Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT

Professional

Both

$7,513.00

Service Code	HCPCS 61582
Min. Negotiated Rate	$1,962.58
Max. Negotiated Rate	$6,335.54
Rate for Payer: Aetna Commercial	$3,893.94
Rate for Payer: Aetna Medicare	$3,756.50
Rate for Payer: BCBS Complete	$2,060.71
Rate for Payer: BCN Commercial	$6,335.54
Rate for Payer: Cash Price	$6,010.40
Rate for Payer: Cash Price	$6,010.40
Rate for Payer: Mclaren Medicaid	$1,962.58
Rate for Payer: Meridian Medicaid	$2,060.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,634.75
Rate for Payer: Priority Health Choice Medicaid	$1,962.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,326.45
Rate for Payer: Priority Health Narrow/Tiered Network	$5,326.45
Rate for Payer: UHC Medicaid	$1,962.58
Rate for Payer: UHCCP Medicaid	$1,962.58

PR CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE

Professional

Both

$8,207.00

Service Code	HCPCS 61583
Min. Negotiated Rate	$1,864.39
Max. Negotiated Rate	$6,155.25
Rate for Payer: Aetna Commercial	$3,781.58
Rate for Payer: Aetna Medicare	$4,103.50
Rate for Payer: BCBS Complete	$1,957.61
Rate for Payer: BCN Commercial	$6,122.27
Rate for Payer: Cash Price	$6,565.60
Rate for Payer: Cash Price	$6,565.60
Rate for Payer: Mclaren Medicaid	$1,864.39
Rate for Payer: Meridian Medicaid	$1,957.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,155.25
Rate for Payer: Priority Health Choice Medicaid	$1,864.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,147.15
Rate for Payer: Priority Health Narrow/Tiered Network	$5,147.15
Rate for Payer: UHC Medicaid	$1,864.39
Rate for Payer: UHCCP Medicaid	$1,864.39

PR CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP

Professional

Both

$3,489.00

Service Code	HCPCS 61557
Min. Negotiated Rate	$1,066.92
Max. Negotiated Rate	$3,563.01
Rate for Payer: Aetna Commercial	$2,174.94
Rate for Payer: Aetna Medicare	$1,744.50
Rate for Payer: BCBS Complete	$1,120.27
Rate for Payer: BCN Commercial	$3,563.01
Rate for Payer: Cash Price	$2,791.20
Rate for Payer: Cash Price	$2,791.20
Rate for Payer: Mclaren Medicaid	$1,066.92
Rate for Payer: Meridian Medicaid	$1,120.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,616.75
Rate for Payer: Priority Health Choice Medicaid	$1,066.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,995.52
Rate for Payer: Priority Health Narrow/Tiered Network	$2,995.52
Rate for Payer: UHC Medicaid	$1,066.92
Rate for Payer: UHCCP Medicaid	$1,066.92

PR CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN

Professional

Both

$9,676.00

Service Code	HCPCS 61570
Min. Negotiated Rate	$1,168.94
Max. Negotiated Rate	$7,257.00
Rate for Payer: Aetna Commercial	$2,417.18
Rate for Payer: Aetna Medicare	$4,838.00
Rate for Payer: BCBS Complete	$1,227.39
Rate for Payer: BCN Commercial	$3,942.08
Rate for Payer: Cash Price	$7,740.80
Rate for Payer: Cash Price	$7,740.80
Rate for Payer: Mclaren Medicaid	$1,168.94
Rate for Payer: Meridian Medicaid	$1,227.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,257.00
Rate for Payer: Priority Health Choice Medicaid	$1,168.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,314.20
Rate for Payer: Priority Health Narrow/Tiered Network	$3,314.20
Rate for Payer: UHC Medicaid	$1,168.94
Rate for Payer: UHCCP Medicaid	$1,168.94

PR CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL

Professional

Both

$4,314.00

Service Code	HCPCS 61305
Min. Negotiated Rate	$1,249.88
Max. Negotiated Rate	$3,549.03
Rate for Payer: Aetna Commercial	$2,593.13
Rate for Payer: Aetna Medicare	$2,157.00
Rate for Payer: BCBS Complete	$1,312.37
Rate for Payer: BCN Commercial	$3,055.61
Rate for Payer: Cash Price	$3,451.20
Rate for Payer: Cash Price	$3,451.20
Rate for Payer: Mclaren Medicaid	$1,249.88
Rate for Payer: Meridian Medicaid	$1,312.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,235.50
Rate for Payer: Priority Health Choice Medicaid	$1,249.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,549.03
Rate for Payer: Priority Health Narrow/Tiered Network	$3,549.03
Rate for Payer: UHC Medicaid	$1,249.88
Rate for Payer: UHCCP Medicaid	$1,249.88

