigna Priority Health	$1,708.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$929.39
Rate for Payer: Priority Health Narrow Network	$929.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$702.11
Rate for Payer: UHC Exchange	$702.11
Rate for Payer: UHCCP Medicaid	$374.45

PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE

Professional

Both

$475.00

Service Code	HCPCS 49083
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$759.70
Rate for Payer: Aetna Commercial	$141.10
Rate for Payer: Aetna Medicare	$237.50
Rate for Payer: BCBS Complete	$70.46
Rate for Payer: BCBS Trust/PPO	$759.70
Rate for Payer: BCN Commercial	$432.48
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Meridian Medicaid	$70.46
Rate for Payer: Priority Health Choice Medicaid	$67.10
Rate for Payer: Priority Health Cigna Priority Health	$308.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$186.14
Rate for Payer: Priority Health Narrow Network	$186.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$144.63
Rate for Payer: UHC Exchange	$144.63
Rate for Payer: UHCCP Medicaid	$67.10

PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

Professional

Both

$260.00

Service Code	HCPCS 49082
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$721.66
Rate for Payer: Aetna Commercial	$97.15
Rate for Payer: Aetna Medicare	$130.00
Rate for Payer: BCBS Complete	$48.75
Rate for Payer: BCBS Trust/PPO	$721.66
Rate for Payer: BCN Commercial	$311.78
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Meridian Medicaid	$48.75
Rate for Payer: Priority Health Choice Medicaid	$46.43
Rate for Payer: Priority Health Cigna Priority Health	$169.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.06
Rate for Payer: Priority Health Narrow Network	$130.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$93.69
Rate for Payer: UHC Exchange	$93.69
Rate for Payer: UHCCP Medicaid	$46.43

PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN

Professional

Both

$876.00

Service Code	HCPCS 93657
Min. Negotiated Rate	$191.49
Max. Negotiated Rate	$3,654.78
Rate for Payer: Aetna Commercial	$570.20
Rate for Payer: Aetna Medicare	$438.00
Rate for Payer: BCBS Complete	$201.06
Rate for Payer: BCBS Trust/PPO	$3,654.78
Rate for Payer: BCN Commercial	$442.74
Rate for Payer: Cash Price	$700.80
Rate for Payer: Cash Price	$700.80
Rate for Payer: Meridian Medicaid	$201.06
Rate for Payer: Priority Health Choice Medicaid	$191.49
Rate for Payer: Priority Health Cigna Priority Health	$569.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$421.87
Rate for Payer: Priority Health Narrow Network	$421.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$558.79
Rate for Payer: UHC Exchange	$558.79
Rate for Payer: UHCCP Medicaid	$191.49

PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE

Professional

Both

$7,268.00

Service Code	HCPCS 20982
Min. Negotiated Rate	$232.60
Max. Negotiated Rate	$5,183.89
Rate for Payer: Aetna Commercial	$489.87
Rate for Payer: Aetna Medicare	$3,634.00
Rate for Payer: BCBS Complete	$244.23
Rate for Payer: BCN Commercial	$5,183.89
Rate for Payer: Cash Price	$5,814.40
Rate for Payer: Cash Price	$5,814.40
Rate for Payer: Meridian Medicaid	$244.23
Rate for Payer: Priority Health Choice Medicaid	$232.60
Rate for Payer: Priority Health Cigna Priority Health	$4,724.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$550.59
Rate for Payer: Priority Health Narrow Network	$550.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$471.26
Rate for Payer: UHC Exchange	$471.26
Rate for Payer: UHCCP Medicaid	$232.60

PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS

Professional

Both

$3,766.00

Service Code	HCPCS 33256
Min. Negotiated Rate	$1,209.84
Max. Negotiated Rate	$3,005.35
Rate for Payer: Aetna Commercial	$2,606.31
Rate for Payer: Aetna Medicare	$1,883.00
Rate for Payer: BCBS Complete	$1,270.33
Rate for Payer: BCBS Trust/PPO	$1,285.88
Rate for Payer: BCN Commercial	$2,757.12
Rate for Payer: Cash Price	$3,012.80
Rate for Payer: Cash Price	$3,012.80
Rate for Payer: Meridian Medicaid	$1,270.33
Rate for Payer: Priority Health Choice Medicaid	$1,209.84
Rate for Payer: Priority Health Cigna Priority Health	$2,447.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,005.35
Rate for Payer: Priority Health Narrow Network	$3,005.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,587.10
Rate for Payer: UHC Exchange	$2,587.10
Rate for Payer: UHCCP Medicaid	$1,209.84

PR ABLATION & RECONSTRUCTION ATRIA LIMITED

Professional

Both

$3,359.00

Service Code	HCPCS 33254
Min. Negotiated Rate	$858.18
Max. Negotiated Rate	$2,183.35
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: Aetna Medicare	$1,679.50
Rate for Payer: BCBS Complete	$901.09
Rate for Payer: BCBS Trust/PPO	$1,663.62
Rate for Payer: BCN Commercial	$1,950.80
Rate for Payer: Cash Price	$2,687.20
Rate for Payer: Cash Price	$2,687.20
Rate for Payer: Meridian Medicaid	$901.09
Rate for Payer: Priority Health Choice Medicaid	$858.18
Rate for Payer: Priority Health Cigna Priority Health	$2,183.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,138.47
Rate for Payer: Priority Health Narrow Network	$2,138.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,781.29
Rate for Payer: UHC Exchange	$1,781.29
Rate for Payer: UHCCP Medicaid	$858.18

PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL

Professional

Both

$557.00

Service Code	HCPCS 30802
Min. Negotiated Rate	$128.65
Max. Negotiated Rate	$724.30
Rate for Payer: Aetna Commercial	$255.96
Rate for Payer: Aetna Medicare	$278.50
Rate for Payer: BCBS Complete	$135.08
Rate for Payer: BCBS Trust/PPO	$724.30
Rate for Payer: BCN Commercial	$411.96
Rate for Payer: Cash Price	$445.60
Rate for Payer: Cash Price	$445.60
Rate for Payer: Meridian Medicaid	$135.08
Rate for Payer: Priority Health Choice Medicaid	$128.65
Rate for Payer: Priority Health Cigna Priority Health	$362.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$283.64
Rate for Payer: Priority Health Narrow Network	$283.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$203.85
Rate for Payer: UHC Exchange	$203.85
Rate for Payer: UHCCP Medicaid	$128.65

PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC

Professional

Both

$372.00

Service Code	HCPCS 30801
Min. Negotiated Rate	$96.06
Max. Negotiated Rate	$959.39
Rate for Payer: Aetna Commercial	$190.20
Rate for Payer: Aetna Medicare	$186.00
Rate for Payer: BCBS Complete	$100.86
Rate for Payer: BCBS Trust/PPO	$959.39
Rate for Payer: BCN Commercial	$324.48
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Meridian Medicaid	$100.86
Rate for Payer: Priority Health Choice Medicaid	$96.06
Rate for Payer: Priority Health Cigna Priority Health	$241.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.19
Rate for Payer: Priority Health Narrow Network	$213.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$141.86
Rate for Payer: UHC Exchange	$141.86
Rate for Payer: UHCCP Medicaid	$96.06

PR ABRASION 1 LESION

Professional

Both

$441.66

Service Code	HCPCS 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$337.19
Rate for Payer: Aetna Commercial	$142.60
Rate for Payer: Aetna Medicare	$220.83
Rate for Payer: BCBS Complete	$91.24
Rate for Payer: BCN Commercial	$337.19
Rate for Payer: Cash Price	$353.33
Rate for Payer: Cash Price	$353.33
Rate for Payer: Meridian Medicaid	$91.24
Rate for Payer: Priority Health Choice Medicaid	$86.90
Rate for Payer: Priority Health Cigna Priority Health	$287.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.41
Rate for Payer: Priority Health Narrow Network	$182.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$148.75
Rate for Payer: UHC Exchange	$148.75
Rate for Payer: UHCCP Medicaid	$86.90

