Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR PRO HEALTH FIT FOR DUTY EXAM

Facility

$229.50

Service Code	CPT 99215
Hospital Charge Code	51000038
Hospital Revenue Code	510
Min. Negotiated Rate	$149.18
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$206.55
Rate for Payer: ASR ASR	$222.62
Rate for Payer: ASR Commercial	$222.62
Rate for Payer: BCBS Trust/PPO	$187.02
Rate for Payer: BCN Commercial	$177.93
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Healthscope Whirlpool	$222.62
Rate for Payer: Mclaren Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: Nomi Health Commercial	$188.19
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.96

PR PRO HEALTH FIT FOR DUTY EXAM

Facility

$229.50

Service Code	CPT 99215
Hospital Charge Code	51000038
Hospital Revenue Code	510
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$229.50
Rate for Payer: Aetna Commercial	$206.55
Rate for Payer: Aetna Medicare	$114.75
Rate for Payer: ASR ASR	$222.62
Rate for Payer: ASR Commercial	$222.62
Rate for Payer: BCBS Complete	$91.80
Rate for Payer: BCBS Trust/PPO	$187.94
Rate for Payer: BCN Commercial	$177.93
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$183.60
Rate for Payer: Healthscope Commercial	$229.50
Rate for Payer: Healthscope Whirlpool	$222.62
Rate for Payer: Mclaren Commercial	$206.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.07
Rate for Payer: Nomi Health Commercial	$188.19
Rate for Payer: Priority Health Cigna Priority Health	$149.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$201.09
Rate for Payer: Priority Health Narrow Network	$160.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$201.96

PR PRO HEALTH LIFT TEST

Facility

$51.00

Service Code	CPT 99212
Hospital Charge Code	51000023
Hospital Revenue Code	510
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: ASR ASR	$49.47
Rate for Payer: ASR Commercial	$49.47
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS Trust/PPO	$41.76
Rate for Payer: BCN Commercial	$39.54
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$47.94
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$51.00
Rate for Payer: Healthscope Whirlpool	$49.47
Rate for Payer: Mclaren Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Nomi Health Commercial	$41.82
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.69
Rate for Payer: Priority Health Narrow Network	$35.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.88

PR PRO HEALTH LIFT TEST

Facility

$51.00

Service Code	CPT 99212
Hospital Charge Code	51000023
Hospital Revenue Code	510
Min. Negotiated Rate	$33.15
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$45.90
Rate for Payer: ASR ASR	$49.47
Rate for Payer: ASR Commercial	$49.47
Rate for Payer: BCBS Trust/PPO	$41.56
Rate for Payer: BCN Commercial	$39.54
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$47.94
Rate for Payer: Encore Health Key Benefits Commercial	$40.80
Rate for Payer: Healthscope Commercial	$51.00
Rate for Payer: Healthscope Whirlpool	$49.47
Rate for Payer: Mclaren Commercial	$45.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.35
Rate for Payer: Nomi Health Commercial	$41.82
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.88

PR PRO HEALTH NURSE VISIT

Facility

$32.64

Service Code	CPT 99211
Hospital Charge Code	51000017
Hospital Revenue Code	510
Min. Negotiated Rate	$21.22
Max. Negotiated Rate	$32.64
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: ASR ASR	$31.66
Rate for Payer: ASR Commercial	$31.66
Rate for Payer: BCBS Trust/PPO	$26.60
Rate for Payer: BCN Commercial	$25.31
Rate for Payer: Cash Price	$26.11
Rate for Payer: Cofinity Commercial	$30.68
Rate for Payer: Encore Health Key Benefits Commercial	$26.11
Rate for Payer: Healthscope Commercial	$32.64
Rate for Payer: Healthscope Whirlpool	$31.66
Rate for Payer: Mclaren Commercial	$29.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.74
Rate for Payer: Nomi Health Commercial	$26.76
Rate for Payer: Priority Health Cigna Priority Health	$21.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$28.72

