Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR FOOT ARCH SUPP LONGITUD/META

Professional

Both

$41.00

Service Code	HCPCS L3060
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$65.84
Rate for Payer: Aetna Commercial	$44.42
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCN Commercial	$65.84
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	$40.07
Rate for Payer: UHC Exchange	$40.07

PR FOOT PLAS HEEL STABI PRE OTS

Professional

Both

$50.00

Service Code	HCPCS L3170
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$48.29
Rate for Payer: Aetna Commercial	$30.64
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCN Commercial	$48.29
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$32.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$27.64
Rate for Payer: UHC Exchange	$27.64

PR FO PIP DIP JNT/SPRNG PRE OTS

Professional

Both

$62.00

Service Code	HCPCS L3925
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$36.01
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCN Commercial	$56.76
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Priority Health Cigna Priority Health	$40.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$32.48
Rate for Payer: UHC Exchange	$32.48

PR FOREARM/ARM CUFFS FREE MOTIO

Professional

Both

$638.00

Service Code	HCPCS L3720
Min. Negotiated Rate	$255.20
Max. Negotiated Rate	$590.45
Rate for Payer: Aetna Commercial	$374.53
Rate for Payer: Aetna Medicare	$319.00
Rate for Payer: BCBS Complete	$255.20
Rate for Payer: BCN Commercial	$590.45
Rate for Payer: Cash Price	$510.40
Rate for Payer: Cash Price	$510.40
Rate for Payer: Priority Health Cigna Priority Health	$414.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$337.82
Rate for Payer: UHC Exchange	$337.82

PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE

Professional

Both

$2,259.00

Service Code	HCPCS 15731
Min. Negotiated Rate	$640.92
Max. Negotiated Rate	$1,643.91
Rate for Payer: Aetna Commercial	$1,071.45
Rate for Payer: Aetna Medicare	$1,129.50
Rate for Payer: BCBS Complete	$672.97
Rate for Payer: BCBS Trust/PPO	$852.18
Rate for Payer: BCN Commercial	$1,643.91
Rate for Payer: Cash Price	$1,807.20
Rate for Payer: Cash Price	$1,807.20
Rate for Payer: Meridian Medicaid	$672.97
Rate for Payer: Priority Health Choice Medicaid	$640.92
Rate for Payer: Priority Health Cigna Priority Health	$1,468.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,350.94
Rate for Payer: Priority Health Narrow Network	$1,350.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,080.46
Rate for Payer: UHC Exchange	$1,080.46
Rate for Payer: UHCCP Medicaid	$640.92

PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING

Professional

Both

$153.00

Service Code	HCPCS 54450
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$1,562.18
Rate for Payer: Aetna Commercial	$73.96
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$38.24
Rate for Payer: BCBS Trust/PPO	$1,562.18
Rate for Payer: BCN Commercial	$99.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Meridian Medicaid	$38.24
Rate for Payer: Priority Health Choice Medicaid	$36.42
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$90.02
Rate for Payer: Priority Health Narrow Network	$90.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.29
Rate for Payer: UHC Exchange	$70.29
Rate for Payer: UHCCP Medicaid	$36.42

PR FO W/O JOINTS CF

Professional

Both

$200.00

Service Code	HCPCS L3933
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$184.38
Rate for Payer: Aetna Commercial	$116.96
Rate for Payer: Aetna Medicare	$100.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: BCN Commercial	$184.38
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Priority Health Cigna Priority Health	$130.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$105.49
Rate for Payer: UHC Exchange	$105.49

PR FRAC FL FACE

Professional

Both

$408.00

Service Code	HCPCS 00100
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20

PR FRAC NECK

Professional

Both

$153.00

Service Code	HCPCS 00102
Hospital Revenue Code	990
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$99.45
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Priority Health Cigna Priority Health	$99.45

PR FRAC SCARS PER INCH

Professional

Both

$51.00

Service Code	HCPCS 00104
Hospital Revenue Code	990
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR FRAC THGH/ABD/BACK

Professional

Both

$459.00

Service Code	HCPCS 00103
Hospital Revenue Code	990
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$298.35
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: Cash Price	$367.20
Rate for Payer: Priority Health Cigna Priority Health	$298.35

PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC

Professional

Both

$532.00

Service Code	HCPCS 30930
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$790.87
Rate for Payer: Aetna Commercial	$147.55
Rate for Payer: Aetna Medicare	$266.00
Rate for Payer: BCBS Complete	$80.29
Rate for Payer: BCBS Trust/PPO	$790.87
Rate for Payer: BCN Commercial	$173.48
Rate for Payer: Cash Price	$425.60
Rate for Payer: Cash Price	$425.60
Rate for Payer: Meridian Medicaid	$80.29
Rate for Payer: Priority Health Choice Medicaid	$76.47
Rate for Payer: Priority Health Cigna Priority Health	$345.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$166.38
Rate for Payer: Priority Health Narrow Network	$166.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$131.69
Rate for Payer: UHC Exchange	$131.69
Rate for Payer: UHCCP Medicaid	$76.47

PR FRAC UP/LOW FACE

Professional

Both

$255.00

Service Code	HCPCS 00101
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY

Professional

Both

$569.00

Service Code	HCPCS 41520
Min. Negotiated Rate	$162.73
Max. Negotiated Rate	$653.51
Rate for Payer: Aetna Commercial	$326.38
Rate for Payer: Aetna Medicare	$284.50
Rate for Payer: BCBS Complete	$170.87
Rate for Payer: BCBS Trust/PPO	$653.51
Rate for Payer: BCN Commercial	$541.46
Rate for Payer: Cash Price	$455.20
Rate for Payer: Cash Price	$455.20
Rate for Payer: Meridian Medicaid	$170.87
Rate for Payer: Priority Health Choice Medicaid	$162.73
Rate for Payer: Priority Health Cigna Priority Health	$369.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$454.01
Rate for Payer: Priority Health Narrow Network	$454.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$299.05
Rate for Payer: UHC Exchange	$299.05
Rate for Payer: UHCCP Medicaid	$162.73

PR FRENULOTOMY PENIS

Professional

Both

$825.00

Service Code	HCPCS 54164
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$1,012.75
Rate for Payer: Aetna Commercial	$244.64
Rate for Payer: Aetna Medicare	$412.50
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCBS Trust/PPO	$1,012.75
Rate for Payer: BCN Commercial	$280.99
Rate for Payer: Cash Price	$660.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health	$536.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$312.64
Rate for Payer: Priority Health Narrow Network	$312.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$229.16
Rate for Payer: UHC Exchange	$229.16
Rate for Payer: UHCCP Medicaid	$126.31

PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK

Professional

Both

$1,503.00

Service Code	HCPCS 15570
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$1,331.65
Rate for Payer: Aetna Commercial	$788.69
Rate for Payer: Aetna Medicare	$751.50
Rate for Payer: BCBS Complete	$493.15
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: BCN Commercial	$1,331.65
Rate for Payer: Cash Price	$1,202.40
Rate for Payer: Cash Price	$1,202.40
Rate for Payer: Meridian Medicaid	$493.15
Rate for Payer: Priority Health Choice Medicaid	$469.67
Rate for Payer: Priority Health Cigna Priority Health	$976.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$988.83
Rate for Payer: Priority Health Narrow Network	$988.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$760.65
Rate for Payer: UHC Exchange	$760.65
Rate for Payer: UHCCP Medicaid	$469.67

PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL

Professional

Both

$1,623.00

Service Code	HCPCS 15576
Min. Negotiated Rate	$418.12
Max. Negotiated Rate	$4,106.40
Rate for Payer: Aetna Commercial	$703.16
Rate for Payer: Aetna Medicare	$811.50
Rate for Payer: BCBS Complete	$439.03
Rate for Payer: BCBS Trust/PPO	$4,106.40
Rate for Payer: BCN Commercial	$1,142.53
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Meridian Medicaid	$439.03
Rate for Payer: Priority Health Choice Medicaid	$418.12
Rate for Payer: Priority Health Cigna Priority Health	$1,054.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$876.84
Rate for Payer: Priority Health Narrow Network	$876.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$709.46
Rate for Payer: UHC Exchange	$709.46
Rate for Payer: UHCCP Medicaid	$418.12

PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS

Professional

Both

$1,566.00

Service Code	HCPCS 15572
Min. Negotiated Rate	$475.84
Max. Negotiated Rate	$6,341.25
Rate for Payer: Aetna Commercial	$789.01
Rate for Payer: Aetna Medicare	$783.00
Rate for Payer: BCBS Complete	$499.63
Rate for Payer: BCBS Trust/PPO	$6,341.25
Rate for Payer: BCN Commercial	$1,290.60
Rate for Payer: Cash Price	$1,252.80
Rate for Payer: Cash Price	$1,252.80
Rate for Payer: Meridian Medicaid	$499.63
Rate for Payer: Priority Health Choice Medicaid	$475.84
Rate for Payer: Priority Health Cigna Priority Health	$1,017.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,000.11
Rate for Payer: Priority Health Narrow Network	$1,000.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$766.66
Rate for Payer: UHC Exchange	$766.66
Rate for Payer: UHCCP Medicaid	$475.84

PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F

Professional

Both

$1,918.00

Service Code	HCPCS 15574
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$1,283.75
Rate for Payer: Aetna Commercial	$791.76
Rate for Payer: Aetna Medicare	$959.00
Rate for Payer: BCBS Complete	$489.12
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: BCN Commercial	$1,283.75
Rate for Payer: Cash Price	$1,534.40
Rate for Payer: Cash Price	$1,534.40
Rate for Payer: Meridian Medicaid	$489.12
Rate for Payer: Priority Health Choice Medicaid	$465.83
Rate for Payer: Priority Health Cigna Priority Health	$1,246.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,003.72
Rate for Payer: Priority Health Narrow Network	$1,003.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$806.56
Rate for Payer: UHC Exchange	$806.56
Rate for Payer: UHCCP Medicaid	$465.83

PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Facility

$1,399.00

Service Code	CPT 15240
Hospital Charge Code	15240
Hospital Revenue Code	960
Min. Negotiated Rate	$909.35
Max. Negotiated Rate	$2,777.97
Rate for Payer: Aetna Commercial	$1,259.10
Rate for Payer: Aetna Medicare	$1,792.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,240.30
Rate for Payer: Amish Plain Church Group Commercial	$2,240.30
Rate for Payer: ASR ASR	$1,357.03
Rate for Payer: ASR Commercial	$1,357.03
Rate for Payer: BCBS Complete	$1,008.67
Rate for Payer: BCBS MAPPO	$1,792.24
Rate for Payer: BCBS Trust/PPO	$1,145.64
Rate for Payer: BCN Commercial	$1,084.64
Rate for Payer: BCN Medicare Advantage	$1,792.24
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cofinity Commercial	$1,315.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,119.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,792.24
Rate for Payer: Healthscope Commercial	$1,399.00
Rate for Payer: Healthscope Whirlpool	$1,357.03
Rate for Payer: Humana Choice PPO Medicare	$1,792.24
Rate for Payer: Mclaren Commercial	$1,259.10
Rate for Payer: Mclaren Medicaid	$960.64
Rate for Payer: Mclaren Medicare	$1,792.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,881.85
Rate for Payer: Meridian Medicaid	$1,008.67
Rate for Payer: MI Amish Medical Board Commercial	$2,061.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,189.15
Rate for Payer: Nomi Health Commercial	$1,147.18
Rate for Payer: PACE Medicare	$1,702.63
Rate for Payer: PACE SWMI	$1,792.24
Rate for Payer: PHP Commercial	$1,971.46
Rate for Payer: PHP Medicaid	$960.64
Rate for Payer: PHP Medicare Advantage	$1,792.24
Rate for Payer: Priority Health Choice Medicaid	$960.64
Rate for Payer: Priority Health Cigna Priority Health	$909.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,225.80
Rate for Payer: Priority Health Medicare	$1,792.24
Rate for Payer: Priority Health Narrow Network	$980.70
Rate for Payer: Railroad Medicare Medicare	$1,792.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,231.12
Rate for Payer: UHC Dual Complete DSNP	$1,792.24
Rate for Payer: UHC Exchange	$2,777.97
Rate for Payer: UHC Medicare Advantage	$1,792.24
Rate for Payer: UHCCP DNSP	$1,792.24
Rate for Payer: UHCCP Medicaid	$960.64
Rate for Payer: VA VA	$1,792.24

PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Professional

Both

$1,399.00

Service Code	HCPCS 15240
Hospital Charge Code	15240
Min. Negotiated Rate	$513.12
Max. Negotiated Rate	$1,357.55
Rate for Payer: Aetna Commercial	$845.41
Rate for Payer: Aetna Medicare	$699.50
Rate for Payer: BCBS Complete	$538.78
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: BCN Commercial	$1,357.55
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Meridian Medicaid	$538.78
Rate for Payer: Priority Health Choice Medicaid	$513.12
Rate for Payer: Priority Health Cigna Priority Health	$909.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,080.03
Rate for Payer: Priority Health Narrow Network	$1,080.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$838.45
Rate for Payer: UHC Exchange	$838.45
Rate for Payer: UHCCP Medicaid	$513.12

PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Facility

$1,399.00

Service Code	CPT 15240
Hospital Charge Code	15240
Hospital Revenue Code	960
Min. Negotiated Rate	$909.35
Max. Negotiated Rate	$1,399.00
Rate for Payer: Aetna Commercial	$1,259.10
Rate for Payer: ASR ASR	$1,357.03
Rate for Payer: ASR Commercial	$1,357.03
Rate for Payer: BCBS Trust/PPO	$1,140.05
Rate for Payer: BCN Commercial	$1,084.64
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cofinity Commercial	$1,315.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,119.20
Rate for Payer: Healthscope Commercial	$1,399.00
Rate for Payer: Healthscope Whirlpool	$1,357.03
Rate for Payer: Mclaren Commercial	$1,259.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,189.15
Rate for Payer: Nomi Health Commercial	$1,147.18
Rate for Payer: Priority Health Cigna Priority Health	$909.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,231.12

PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<

Professional

Both

$1,399.00

Service Code	HCPCS 15240
Min. Negotiated Rate	$513.12
Max. Negotiated Rate	$1,357.55
Rate for Payer: Aetna Commercial	$845.41
Rate for Payer: Aetna Medicare	$699.50
Rate for Payer: BCBS Complete	$538.78
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: BCN Commercial	$1,357.55
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Meridian Medicaid	$538.78
Rate for Payer: Priority Health Choice Medicaid	$513.12
Rate for Payer: Priority Health Cigna Priority Health	$909.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,080.03
Rate for Payer: Priority Health Narrow Network	$1,080.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$838.45
Rate for Payer: UHC Exchange	$838.45
Rate for Payer: UHCCP Medicaid	$513.12

PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM

Professional

Both

$426.00

Service Code	HCPCS 15261
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$301.02
Rate for Payer: Aetna Commercial	$147.92
Rate for Payer: Aetna Medicare	$213.00
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCN Commercial	$301.02
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cash Price	$340.80
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health	$276.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.52
Rate for Payer: Priority Health Narrow Network	$181.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$154.21
Rate for Payer: UHC Exchange	$154.21
Rate for Payer: UHCCP Medicaid	$85.84

PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<

Professional

Both

$1,700.00

Service Code	HCPCS 15260
Min. Negotiated Rate	$35.25
Max. Negotiated Rate	$1,458.22
Rate for Payer: Aetna Commercial	$898.38
Rate for Payer: Aetna Medicare	$850.00
Rate for Payer: BCBS Complete	$572.09
Rate for Payer: BCBS Trust/PPO	$35.25
Rate for Payer: BCN Commercial	$1,458.22
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Meridian Medicaid	$572.09
Rate for Payer: Priority Health Choice Medicaid	$544.85
Rate for Payer: Priority Health Cigna Priority Health	$1,105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,144.60
Rate for Payer: Priority Health Narrow Network	$1,144.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$911.22
Rate for Payer: UHC Exchange	$911.22
Rate for Payer: UHCCP Medicaid	$544.85

Know your out-of-pocket cost for care.

All Charges