PR CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL

Professional

Both

$5,627.00

Service Code	HCPCS 61304
Min. Negotiated Rate	$1,026.02
Max. Negotiated Rate	$4,220.25
Rate for Payer: Aetna Commercial	$2,122.58
Rate for Payer: Aetna Medicare	$2,813.50
Rate for Payer: BCBS Complete	$1,077.32
Rate for Payer: BCN Commercial	$3,454.31
Rate for Payer: Cash Price	$4,501.60
Rate for Payer: Cash Price	$4,501.60
Rate for Payer: Mclaren Medicaid	$1,026.02
Rate for Payer: Meridian Medicaid	$1,077.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,220.25
Rate for Payer: Priority Health Choice Medicaid	$1,026.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,904.13
Rate for Payer: Priority Health Narrow/Tiered Network	$2,904.13
Rate for Payer: UHC Medicaid	$1,026.02
Rate for Payer: UHCCP Medicaid	$1,026.02

PR CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN

Professional

Both

$9,252.00

Service Code	HCPCS 61571
Min. Negotiated Rate	$1,239.45
Max. Negotiated Rate	$6,939.00
Rate for Payer: Aetna Commercial	$2,572.96
Rate for Payer: Aetna Medicare	$4,626.00
Rate for Payer: BCBS Complete	$1,301.42
Rate for Payer: BCN Commercial	$3,035.20
Rate for Payer: Cash Price	$7,401.60
Rate for Payer: Cash Price	$7,401.60
Rate for Payer: Mclaren Medicaid	$1,239.45
Rate for Payer: Meridian Medicaid	$1,301.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,939.00
Rate for Payer: Priority Health Choice Medicaid	$1,239.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,525.32
Rate for Payer: Priority Health Narrow/Tiered Network	$3,525.32
Rate for Payer: UHC Medicaid	$1,239.45
Rate for Payer: UHCCP Medicaid	$1,239.45

PR CRANIECTOMY FOR OSTEOMYELITIS

Professional

Both

$5,521.00

Service Code	HCPCS 61501
Min. Negotiated Rate	$673.51
Max. Negotiated Rate	$4,140.75
Rate for Payer: Aetna Commercial	$1,448.08
Rate for Payer: Aetna Medicare	$2,760.50
Rate for Payer: BCBS Complete	$707.19
Rate for Payer: BCN Commercial	$2,374.88
Rate for Payer: Cash Price	$4,416.80
Rate for Payer: Cash Price	$4,416.80
Rate for Payer: Mclaren Medicaid	$673.51
Rate for Payer: Meridian Medicaid	$707.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,140.75
Rate for Payer: Priority Health Choice Medicaid	$673.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,996.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,996.62
Rate for Payer: UHC Medicaid	$673.51
Rate for Payer: UHCCP Medicaid	$673.51

PR CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NRV

Professional

Both

$6,490.00

Service Code	HCPCS 61460
Min. Negotiated Rate	$1,306.12
Max. Negotiated Rate	$4,867.50
Rate for Payer: Aetna Commercial	$2,721.64
Rate for Payer: Aetna Medicare	$3,245.00
Rate for Payer: BCBS Complete	$1,371.43
Rate for Payer: BCN Commercial	$4,430.54
Rate for Payer: Cash Price	$5,192.00
Rate for Payer: Cash Price	$5,192.00
Rate for Payer: Mclaren Medicaid	$1,306.12
Rate for Payer: Meridian Medicaid	$1,371.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,867.50
Rate for Payer: Priority Health Choice Medicaid	$1,306.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,724.86
Rate for Payer: Priority Health Narrow/Tiered Network	$3,724.86
Rate for Payer: UHC Medicaid	$1,306.12
Rate for Payer: UHCCP Medicaid	$1,306.12