PR PRO HEALTH NURSE VISIT

Facility

$32.64

Service Code	CPT 99211
Hospital Charge Code	51000017
Hospital Revenue Code	510
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$32.64
Rate for Payer: Aetna Commercial	$29.38
Rate for Payer: Aetna Medicare	$16.32
Rate for Payer: ASR ASR	$31.66
Rate for Payer: ASR Commercial	$31.66
Rate for Payer: BCBS Complete	$13.06
Rate for Payer: BCBS Trust/PPO	$26.73
Rate for Payer: BCN Commercial	$25.31
Rate for Payer: Cash Price	$26.11
Rate for Payer: Cofinity Commercial	$30.68
Rate for Payer: Encore Health Key Benefits Commercial	$26.11
Rate for Payer: Healthscope Commercial	$32.64
Rate for Payer: Healthscope Whirlpool	$31.66
Rate for Payer: Mclaren Commercial	$29.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.74
Rate for Payer: Nomi Health Commercial	$26.76
Rate for Payer: Priority Health Cigna Priority Health	$21.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.60
Rate for Payer: Priority Health Narrow Network	$22.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$28.72

PR PRO HEALTH PHYSICAL AGILITY TEST

Facility

$71.40

Service Code	CPT 99213
Hospital Charge Code	51000028
Hospital Revenue Code	510
Min. Negotiated Rate	$46.41
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Trust/PPO	$58.18
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

PR PRO HEALTH PHYSICAL AGILITY TEST

Facility

$71.40

Service Code	CPT 99213
Hospital Charge Code	51000028
Hospital Revenue Code	510
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$71.40
Rate for Payer: Aetna Commercial	$64.26
Rate for Payer: Aetna Medicare	$35.70
Rate for Payer: ASR ASR	$69.26
Rate for Payer: ASR Commercial	$69.26
Rate for Payer: BCBS Complete	$28.56
Rate for Payer: BCBS Trust/PPO	$58.47
Rate for Payer: BCN Commercial	$55.36
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$67.12
Rate for Payer: Encore Health Key Benefits Commercial	$57.12
Rate for Payer: Healthscope Commercial	$71.40
Rate for Payer: Healthscope Whirlpool	$69.26
Rate for Payer: Mclaren Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.69
Rate for Payer: Nomi Health Commercial	$58.55
Rate for Payer: Priority Health Cigna Priority Health	$46.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.56
Rate for Payer: Priority Health Narrow Network	$50.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$62.83

PR PRO HEALTH VISION TESTING

Facility

$25.50

Service Code	CPT 99211
Hospital Charge Code	51000018
Hospital Revenue Code	510
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$22.95
Rate for Payer: ASR ASR	$24.73
Rate for Payer: ASR Commercial	$24.73
Rate for Payer: BCBS Trust/PPO	$20.78
Rate for Payer: BCN Commercial	$19.77
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$23.97
Rate for Payer: Encore Health Key Benefits Commercial	$20.40
Rate for Payer: Healthscope Commercial	$25.50
Rate for Payer: Healthscope Whirlpool	$24.73
Rate for Payer: Mclaren Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.68
Rate for Payer: Nomi Health Commercial	$20.91
Rate for Payer: Priority Health Cigna Priority Health	$16.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.44

PR PRO HEALTH VISION TESTING

Facility

$25.50

Service Code	CPT 99211
Hospital Charge Code	51000018
Hospital Revenue Code	510
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$22.95
Rate for Payer: Aetna Medicare	$12.75
Rate for Payer: ASR ASR	$24.73
Rate for Payer: ASR Commercial	$24.73
Rate for Payer: BCBS Complete	$10.20
Rate for Payer: BCBS Trust/PPO	$20.88
Rate for Payer: BCN Commercial	$19.77
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$23.97
Rate for Payer: Encore Health Key Benefits Commercial	$20.40
Rate for Payer: Healthscope Commercial	$25.50
Rate for Payer: Healthscope Whirlpool	$24.73
Rate for Payer: Mclaren Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.68
Rate for Payer: Nomi Health Commercial	$20.91
Rate for Payer: Priority Health Cigna Priority Health	$16.57
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22.34
Rate for Payer: Priority Health Narrow Network	$17.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.44