PR ABRASION 1 LESION

Facility

$442.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$442.00
Rate for Payer: Aetna Commercial	$397.80
Rate for Payer: ASR ASR	$428.74
Rate for Payer: ASR Commercial	$428.74
Rate for Payer: BCBS Trust/PPO	$360.19
Rate for Payer: BCN Commercial	$342.68
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cofinity Commercial	$415.48
Rate for Payer: Encore Health Key Benefits Commercial	$353.60
Rate for Payer: Healthscope Commercial	$442.00
Rate for Payer: Healthscope Whirlpool	$428.74
Rate for Payer: Mclaren Commercial	$397.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.70
Rate for Payer: Nomi Health Commercial	$362.44
Rate for Payer: Priority Health Cigna Priority Health	$287.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$388.96

PR ABRASION 1 LESION

Facility

$442.00

Service Code	CPT 15786
Hospital Charge Code	15786
Min. Negotiated Rate	$104.35
Max. Negotiated Rate	$442.00
Rate for Payer: Aetna Commercial	$397.80
Rate for Payer: Aetna Medicare	$194.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$243.35
Rate for Payer: Amish Plain Church Group Commercial	$243.35
Rate for Payer: ASR ASR	$428.74
Rate for Payer: ASR Commercial	$428.74
Rate for Payer: BCBS Complete	$109.57
Rate for Payer: BCBS MAPPO	$194.68
Rate for Payer: BCBS Trust/PPO	$361.95
Rate for Payer: BCN Commercial	$342.68
Rate for Payer: BCN Medicare Advantage	$194.68
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cofinity Commercial	$415.48
Rate for Payer: Encore Health Key Benefits Commercial	$353.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$194.68
Rate for Payer: Healthscope Commercial	$442.00
Rate for Payer: Healthscope Whirlpool	$428.74
Rate for Payer: Humana Choice PPO Medicare	$194.68
Rate for Payer: Mclaren Commercial	$397.80
Rate for Payer: Mclaren Medicaid	$104.35
Rate for Payer: Mclaren Medicare	$194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$204.41
Rate for Payer: Meridian Medicaid	$109.57
Rate for Payer: MI Amish Medical Board Commercial	$223.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.70
Rate for Payer: Nomi Health Commercial	$362.44
Rate for Payer: PACE Medicare	$184.95
Rate for Payer: PACE SWMI	$194.68
Rate for Payer: PHP Commercial	$214.15
Rate for Payer: PHP Medicaid	$104.35
Rate for Payer: PHP Medicare Advantage	$194.68
Rate for Payer: Priority Health Choice Medicaid	$104.35
Rate for Payer: Priority Health Cigna Priority Health	$287.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.28
Rate for Payer: Priority Health Medicare	$194.68
Rate for Payer: Priority Health Narrow Network	$309.84
Rate for Payer: Railroad Medicare Medicare	$194.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$388.96
Rate for Payer: UHC Dual Complete DSNP	$194.68
Rate for Payer: UHC Exchange	$301.75
Rate for Payer: UHC Medicare Advantage	$194.68
Rate for Payer: UHCCP DNSP	$194.68
Rate for Payer: UHCCP Medicaid	$104.35
Rate for Payer: VA VA	$194.68

PR ABRASION 1 LESION

Professional

Both

$441.66

Service Code	HCPCS 15786
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$337.19
Rate for Payer: Aetna Commercial	$142.60
Rate for Payer: Aetna Medicare	$220.83
Rate for Payer: BCBS Complete	$91.24
Rate for Payer: BCN Commercial	$337.19
Rate for Payer: Cash Price	$353.33
Rate for Payer: Cash Price	$353.33
Rate for Payer: Meridian Medicaid	$91.24
Rate for Payer: Priority Health Choice Medicaid	$86.90
Rate for Payer: Priority Health Cigna Priority Health	$287.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.41
Rate for Payer: Priority Health Narrow Network	$182.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$148.75
Rate for Payer: UHC Exchange	$148.75
Rate for Payer: UHCCP Medicaid	$86.90

