Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR BONE GRAFT ANY DONOR AREA MINOR/SMALL

Professional

Both

$909.00

Service Code	HCPCS 20900
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$590.85
Rate for Payer: Aetna Commercial	$244.23
Rate for Payer: Aetna Medicare	$454.50
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCBS Trust/PPO	$580.95
Rate for Payer: BCN Commercial	$574.19
Rate for Payer: Cash Price	$727.20
Rate for Payer: Cash Price	$727.20
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health	$590.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$274.28
Rate for Payer: Priority Health Narrow Network	$274.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.96
Rate for Payer: UHC Exchange	$277.96
Rate for Payer: UHCCP Medicaid	$115.45

PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR

Professional

Both

$4,588.00

Service Code	HCPCS 20962
Min. Negotiated Rate	$1,721.25
Max. Negotiated Rate	$4,077.50
Rate for Payer: Aetna Commercial	$3,549.97
Rate for Payer: Aetna Medicare	$2,294.00
Rate for Payer: BCBS Complete	$1,807.31
Rate for Payer: BCBS Trust/PPO	$3,247.68
Rate for Payer: BCN Commercial	$3,886.45
Rate for Payer: Cash Price	$3,670.40
Rate for Payer: Cash Price	$3,670.40
Rate for Payer: Meridian Medicaid	$1,807.31
Rate for Payer: Priority Health Choice Medicaid	$1,721.25
Rate for Payer: Priority Health Cigna Priority Health	$2,982.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,077.50
Rate for Payer: Priority Health Narrow Network	$4,077.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,031.27
Rate for Payer: UHC Exchange	$3,031.27
Rate for Payer: UHCCP Medicaid	$1,721.25

PR BOTOX UNIT

Professional

Both

$13.00

Service Code	HCPCS 00084
Hospital Revenue Code	990
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45

PR BRACHIOPLASTY

Professional

Both

$4,590.00

Service Code	HCPCS 00537
Hospital Revenue Code	990
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,983.50
Rate for Payer: Aetna Medicare	$2,295.00
Rate for Payer: BCBS Complete	$1,836.00
Rate for Payer: Cash Price	$3,672.00
Rate for Payer: Priority Health Cigna Priority Health	$2,983.50

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,040.00

Service Code	HCPCS 19325
Min. Negotiated Rate	$399.38
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Commercial	$661.62
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$419.35
Rate for Payer: BCBS Trust/PPO	$630.49
Rate for Payer: BCN Commercial	$901.13
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Meridian Medicaid	$419.35
Rate for Payer: Priority Health Choice Medicaid	$399.38
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$838.02
Rate for Payer: Priority Health Narrow Network	$838.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$675.31
Rate for Payer: UHC Exchange	$675.31
Rate for Payer: UHCCP Medicaid	$399.38

PR BREAST AUGMENT W MASTOPEXY-GEL 2.5

Professional

Both

$6,671.00

Service Code	HCPCS 00258
Hospital Revenue Code	990
Min. Negotiated Rate	$2,668.40
Max. Negotiated Rate	$4,336.15
Rate for Payer: Aetna Medicare	$3,335.50
Rate for Payer: BCBS Complete	$2,668.40
Rate for Payer: Cash Price	$5,336.80
Rate for Payer: Priority Health Cigna Priority Health	$4,336.15

PR BREAST AUGMENT W MASTOPEXY-GEL 3.5

Professional

Both

$7,589.00

Service Code	HCPCS 00260
Hospital Revenue Code	990
Min. Negotiated Rate	$3,035.60
Max. Negotiated Rate	$4,932.85
Rate for Payer: Aetna Medicare	$3,794.50
Rate for Payer: BCBS Complete	$3,035.60
Rate for Payer: Cash Price	$6,071.20
Rate for Payer: Priority Health Cigna Priority Health	$4,932.85

PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5

Professional

Both

$5,610.00

Service Code	HCPCS 00257
Hospital Revenue Code	990
Min. Negotiated Rate	$2,244.00
Max. Negotiated Rate	$3,646.50
Rate for Payer: Aetna Medicare	$2,805.00
Rate for Payer: BCBS Complete	$2,244.00
Rate for Payer: Cash Price	$4,488.00
Rate for Payer: Priority Health Cigna Priority Health	$3,646.50

PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5

Professional

Both

$6,528.00

Service Code	HCPCS 00259
Hospital Revenue Code	990
Min. Negotiated Rate	$2,611.20
Max. Negotiated Rate	$4,243.20
Rate for Payer: Aetna Medicare	$3,264.00
Rate for Payer: BCBS Complete	$2,611.20
Rate for Payer: Cash Price	$5,222.40
Rate for Payer: Priority Health Cigna Priority Health	$4,243.20

PR BREAST IMPLANT WARRANTY

Professional

Both

$357.00

Service Code	HCPCS 00523
Hospital Revenue Code	990
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Priority Health Cigna Priority Health	$232.05

PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$4,809.00

Service Code	HCPCS 19368
Min. Negotiated Rate	$1,327.27
Max. Negotiated Rate	$3,163.69
Rate for Payer: Aetna Commercial	$2,367.91
Rate for Payer: Aetna Medicare	$2,404.50
Rate for Payer: BCBS Complete	$1,461.33
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: BCN Commercial	$3,163.69
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Meridian Medicaid	$1,461.33
Rate for Payer: Priority Health Choice Medicaid	$1,391.74
Rate for Payer: Priority Health Cigna Priority Health	$3,125.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,926.28
Rate for Payer: Priority Health Narrow Network	$2,926.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,375.30
Rate for Payer: UHC Exchange	$2,375.30
Rate for Payer: UHCCP Medicaid	$1,391.74

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$4,213.00

Service Code	HCPCS 19369
Min. Negotiated Rate	$199.98
Max. Negotiated Rate	$2,939.88
Rate for Payer: Aetna Commercial	$2,199.14
Rate for Payer: Aetna Medicare	$2,106.50
Rate for Payer: BCBS Complete	$1,358.01
Rate for Payer: BCBS Trust/PPO	$199.98
Rate for Payer: BCN Commercial	$2,939.88
Rate for Payer: Cash Price	$3,370.40
Rate for Payer: Cash Price	$3,370.40
Rate for Payer: Meridian Medicaid	$1,358.01
Rate for Payer: Priority Health Choice Medicaid	$1,293.34
Rate for Payer: Priority Health Cigna Priority Health	$2,738.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,719.49
Rate for Payer: Priority Health Narrow Network	$2,719.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,188.38
Rate for Payer: UHC Exchange	$2,188.38
Rate for Payer: UHCCP Medicaid	$1,293.34

PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP

Professional

Both

$3,032.00

Service Code	HCPCS 19367
Min. Negotiated Rate	$1,139.12
Max. Negotiated Rate	$2,583.15
Rate for Payer: Aetna Commercial	$1,924.16
Rate for Payer: Aetna Medicare	$1,516.00
Rate for Payer: BCBS Complete	$1,196.08
Rate for Payer: BCBS Trust/PPO	$1,327.27
Rate for Payer: BCN Commercial	$2,583.15
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Meridian Medicaid	$1,196.08
Rate for Payer: Priority Health Choice Medicaid	$1,139.12
Rate for Payer: Priority Health Cigna Priority Health	$1,970.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,392.58
Rate for Payer: Priority Health Narrow Network	$2,392.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,918.77
Rate for Payer: UHC Exchange	$1,918.77
Rate for Payer: UHCCP Medicaid	$1,139.12

PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP

Professional

Both

$2,920.00

Service Code	HCPCS 19361
Min. Negotiated Rate	$312.59
Max. Negotiated Rate	$2,274.31
Rate for Payer: Aetna Commercial	$1,693.89
Rate for Payer: Aetna Medicare	$1,460.00
Rate for Payer: BCBS Complete	$1,053.61
Rate for Payer: BCBS Trust/PPO	$312.59
Rate for Payer: BCN Commercial	$2,274.31
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Meridian Medicaid	$1,053.61
Rate for Payer: Priority Health Choice Medicaid	$1,003.44
Rate for Payer: Priority Health Cigna Priority Health	$1,898.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,107.68
Rate for Payer: Priority Health Narrow Network	$2,107.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,767.47
Rate for Payer: UHC Exchange	$1,767.47
Rate for Payer: UHCCP Medicaid	$1,003.44

PR BREAST RECONSTRUC W OTHR TECHNIQ

Professional

Both

$2,903.00

Service Code	HCPCS 19366
Min. Negotiated Rate	$1,161.20
Max. Negotiated Rate	$1,886.95
Rate for Payer: Aetna Medicare	$1,451.50
Rate for Payer: BCBS Complete	$1,161.20
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Priority Health Cigna Priority Health	$1,886.95