PR PROHEALTH WORKSTATION EVAL

Facility

$102.00

Hospital Charge Code	98300182
Hospital Revenue Code	983
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: ASR ASR	$98.94
Rate for Payer: ASR Commercial	$98.94
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$83.53
Rate for Payer: BCN Commercial	$79.08
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$95.88
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$102.00
Rate for Payer: Healthscope Whirlpool	$98.94
Rate for Payer: Mclaren Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: Nomi Health Commercial	$83.64
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$89.37
Rate for Payer: Priority Health Narrow Network	$71.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$89.76

PR PROHEALTH WORKSTATION EVAL

Facility

$102.00

Hospital Charge Code	98300182
Hospital Revenue Code	983
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$91.80
Rate for Payer: ASR ASR	$98.94
Rate for Payer: ASR Commercial	$98.94
Rate for Payer: BCBS Trust/PPO	$83.12
Rate for Payer: BCN Commercial	$79.08
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cofinity Commercial	$95.88
Rate for Payer: Encore Health Key Benefits Commercial	$81.60
Rate for Payer: Healthscope Commercial	$102.00
Rate for Payer: Healthscope Whirlpool	$98.94
Rate for Payer: Mclaren Commercial	$91.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.70
Rate for Payer: Nomi Health Commercial	$83.64
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$89.76

PR PROLNG E/M BEFORE&/AFTER DIR CARE EA 30 MINUTES

Professional

Both

$121.00

Service Code	HCPCS 99359
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$78.65
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$78.65

PR PROLNG E/M SVC BEFORE&/AFTER DIR PT CARE 1ST HR

Professional

Both

$242.00

Service Code	HCPCS 99358
Min. Negotiated Rate	$96.80
Max. Negotiated Rate	$157.30
Rate for Payer: Aetna Medicare	$121.00
Rate for Payer: BCBS Complete	$96.80
Rate for Payer: Cash Price	$193.60
Rate for Payer: Priority Health Cigna Priority Health	$157.30

PR PROLONGED EXTRACORPOREAL CIRCULATION INIT DAY

Professional

Both

$2,772.00

Service Code	HCPCS 33960
Min. Negotiated Rate	$1,108.80
Max. Negotiated Rate	$1,801.80
Rate for Payer: Aetna Medicare	$1,386.00
Rate for Payer: BCBS Complete	$1,108.80
Rate for Payer: Cash Price	$2,217.60
Rate for Payer: Priority Health Cigna Priority Health	$1,801.80

PR PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN

Professional

Both

$79.00

Service Code	HCPCS 99418
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$51.35
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: Cash Price	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$51.35

PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES

Professional

Both

$66.00

Service Code	HCPCS 99417
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$42.90
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$42.90

PR PROLONGED SVC I/P OR OBS SETTING 1ST HOUR

Professional

Both

$303.00

Service Code	HCPCS 99356
Min. Negotiated Rate	$121.20
Max. Negotiated Rate	$196.95
Rate for Payer: Aetna Medicare	$151.50
Rate for Payer: BCBS Complete	$121.20
Rate for Payer: Cash Price	$242.40
Rate for Payer: Priority Health Cigna Priority Health	$196.95

PR PROLONGED SVC I/P OR OBS SETTING EA ADDL 30 MIN

Professional

Both

$160.00

Service Code	HCPCS 99357
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Priority Health Cigna Priority Health	$104.00

PR PROLONGED SVC OUTPATIENT SETTING 1ST HOUR

Professional

Both

$233.00

Service Code	HCPCS 99354
Min. Negotiated Rate	$93.20
Max. Negotiated Rate	$151.45
Rate for Payer: Aetna Medicare	$116.50
Rate for Payer: BCBS Complete	$93.20
Rate for Payer: Cash Price	$186.40
Rate for Payer: Priority Health Cigna Priority Health	$151.45

PR PROLONGED SVC OUTPATIENT SETTING EA ADDL 30 MIN

Professional

Both

$173.00

Service Code	HCPCS 99355
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$112.45
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: Cash Price	$138.40
Rate for Payer: Priority Health Cigna Priority Health	$112.45