PR ACETABULOPLASTY RESECTION FEMORAL HEAD

Professional

Both

$1,976.00

Service Code	HCPCS 27122
Min. Negotiated Rate	$674.11
Max. Negotiated Rate	$1,695.02
Rate for Payer: Aetna Commercial	$1,473.67
Rate for Payer: Aetna Medicare	$988.00
Rate for Payer: BCBS Complete	$750.12
Rate for Payer: BCBS Trust/PPO	$674.11
Rate for Payer: BCN Commercial	$1,615.08
Rate for Payer: Cash Price	$1,580.80
Rate for Payer: Cash Price	$1,580.80
Rate for Payer: Meridian Medicaid	$750.12
Rate for Payer: Priority Health Choice Medicaid	$714.40
Rate for Payer: Priority Health Cigna Priority Health	$1,284.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,695.02
Rate for Payer: Priority Health Narrow Network	$1,695.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,274.75
Rate for Payer: UHC Exchange	$1,274.75
Rate for Payer: UHCCP Medicaid	$714.40

PR ACNE SURGERY

Professional

Both

$181.00

Service Code	HCPCS 10040
Min. Negotiated Rate	$22.20
Max. Negotiated Rate	$137.04
Rate for Payer: Aetna Commercial	$56.49
Rate for Payer: Aetna Medicare	$90.50
Rate for Payer: BCBS Complete	$34.89
Rate for Payer: BCBS Trust/PPO	$22.20
Rate for Payer: BCN Commercial	$137.04
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Meridian Medicaid	$34.89
Rate for Payer: Priority Health Choice Medicaid	$33.23
Rate for Payer: Priority Health Cigna Priority Health	$117.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$69.99
Rate for Payer: Priority Health Narrow Network	$69.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$93.41
Rate for Payer: UHC Exchange	$93.41
Rate for Payer: UHCCP Medicaid	$33.23

PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY

Professional

Both

$58.00

Service Code	HCPCS 92570
Min. Negotiated Rate	$18.32
Max. Negotiated Rate	$1,989.05
Rate for Payer: Aetna Commercial	$32.99
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCBS Complete	$19.24
Rate for Payer: BCBS Trust/PPO	$1,989.05
Rate for Payer: BCN Commercial	$46.92
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Meridian Medicaid	$19.24
Rate for Payer: Priority Health Choice Medicaid	$18.32
Rate for Payer: Priority Health Cigna Priority Health	$37.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38.90
Rate for Payer: Priority Health Narrow Network	$38.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.45
Rate for Payer: UHC Exchange	$31.45
Rate for Payer: UHCCP Medicaid	$18.32

PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS

Professional

Both

$1,143.00

Service Code	HCPCS 23130
Min. Negotiated Rate	$47.54
Max. Negotiated Rate	$961.24
Rate for Payer: Aetna Commercial	$821.57
Rate for Payer: Aetna Medicare	$571.50
Rate for Payer: BCBS Complete	$426.28
Rate for Payer: BCBS Trust/PPO	$47.54
Rate for Payer: BCN Commercial	$914.32
Rate for Payer: Cash Price	$914.40
Rate for Payer: Cash Price	$914.40
Rate for Payer: Meridian Medicaid	$426.28
Rate for Payer: Priority Health Choice Medicaid	$405.98
Rate for Payer: Priority Health Cigna Priority Health	$742.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$961.24
Rate for Payer: Priority Health Narrow Network	$961.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$684.79
Rate for Payer: UHC Exchange	$684.79
Rate for Payer: UHCCP Medicaid	$405.98

Know your out-of-pocket cost for care.

All Charges