PR CRANIECTOMY W/EXCISION TUMOR/OTH BONE LESION SKL

Professional

Both

$2,821.00

Service Code	HCPCS 61500
Min. Negotiated Rate	$764.46
Max. Negotiated Rate	$2,714.74
Rate for Payer: Aetna Commercial	$1,684.10
Rate for Payer: Aetna Medicare	$1,410.50
Rate for Payer: BCBS Complete	$802.68
Rate for Payer: BCN Commercial	$2,714.74
Rate for Payer: Cash Price	$2,256.80
Rate for Payer: Cash Price	$2,256.80
Rate for Payer: Mclaren Medicaid	$764.46
Rate for Payer: Meridian Medicaid	$802.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,115.75
Rate for Payer: Priority Health Choice Medicaid	$764.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,282.34
Rate for Payer: Priority Health Narrow/Tiered Network	$2,282.34
Rate for Payer: UHC Medicaid	$764.46
Rate for Payer: UHCCP Medicaid	$764.46

PR CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ

Professional

Both

$5,471.00

Service Code	HCPCS 61580
Min. Negotiated Rate	$1,414.75
Max. Negotiated Rate	$4,329.30
Rate for Payer: Aetna Commercial	$3,215.20
Rate for Payer: Aetna Medicare	$2,735.50
Rate for Payer: BCBS Complete	$1,485.49
Rate for Payer: BCN Commercial	$3,727.39
Rate for Payer: Cash Price	$4,376.80
Rate for Payer: Cash Price	$4,376.80
Rate for Payer: Mclaren Medicaid	$1,414.75
Rate for Payer: Meridian Medicaid	$1,485.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,103.25
Rate for Payer: Priority Health Choice Medicaid	$1,414.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,329.30
Rate for Payer: Priority Health Narrow/Tiered Network	$4,329.30
Rate for Payer: UHC Medicaid	$1,414.75
Rate for Payer: UHCCP Medicaid	$1,414.75

PR CRANIOPLASTY SKULL DEFECT <5 CM DIAMETER

Professional

Both

$5,502.00

Service Code	HCPCS 62140
Min. Negotiated Rate	$624.30
Max. Negotiated Rate	$4,126.50
Rate for Payer: Aetna Commercial	$1,313.67
Rate for Payer: Aetna Medicare	$2,751.00
Rate for Payer: BCBS Complete	$655.51
Rate for Payer: BCN Commercial	$2,154.04
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Mclaren Medicaid	$624.30
Rate for Payer: Meridian Medicaid	$655.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,126.50
Rate for Payer: Priority Health Choice Medicaid	$624.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,810.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,810.96
Rate for Payer: UHC Medicaid	$624.30
Rate for Payer: UHCCP Medicaid	$624.30

PR CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER

Professional

Both

$6,553.00

Service Code	HCPCS 62141
Min. Negotiated Rate	$711.42
Max. Negotiated Rate	$4,914.75
Rate for Payer: Aetna Commercial	$1,476.78
Rate for Payer: Aetna Medicare	$3,276.50
Rate for Payer: BCBS Complete	$746.99
Rate for Payer: BCN Commercial	$2,415.47
Rate for Payer: Cash Price	$5,242.40
Rate for Payer: Cash Price	$5,242.40
Rate for Payer: Mclaren Medicaid	$711.42
Rate for Payer: Meridian Medicaid	$746.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,914.75
Rate for Payer: Priority Health Choice Medicaid	$711.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,030.75
Rate for Payer: Priority Health Narrow/Tiered Network	$2,030.75
Rate for Payer: UHC Medicaid	$711.42
Rate for Payer: UHCCP Medicaid	$711.42

PR CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG

Professional

Both

$6,166.00

Service Code	HCPCS 62145
Min. Negotiated Rate	$871.17
Max. Negotiated Rate	$4,624.50
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: Aetna Medicare	$3,083.00
Rate for Payer: BCBS Complete	$914.73
Rate for Payer: BCN Commercial	$2,137.83
Rate for Payer: Cash Price	$4,932.80
Rate for Payer: Cash Price	$4,932.80
Rate for Payer: Mclaren Medicaid	$871.17
Rate for Payer: Meridian Medicaid	$914.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,624.50
Rate for Payer: Priority Health Choice Medicaid	$871.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,483.06
Rate for Payer: Priority Health Narrow/Tiered Network	$2,483.06
Rate for Payer: UHC Medicaid	$871.17
Rate for Payer: UHCCP Medicaid	$871.17