PR PROLONG INPT EVAL ADD15 M

Professional

Both

$63.00

Service Code	HCPCS G0316
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$41.63
Rate for Payer: Aetna Commercial	$38.74
Rate for Payer: Aetna Medicare	$28.91
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCBS MAPPO	$28.91
Rate for Payer: BCN Medicare Advantage	$28.91
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cofinity Commercial	$41.63
Rate for Payer: Cofinity Commercial	$38.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.91
Rate for Payer: Healthscope Commercial	$34.69
Rate for Payer: Healthscope Whirlpool	$34.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.36
Rate for Payer: Nomi Health Commercial	$34.69
Rate for Payer: PACE SWMI	$28.91
Rate for Payer: PHP Medicare Advantage	$28.91
Rate for Payer: Priority Health Cigna Priority Health	$40.95
Rate for Payer: Priority Health Medicare	$28.91
Rate for Payer: UHC Dual Complete DSNP	$28.91
Rate for Payer: UHC Medicare Advantage	$28.91
Rate for Payer: UHCCP DNSP	$28.91

PR PROLONG OUTPT/OFFICE VIS

Professional

Both

$66.00

Service Code	HCPCS G2212
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$42.90
Rate for Payer: Aetna Commercial	$39.14
Rate for Payer: Aetna Medicare	$29.21
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: BCBS MAPPO	$29.21
Rate for Payer: BCN Medicare Advantage	$29.21
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cofinity Commercial	$42.06
Rate for Payer: Cofinity Commercial	$39.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$29.21
Rate for Payer: Healthscope Commercial	$35.05
Rate for Payer: Healthscope Whirlpool	$35.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.67
Rate for Payer: Nomi Health Commercial	$35.05
Rate for Payer: PACE SWMI	$29.21
Rate for Payer: PHP Medicare Advantage	$29.21
Rate for Payer: Priority Health Cigna Priority Health	$42.90
Rate for Payer: Priority Health Medicare	$29.21
Rate for Payer: UHC Dual Complete DSNP	$29.21
Rate for Payer: UHC Medicare Advantage	$29.21
Rate for Payer: UHCCP DNSP	$29.21

PR PROMETHAZINE HCL INJECTION

Professional

Both

$15.00

Service Code	HCPCS J2550
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Commercial	$3.95
Rate for Payer: Aetna Medicare	$2.95
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS MAPPO	$2.95
Rate for Payer: BCN Medicare Advantage	$2.95
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cofinity Commercial	$4.25
Rate for Payer: Cofinity Commercial	$3.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$2.95
Rate for Payer: Healthscope Commercial	$3.54
Rate for Payer: Healthscope Whirlpool	$3.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3.10
Rate for Payer: Nomi Health Commercial	$3.54
Rate for Payer: PACE SWMI	$2.95
Rate for Payer: PHP Medicare Advantage	$2.95
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: Priority Health Medicare	$2.95
Rate for Payer: UHC Dual Complete DSNP	$2.95
Rate for Payer: UHC Medicare Advantage	$2.95
Rate for Payer: UHCCP DNSP	$2.95

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR

Professional

Both

$2,782.00

Service Code	HCPCS 27495
Min. Negotiated Rate	$1,088.89
Max. Negotiated Rate	$1,808.30
Rate for Payer: Aetna Commercial	$1,459.11
Rate for Payer: Aetna Medicare	$1,088.89
Rate for Payer: BCBS Complete	$1,112.80
Rate for Payer: BCBS MAPPO	$1,088.89
Rate for Payer: BCN Medicare Advantage	$1,088.89
Rate for Payer: Cash Price	$2,225.60
Rate for Payer: Cash Price	$2,225.60
Rate for Payer: Cofinity Commercial	$1,568.00
Rate for Payer: Cofinity Commercial	$1,459.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,088.89
Rate for Payer: Healthscope Commercial	$1,306.67
Rate for Payer: Healthscope Whirlpool	$1,306.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,143.33
Rate for Payer: Nomi Health Commercial	$1,306.67
Rate for Payer: PACE SWMI	$1,088.89
Rate for Payer: PHP Medicare Advantage	$1,088.89
Rate for Payer: Priority Health Cigna Priority Health	$1,808.30
Rate for Payer: Priority Health Medicare	$1,088.89
Rate for Payer: UHC Dual Complete DSNP	$1,088.89
Rate for Payer: UHC Medicare Advantage	$1,088.89
Rate for Payer: UHCCP DNSP	$1,088.89

Know your out-of-pocket cost for care.

All Charges