Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$116.00

Service Code	HCPCS 96401
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$1,111.54
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: Aetna Medicare	$58.00
Rate for Payer: BCBS Complete	$46.40
Rate for Payer: BCBS Trust/PPO	$1,111.54
Rate for Payer: BCN Commercial	$106.04
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Priority Health Cigna Priority Health	$75.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.25
Rate for Payer: Priority Health Narrow Network	$97.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$73.44
Rate for Payer: UHC Exchange	$73.44

PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT

Professional

Both

$284.00

Service Code	HCPCS 96542
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$1,570.64
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: Aetna Medicare	$142.00
Rate for Payer: BCBS Complete	$27.51
Rate for Payer: BCBS Trust/PPO	$1,570.64
Rate for Payer: BCN Commercial	$189.12
Rate for Payer: Cash Price	$227.20
Rate for Payer: Cash Price	$227.20
Rate for Payer: Meridian Medicaid	$27.51
Rate for Payer: Priority Health Choice Medicaid	$26.20
Rate for Payer: Priority Health Cigna Priority Health	$184.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.54
Rate for Payer: Priority Health Narrow Network	$56.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$48.52
Rate for Payer: UHC Exchange	$48.52
Rate for Payer: UHCCP Medicaid	$26.20

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS

Professional

Both

$62.00

Service Code	HCPCS 98941
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$583.77
Rate for Payer: Aetna Commercial	$29.14
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCBS Trust/PPO	$583.77
Rate for Payer: BCN Commercial	$38.50
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: Priority Health HMO/PPO/Tiered Network	$45.23
Rate for Payer: Priority Health Narrow Network	$45.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.53
Rate for Payer: UHC Exchange	$30.53

PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

Professional

Both

$150.00

Service Code	HCPCS 50688
Min. Negotiated Rate	$50.06
Max. Negotiated Rate	$2,900.37
Rate for Payer: Aetna Commercial	$97.34
Rate for Payer: Aetna Medicare	$75.00
Rate for Payer: BCBS Complete	$52.56
Rate for Payer: BCBS Trust/PPO	$2,900.37
Rate for Payer: BCN Commercial	$111.42
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Meridian Medicaid	$52.56
Rate for Payer: Priority Health Choice Medicaid	$50.06
Rate for Payer: Priority Health Cigna Priority Health	$97.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.02
Rate for Payer: Priority Health Narrow Network	$123.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$94.53
Rate for Payer: UHC Exchange	$94.53
Rate for Payer: UHCCP Medicaid	$50.06

PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,120.00

Service Code	HCPCS 47620
Min. Negotiated Rate	$521.43
Max. Negotiated Rate	$2,459.75
Rate for Payer: Aetna Commercial	$1,866.04
Rate for Payer: Aetna Medicare	$1,060.00
Rate for Payer: BCBS Complete	$926.13
Rate for Payer: BCBS Trust/PPO	$521.43
Rate for Payer: BCN Commercial	$2,007.00
Rate for Payer: Cash Price	$1,696.00
Rate for Payer: Cash Price	$1,696.00
Rate for Payer: Meridian Medicaid	$926.13
Rate for Payer: Priority Health Choice Medicaid	$882.03
Rate for Payer: Priority Health Cigna Priority Health	$1,378.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,459.75
Rate for Payer: Priority Health Narrow Network	$2,459.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,659.54
Rate for Payer: UHC Exchange	$1,659.54
Rate for Payer: UHCCP Medicaid	$882.03

PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

Professional

Both

$2,644.00

Service Code	HCPCS 47741
Min. Negotiated Rate	$446.41
Max. Negotiated Rate	$2,641.72
Rate for Payer: Aetna Commercial	$2,001.81
Rate for Payer: Aetna Medicare	$1,322.00
Rate for Payer: BCBS Complete	$994.79
Rate for Payer: BCBS Trust/PPO	$446.41
Rate for Payer: BCN Commercial	$2,155.07
Rate for Payer: Cash Price	$2,115.20
Rate for Payer: Cash Price	$2,115.20
Rate for Payer: Meridian Medicaid	$994.79
Rate for Payer: Priority Health Choice Medicaid	$947.42
Rate for Payer: Priority Health Cigna Priority Health	$1,718.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,641.72
Rate for Payer: Priority Health Narrow Network	$2,641.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,767.08
Rate for Payer: UHC Exchange	$1,767.08
Rate for Payer: UHCCP Medicaid	$947.42

PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

Professional

Both

$2,623.00

Service Code	HCPCS 47480
Min. Negotiated Rate	$566.79
Max. Negotiated Rate	$1,704.95
Rate for Payer: Aetna Commercial	$1,185.52
Rate for Payer: Aetna Medicare	$1,311.50
Rate for Payer: BCBS Complete	$595.13
Rate for Payer: BCBS Trust/PPO	$1,405.28
Rate for Payer: BCN Commercial	$1,283.75
Rate for Payer: Cash Price	$2,098.40
Rate for Payer: Cash Price	$2,098.40
Rate for Payer: Meridian Medicaid	$595.13
Rate for Payer: Priority Health Choice Medicaid	$566.79
Rate for Payer: Priority Health Cigna Priority Health	$1,704.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,572.62
Rate for Payer: Priority Health Narrow Network	$1,572.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,029.01
Rate for Payer: UHC Exchange	$1,029.01
Rate for Payer: UHCCP Medicaid	$566.79

PR CHOLECYSTECTOMY

Professional

Both

$2,617.00

Service Code	HCPCS 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$690.12
Max. Negotiated Rate	$2,558.03
Rate for Payer: Aetna Commercial	$1,444.32
Rate for Payer: Aetna Medicare	$1,308.50
Rate for Payer: BCBS Complete	$724.63
Rate for Payer: BCBS Trust/PPO	$2,558.03
Rate for Payer: BCN Commercial	$1,562.79
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Meridian Medicaid	$724.63
Rate for Payer: Priority Health Choice Medicaid	$690.12
Rate for Payer: Priority Health Cigna Priority Health	$1,701.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,919.24
Rate for Payer: Priority Health Narrow Network	$1,919.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,289.51
Rate for Payer: UHC Exchange	$1,289.51
Rate for Payer: UHCCP Medicaid	$690.12

PR CHOLECYSTECTOMY

Facility

$2,617.00

Service Code	CPT 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$1,701.05
Max. Negotiated Rate	$2,617.00
Rate for Payer: Aetna Commercial	$2,355.30
Rate for Payer: ASR ASR	$2,538.49
Rate for Payer: ASR Commercial	$2,538.49
Rate for Payer: BCBS Trust/PPO	$2,132.59
Rate for Payer: BCN Commercial	$2,028.96
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Cofinity Commercial	$2,459.98
Rate for Payer: Encore Health Key Benefits Commercial	$2,093.60
Rate for Payer: Healthscope Commercial	$2,617.00
Rate for Payer: Healthscope Whirlpool	$2,538.49
Rate for Payer: Mclaren Commercial	$2,355.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,224.45
Rate for Payer: Nomi Health Commercial	$2,145.94
Rate for Payer: Priority Health Cigna Priority Health	$1,701.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,302.96

PR CHOLECYSTECTOMY

Professional

Both

$2,617.00

Service Code	HCPCS 47600
Min. Negotiated Rate	$690.12
Max. Negotiated Rate	$2,558.03
Rate for Payer: Aetna Commercial	$1,444.32
Rate for Payer: Aetna Medicare	$1,308.50
Rate for Payer: BCBS Complete	$724.63
Rate for Payer: BCBS Trust/PPO	$2,558.03
Rate for Payer: BCN Commercial	$1,562.79
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Meridian Medicaid	$724.63
Rate for Payer: Priority Health Choice Medicaid	$690.12
Rate for Payer: Priority Health Cigna Priority Health	$1,701.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,919.24
Rate for Payer: Priority Health Narrow Network	$1,919.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,289.51
Rate for Payer: UHC Exchange	$1,289.51
Rate for Payer: UHCCP Medicaid	$690.12