PR CRANIOPLASTY W/AUTOGRAFT <5 CM DIAMETER

Professional

Both

$6,568.00

Service Code	HCPCS 62146
Min. Negotiated Rate	$792.79
Max. Negotiated Rate	$4,926.00
Rate for Payer: Aetna Commercial	$1,615.24
Rate for Payer: Aetna Medicare	$3,284.00
Rate for Payer: BCBS Complete	$832.43
Rate for Payer: BCN Commercial	$2,643.88
Rate for Payer: Cash Price	$5,254.40
Rate for Payer: Cash Price	$5,254.40
Rate for Payer: Mclaren Medicaid	$792.79
Rate for Payer: Meridian Medicaid	$832.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,926.00
Rate for Payer: Priority Health Choice Medicaid	$792.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,222.78
Rate for Payer: Priority Health Narrow/Tiered Network	$2,222.78
Rate for Payer: UHC Medicaid	$792.79
Rate for Payer: UHCCP Medicaid	$792.79

PR CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER

Professional

Both

$7,515.00

Service Code	HCPCS 62147
Min. Negotiated Rate	$868.83
Max. Negotiated Rate	$5,636.25
Rate for Payer: Aetna Commercial	$1,834.50
Rate for Payer: Aetna Medicare	$3,757.50
Rate for Payer: BCBS Complete	$912.27
Rate for Payer: BCN Commercial	$3,007.82
Rate for Payer: Cash Price	$6,012.00
Rate for Payer: Cash Price	$6,012.00
Rate for Payer: Mclaren Medicaid	$868.83
Rate for Payer: Meridian Medicaid	$912.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,636.25
Rate for Payer: Priority Health Choice Medicaid	$868.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,528.75
Rate for Payer: Priority Health Narrow/Tiered Network	$2,528.75
Rate for Payer: UHC Medicaid	$868.83
Rate for Payer: UHCCP Medicaid	$868.83

PR CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG

Professional

Both

$8,102.00

Service Code	HCPCS 61540
Min. Negotiated Rate	$1,348.08
Max. Negotiated Rate	$6,076.50
Rate for Payer: Aetna Commercial	$2,815.85
Rate for Payer: Aetna Medicare	$4,051.00
Rate for Payer: BCBS Complete	$1,415.48
Rate for Payer: BCN Commercial	$3,311.57
Rate for Payer: Cash Price	$6,481.60
Rate for Payer: Cash Price	$6,481.60
Rate for Payer: Mclaren Medicaid	$1,348.08
Rate for Payer: Meridian Medicaid	$1,415.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,076.50
Rate for Payer: Priority Health Choice Medicaid	$1,348.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,846.33
Rate for Payer: Priority Health Narrow/Tiered Network	$3,846.33
Rate for Payer: UHC Medicaid	$1,348.08
Rate for Payer: UHCCP Medicaid	$1,348.08

PR CRANIOTOMY EXCISION CRANIOPHARYNGIOMA

Professional

Both

$6,897.00

Service Code	HCPCS 61545
Min. Negotiated Rate	$1,956.83
Max. Negotiated Rate	$6,687.78
Rate for Payer: Aetna Commercial	$4,116.77
Rate for Payer: Aetna Medicare	$3,448.50
Rate for Payer: BCBS Complete	$2,054.67
Rate for Payer: BCN Commercial	$6,687.78
Rate for Payer: Cash Price	$5,517.60
Rate for Payer: Cash Price	$5,517.60
Rate for Payer: Mclaren Medicaid	$1,956.83
Rate for Payer: Meridian Medicaid	$2,054.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,172.75
Rate for Payer: Priority Health Choice Medicaid	$1,956.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,622.58
Rate for Payer: Priority Health Narrow/Tiered Network	$5,622.58
Rate for Payer: UHC Medicaid	$1,956.83
Rate for Payer: UHCCP Medicaid	$1,956.83

PR CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE

Professional

Both

$5,780.00

Service Code	HCPCS 62121
Min. Negotiated Rate	$913.98
Max. Negotiated Rate	$4,335.00
Rate for Payer: Aetna Commercial	$2,019.44
Rate for Payer: Aetna Medicare	$2,890.00
Rate for Payer: BCBS Complete	$959.68
Rate for Payer: BCN Commercial	$2,333.54
Rate for Payer: Cash Price	$4,624.00
Rate for Payer: Cash Price	$4,624.00
Rate for Payer: Mclaren Medicaid	$913.98
Rate for Payer: Meridian Medicaid	$959.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,335.00
Rate for Payer: Priority Health Choice Medicaid	$913.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,710.37
Rate for Payer: Priority Health Narrow/Tiered Network	$2,710.37
Rate for Payer: UHC Medicaid	$913.98
Rate for Payer: UHCCP Medicaid	$913.98