PR BREAST REDUCTION

Facility

$1,938.00

Service Code	CPT 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$1,259.70
Max. Negotiated Rate	$9,903.88
Rate for Payer: Aetna Commercial	$1,744.20
Rate for Payer: Aetna Medicare	$6,389.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,987.00
Rate for Payer: Amish Plain Church Group Commercial	$7,987.00
Rate for Payer: ASR ASR	$1,879.86
Rate for Payer: ASR Commercial	$1,879.86
Rate for Payer: BCBS Complete	$3,596.07
Rate for Payer: BCBS MAPPO	$6,389.60
Rate for Payer: BCBS Trust/PPO	$1,587.03
Rate for Payer: BCN Commercial	$1,502.53
Rate for Payer: BCN Medicare Advantage	$6,389.60
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,821.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,550.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,389.60
Rate for Payer: Healthscope Commercial	$1,938.00
Rate for Payer: Healthscope Whirlpool	$1,879.86
Rate for Payer: Humana Choice PPO Medicare	$6,389.60
Rate for Payer: Mclaren Commercial	$1,744.20
Rate for Payer: Mclaren Medicaid	$3,424.83
Rate for Payer: Mclaren Medicare	$6,389.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,709.08
Rate for Payer: Meridian Medicaid	$3,596.07
Rate for Payer: MI Amish Medical Board Commercial	$7,348.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,647.30
Rate for Payer: Nomi Health Commercial	$1,589.16
Rate for Payer: PACE Medicare	$6,070.12
Rate for Payer: PACE SWMI	$6,389.60
Rate for Payer: PHP Commercial	$7,028.56
Rate for Payer: PHP Medicaid	$3,424.83
Rate for Payer: PHP Medicare Advantage	$6,389.60
Rate for Payer: Priority Health Choice Medicaid	$3,424.83
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,698.08
Rate for Payer: Priority Health Medicare	$6,389.60
Rate for Payer: Priority Health Narrow Network	$1,358.54
Rate for Payer: Railroad Medicare Medicare	$6,389.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,705.44
Rate for Payer: UHC Dual Complete DSNP	$6,389.60
Rate for Payer: UHC Exchange	$9,903.88
Rate for Payer: UHC Medicare Advantage	$6,389.60
Rate for Payer: UHCCP DNSP	$6,389.60
Rate for Payer: UHCCP Medicaid	$3,424.83
Rate for Payer: VA VA	$6,389.60

PR BREAST REDUCTION

Professional

Both

$1,938.00

Service Code	HCPCS 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$293.06
Max. Negotiated Rate	$1,597.97
Rate for Payer: Aetna Commercial	$1,186.12
Rate for Payer: Aetna Medicare	$969.00
Rate for Payer: BCBS Complete	$741.40
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: BCN Commercial	$1,597.97
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Meridian Medicaid	$741.40
Rate for Payer: Priority Health Choice Medicaid	$706.10
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,482.33
Rate for Payer: Priority Health Narrow Network	$1,482.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,182.47
Rate for Payer: UHC Exchange	$1,182.47
Rate for Payer: UHCCP Medicaid	$706.10

PR BREAST REDUCTION

Facility

$1,938.00

Service Code	CPT 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$1,259.70
Max. Negotiated Rate	$1,938.00
Rate for Payer: Aetna Commercial	$1,744.20
Rate for Payer: ASR ASR	$1,879.86
Rate for Payer: ASR Commercial	$1,879.86
Rate for Payer: BCBS Trust/PPO	$1,579.28
Rate for Payer: BCN Commercial	$1,502.53
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,821.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,550.40
Rate for Payer: Healthscope Commercial	$1,938.00
Rate for Payer: Healthscope Whirlpool	$1,879.86
Rate for Payer: Mclaren Commercial	$1,744.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,647.30
Rate for Payer: Nomi Health Commercial	$1,589.16
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,705.44

PR BREAST REDUCTION

Professional

Both

$1,938.00

Service Code	HCPCS 19318
Min. Negotiated Rate	$293.06
Max. Negotiated Rate	$1,597.97
Rate for Payer: Aetna Commercial	$1,186.12
Rate for Payer: Aetna Medicare	$969.00
Rate for Payer: BCBS Complete	$741.40
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: BCN Commercial	$1,597.97
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Meridian Medicaid	$741.40
Rate for Payer: Priority Health Choice Medicaid	$706.10
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,482.33
Rate for Payer: Priority Health Narrow Network	$1,482.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,182.47
Rate for Payer: UHC Exchange	$1,182.47
Rate for Payer: UHCCP Medicaid	$706.10