PR CHOLECYSTECTOMY

Facility

$2,617.00

Service Code	CPT 47600
Hospital Charge Code	47600
Min. Negotiated Rate	$1,046.80
Max. Negotiated Rate	$2,617.00
Rate for Payer: Aetna Commercial	$2,355.30
Rate for Payer: Aetna Medicare	$1,308.50
Rate for Payer: ASR ASR	$2,538.49
Rate for Payer: ASR Commercial	$2,538.49
Rate for Payer: BCBS Complete	$1,046.80
Rate for Payer: BCBS Trust/PPO	$2,143.06
Rate for Payer: BCN Commercial	$2,028.96
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Cofinity Commercial	$2,459.98
Rate for Payer: Encore Health Key Benefits Commercial	$2,093.60
Rate for Payer: Healthscope Commercial	$2,617.00
Rate for Payer: Healthscope Whirlpool	$2,538.49
Rate for Payer: Mclaren Commercial	$2,355.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,224.45
Rate for Payer: Nomi Health Commercial	$2,145.94
Rate for Payer: Priority Health Cigna Priority Health	$1,701.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,293.02
Rate for Payer: Priority Health Narrow Network	$1,834.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,302.96

PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY

Professional

Both

$4,710.00

Service Code	HCPCS 47612
Min. Negotiated Rate	$676.22
Max. Negotiated Rate	$3,061.50
Rate for Payer: Aetna Commercial	$1,727.64
Rate for Payer: Aetna Medicare	$2,355.00
Rate for Payer: BCBS Complete	$858.14
Rate for Payer: BCBS Trust/PPO	$676.22
Rate for Payer: BCN Commercial	$1,858.93
Rate for Payer: Cash Price	$3,768.00
Rate for Payer: Cash Price	$3,768.00
Rate for Payer: Meridian Medicaid	$858.14
Rate for Payer: Priority Health Choice Medicaid	$817.28
Rate for Payer: Priority Health Cigna Priority Health	$3,061.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,278.98
Rate for Payer: Priority Health Narrow Network	$2,278.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,529.46
Rate for Payer: UHC Exchange	$1,529.46
Rate for Payer: UHCCP Medicaid	$817.28

PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$3,009.00

Service Code	HCPCS 47605
Min. Negotiated Rate	$725.69
Max. Negotiated Rate	$2,020.67
Rate for Payer: Aetna Commercial	$1,522.79
Rate for Payer: Aetna Medicare	$1,504.50
Rate for Payer: BCBS Complete	$761.97
Rate for Payer: BCBS Trust/PPO	$1,918.79
Rate for Payer: BCN Commercial	$1,648.31
Rate for Payer: Cash Price	$2,407.20
Rate for Payer: Cash Price	$2,407.20
Rate for Payer: Meridian Medicaid	$761.97
Rate for Payer: Priority Health Choice Medicaid	$725.69
Rate for Payer: Priority Health Cigna Priority Health	$1,955.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,020.67
Rate for Payer: Priority Health Narrow Network	$2,020.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,178.36
Rate for Payer: UHC Exchange	$1,178.36
Rate for Payer: UHCCP Medicaid	$725.69

PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT

Professional

Both

$3,310.00

Service Code	HCPCS 47610
Min. Negotiated Rate	$141.58
Max. Negotiated Rate	$2,235.43
Rate for Payer: Aetna Commercial	$1,695.84
Rate for Payer: Aetna Medicare	$1,655.00
Rate for Payer: BCBS Complete	$846.74
Rate for Payer: BCBS Trust/PPO	$141.58
Rate for Payer: BCN Commercial	$1,829.12
Rate for Payer: Cash Price	$2,648.00
Rate for Payer: Cash Price	$2,648.00
Rate for Payer: Meridian Medicaid	$846.74
Rate for Payer: Priority Health Choice Medicaid	$806.42
Rate for Payer: Priority Health Cigna Priority Health	$2,151.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,235.43
Rate for Payer: Priority Health Narrow Network	$2,235.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,513.21
Rate for Payer: UHC Exchange	$1,513.21
Rate for Payer: UHCCP Medicaid	$806.42

PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT

Professional

Both

$677.00

Service Code	HCPCS 47490
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$4,357.95
Rate for Payer: Aetna Commercial	$438.85
Rate for Payer: Aetna Medicare	$338.50
Rate for Payer: BCBS Complete	$220.74
Rate for Payer: BCBS Trust/PPO	$4,357.95
Rate for Payer: BCN Commercial	$480.37
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Meridian Medicaid	$220.74
Rate for Payer: Priority Health Choice Medicaid	$210.23
Rate for Payer: Priority Health Cigna Priority Health	$440.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$584.06
Rate for Payer: Priority Health Narrow Network	$584.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$643.00
Rate for Payer: UHC Exchange	$643.00
Rate for Payer: UHCCP Medicaid	$210.23

PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,405.00

Service Code	HCPCS 47420
Min. Negotiated Rate	$856.69
Max. Negotiated Rate	$2,396.52
Rate for Payer: Aetna Commercial	$1,804.45
Rate for Payer: Aetna Medicare	$1,202.50
Rate for Payer: BCBS Complete	$899.52
Rate for Payer: BCBS Trust/PPO	$1,478.71
Rate for Payer: BCN Commercial	$1,943.96
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Meridian Medicaid	$899.52
Rate for Payer: Priority Health Choice Medicaid	$856.69
Rate for Payer: Priority Health Cigna Priority Health	$1,563.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,396.52
Rate for Payer: Priority Health Narrow Network	$2,396.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,613.59
Rate for Payer: UHC Exchange	$1,613.59
Rate for Payer: UHCCP Medicaid	$856.69

PR CHOLERA IMMUNIZATION,INJECTABLE

Professional

Both

$12.00

Service Code	HCPCS 90725
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$7.80

PR CHOLINESTERASE INHIBITOR CHALLENGE TEST

Professional

Both

$161.00

Service Code	HCPCS 95857
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$220.30
Rate for Payer: Aetna Commercial	$32.57
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCBS Complete	$18.78
Rate for Payer: BCBS Trust/PPO	$220.30
Rate for Payer: BCN Commercial	$90.89
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Meridian Medicaid	$18.78
Rate for Payer: Priority Health Choice Medicaid	$17.89
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.99
Rate for Payer: Priority Health Narrow Network	$37.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$29.60
Rate for Payer: UHC Exchange	$29.60
Rate for Payer: UHCCP Medicaid	$17.89

PR CHORIONIC VILLUS SAMPLING

Professional

Both

$398.00

Service Code	HCPCS 59015
Min. Negotiated Rate	$83.92
Max. Negotiated Rate	$258.70
Rate for Payer: Aetna Commercial	$144.10
Rate for Payer: Aetna Medicare	$199.00
Rate for Payer: BCBS Complete	$88.12
Rate for Payer: BCBS Trust/PPO	$143.17
Rate for Payer: BCN Commercial	$231.15
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cash Price	$318.40
Rate for Payer: Meridian Medicaid	$88.12
Rate for Payer: Priority Health Choice Medicaid	$83.92
Rate for Payer: Priority Health Cigna Priority Health	$258.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.98
Rate for Payer: Priority Health Narrow Network	$183.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$152.35
Rate for Payer: UHC Exchange	$152.35
Rate for Payer: UHCCP Medicaid	$83.92

PR CHROMOTUBATION OVIDUCT W/MATERIALS

Professional

Both

$204.00

Service Code	HCPCS 58350
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$508.22
Rate for Payer: Aetna Commercial	$108.54
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: BCBS Trust/PPO	$508.22
Rate for Payer: BCN Commercial	$228.22
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Meridian Medicaid	$63.75
Rate for Payer: Priority Health Choice Medicaid	$60.71
Rate for Payer: Priority Health Cigna Priority Health	$132.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$142.86
Rate for Payer: Priority Health Narrow Network	$142.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$88.45
Rate for Payer: UHC Exchange	$88.45
Rate for Payer: UHCCP Medicaid	$60.71