PR CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY

Professional

Both

$7,279.00

Service Code	HCPCS 61537
Min. Negotiated Rate	$1,501.86
Max. Negotiated Rate	$5,459.25
Rate for Payer: Aetna Commercial	$3,184.49
Rate for Payer: Aetna Medicare	$3,639.50
Rate for Payer: BCBS Complete	$1,576.95
Rate for Payer: BCN Commercial	$3,729.87
Rate for Payer: Cash Price	$5,823.20
Rate for Payer: Cash Price	$5,823.20
Rate for Payer: Mclaren Medicaid	$1,501.86
Rate for Payer: Meridian Medicaid	$1,576.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,459.25
Rate for Payer: Priority Health Choice Medicaid	$1,501.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,332.18
Rate for Payer: Priority Health Narrow/Tiered Network	$4,332.18
Rate for Payer: UHC Medicaid	$1,501.86
Rate for Payer: UHCCP Medicaid	$1,501.86

PR CRICOPHARYNGEAL MYOTOMY

Professional

Both

$2,353.00

Service Code	HCPCS 43030
Min. Negotiated Rate	$297.56
Max. Negotiated Rate	$1,764.75
Rate for Payer: Aetna Commercial	$688.64
Rate for Payer: Aetna Medicare	$1,176.50
Rate for Payer: BCBS Complete	$312.44
Rate for Payer: BCN Commercial	$792.29
Rate for Payer: Cash Price	$1,882.40
Rate for Payer: Cash Price	$1,882.40
Rate for Payer: Mclaren Medicaid	$297.56
Rate for Payer: Meridian Medicaid	$312.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,764.75
Rate for Payer: Priority Health Choice Medicaid	$297.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$965.35
Rate for Payer: Priority Health Narrow/Tiered Network	$965.35
Rate for Payer: UHC Medicaid	$297.56
Rate for Payer: UHCCP Medicaid	$297.56

PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN

Professional

Both

$222.00

Service Code	HCPCS 99292
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$109.66
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Complete	$67.09
Rate for Payer: BCN Commercial	$158.36
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Mclaren Medicaid	$63.90
Rate for Payer: Meridian Medicaid	$67.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50
Rate for Payer: Priority Health Choice Medicaid	$63.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.44
Rate for Payer: Priority Health Narrow/Tiered Network	$142.44
Rate for Payer: UHC Medicaid	$63.90
Rate for Payer: UHCCP Medicaid	$63.90

PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN

Professional

Both

$490.00

Service Code	HCPCS 99291
Min. Negotiated Rate	$126.95
Max. Negotiated Rate	$414.84
Rate for Payer: Aetna Commercial	$218.32
Rate for Payer: Aetna Medicare	$245.00
Rate for Payer: BCBS Complete	$133.30
Rate for Payer: BCN Commercial	$316.71
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Mclaren Medicaid	$126.95
Rate for Payer: Meridian Medicaid	$133.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$367.50
Rate for Payer: Priority Health Choice Medicaid	$126.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$414.84
Rate for Payer: Priority Health Narrow/Tiered Network	$414.84
Rate for Payer: UHC Medicaid	$126.95
Rate for Payer: UHCCP Medicaid	$126.95

PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN

Professional

Both

$599.00

Service Code	HCPCS 99466
Min. Negotiated Rate	$234.41
Max. Negotiated Rate	$449.25
Rate for Payer: Aetna Commercial	$234.41
Rate for Payer: Aetna Medicare	$299.50
Rate for Payer: BCBS Complete	$239.60
Rate for Payer: BCN Commercial	$340.62
Rate for Payer: Cash Price	$479.20
Rate for Payer: Cash Price	$479.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$449.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$306.39
Rate for Payer: Priority Health Narrow/Tiered Network	$306.39

PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN

Professional

Both

$250.00

Service Code	HCPCS 99467
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$117.37
Rate for Payer: Aetna Medicare	$125.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: BCN Commercial	$170.81
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$187.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$153.65
Rate for Payer: Priority Health Narrow/Tiered Network	$153.65

Know your out-of-pocket cost for care.

All Charges