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$167.00

Service Code	HCPCS 91065
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$1,135.85
Rate for Payer: Aetna Commercial	$96.87
Rate for Payer: Aetna Medicare	$83.50
Rate for Payer: BCBS Complete	$6.26
Rate for Payer: BCBS Trust/PPO	$1,135.85
Rate for Payer: BCN Commercial	$123.15
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Meridian Medicaid	$6.26
Rate for Payer: Priority Health Choice Medicaid	$5.96
Rate for Payer: Priority Health Cigna Priority Health	$108.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.11
Rate for Payer: Priority Health Narrow Network	$13.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$66.31
Rate for Payer: UHC Exchange	$66.31
Rate for Payer: UHCCP Medicaid	$5.96

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$180.00

Service Code	HCPCS 94450
Min. Negotiated Rate	$12.57
Max. Negotiated Rate	$1,113.66
Rate for Payer: Aetna Commercial	$65.23
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS Trust/PPO	$1,113.66
Rate for Payer: BCN Commercial	$119.72
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Meridian Medicaid	$13.20
Rate for Payer: Priority Health Choice Medicaid	$12.57
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.78
Rate for Payer: Priority Health Narrow Network	$25.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$55.81
Rate for Payer: UHC Exchange	$55.81
Rate for Payer: UHCCP Medicaid	$12.57

PR BRIEF CHECK IN BY MD/QHP

Professional

Both

$30.00

Service Code	HCPCS G2012
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$403.09
Rate for Payer: Aetna Commercial	$13.03
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$403.09
Rate for Payer: BCN Commercial	$20.53
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$19.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.05
Rate for Payer: Priority Health Narrow Network	$17.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.92
Rate for Payer: UHC Exchange	$14.92

PR BRIEF COMMUNICATION TECH-BSD SVC EST PT 5-10 MIN

Professional

Both

$43.00

Service Code	HCPCS 98016
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$27.95
Rate for Payer: Aetna Medicare	$21.50
Rate for Payer: BCBS Complete	$10.07
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Meridian Medicaid	$10.07
Rate for Payer: Priority Health Choice Medicaid	$9.59
Rate for Payer: Priority Health Cigna Priority Health	$27.95
Rate for Payer: UHCCP Medicaid	$9.59

PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN

Professional

Both

$123.00

Service Code	HCPCS 94060
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$1,399.47
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Commercial	$48.88
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCBS Complete	$6.71
Rate for Payer: BCBS Complete	$6.71
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: BCN Commercial	$56.19
Rate for Payer: BCN Commercial	$56.19
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Meridian Medicaid	$6.71
Rate for Payer: Meridian Medicaid	$6.71
Rate for Payer: Priority Health Choice Medicaid	$6.39
Rate for Payer: Priority Health Choice Medicaid	$6.39
Rate for Payer: Priority Health Cigna Priority Health	$79.95
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: Priority Health Narrow Network	$18.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$59.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$59.02
Rate for Payer: UHC Exchange	$59.02
Rate for Payer: UHC Exchange	$59.02
Rate for Payer: UHCCP Medicaid	$6.39
Rate for Payer: UHCCP Medicaid	$6.39

PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS

Professional

Both

$649.00

Service Code	HCPCS 31623
Min. Negotiated Rate	$82.64
Max. Negotiated Rate	$720.60
Rate for Payer: Aetna Commercial	$170.36
Rate for Payer: Aetna Medicare	$324.50
Rate for Payer: BCBS Complete	$86.77
Rate for Payer: BCBS Trust/PPO	$720.60
Rate for Payer: BCN Commercial	$399.74
Rate for Payer: Cash Price	$519.20
Rate for Payer: Cash Price	$519.20
Rate for Payer: Meridian Medicaid	$86.77
Rate for Payer: Priority Health Choice Medicaid	$82.64
Rate for Payer: Priority Health Cigna Priority Health	$421.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$179.36
Rate for Payer: Priority Health Narrow Network	$179.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$170.42
Rate for Payer: UHC Exchange	$170.42
Rate for Payer: UHCCP Medicaid	$82.64

Know your out-of-pocket cost for care.

All Charges