PR CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE

Professional

Both

$3,535.00

Service Code	HCPCS 24940
Min. Negotiated Rate	$602.42
Max. Negotiated Rate	$11,675.93
Rate for Payer: Aetna Commercial	$1,439.82
Rate for Payer: Aetna Medicare	$1,767.50
Rate for Payer: BCBS Complete	$632.54
Rate for Payer: BCBS Trust/PPO	$730.11
Rate for Payer: BCN Commercial	$11,675.93
Rate for Payer: Cash Price	$2,828.00
Rate for Payer: Cash Price	$2,828.00
Rate for Payer: Meridian Medicaid	$632.54
Rate for Payer: Priority Health Choice Medicaid	$602.42
Rate for Payer: Priority Health Cigna Priority Health	$2,297.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,680.25
Rate for Payer: Priority Health Narrow Network	$1,680.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,143.59
Rate for Payer: UHC Exchange	$1,143.59
Rate for Payer: UHCCP Medicaid	$602.42

PR CIRCADIAN RESPIRATRY PATTERN REC 12-24 HR INFANT

Professional

Both

$646.00

Service Code	HCPCS 94772
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$544.82
Rate for Payer: Aetna Commercial	$318.52
Rate for Payer: Aetna Medicare	$323.00
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$518.79
Rate for Payer: BCN Commercial	$544.82
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cash Price	$516.80
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$419.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$170.98
Rate for Payer: Priority Health Narrow Network	$170.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$319.59
Rate for Payer: UHC Exchange	$319.59
Rate for Payer: UHCCP Medicaid	$36.85

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,543.00

Service Code	HCPCS 54161
Min. Negotiated Rate	$127.16
Max. Negotiated Rate	$1,002.95
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: Aetna Medicare	$771.50
Rate for Payer: BCBS Complete	$133.52
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: BCN Commercial	$285.39
Rate for Payer: Cash Price	$1,234.40
Rate for Payer: Cash Price	$1,234.40
Rate for Payer: Meridian Medicaid	$133.52
Rate for Payer: Priority Health Choice Medicaid	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$1,002.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$315.30
Rate for Payer: Priority Health Narrow Network	$315.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$236.29
Rate for Payer: UHC Exchange	$236.29
Rate for Payer: UHCCP Medicaid	$127.16

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,543.00

Service Code	HCPCS 54161
Hospital Charge Code	54161
Min. Negotiated Rate	$127.16
Max. Negotiated Rate	$1,002.95
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: Aetna Medicare	$771.50
Rate for Payer: BCBS Complete	$133.52
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: BCN Commercial	$285.39
Rate for Payer: Cash Price	$1,234.40
Rate for Payer: Cash Price	$1,234.40
Rate for Payer: Meridian Medicaid	$133.52
Rate for Payer: Priority Health Choice Medicaid	$127.16
Rate for Payer: Priority Health Cigna Priority Health	$1,002.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$315.30
Rate for Payer: Priority Health Narrow Network	$315.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$236.29
Rate for Payer: UHC Exchange	$236.29
Rate for Payer: UHCCP Medicaid	$127.16

PR CIRCUMCISION AGE >28 DAYS

Facility

$1,543.00

Service Code	CPT 54161
Hospital Charge Code	54161
Hospital Revenue Code	960
Min. Negotiated Rate	$1,002.95
Max. Negotiated Rate	$1,543.00
Rate for Payer: Aetna Commercial	$1,388.70
Rate for Payer: ASR ASR	$1,496.71
Rate for Payer: ASR Commercial	$1,496.71
Rate for Payer: BCBS Trust/PPO	$1,257.39
Rate for Payer: BCN Commercial	$1,196.29
Rate for Payer: Cash Price	$1,234.40
Rate for Payer: Cofinity Commercial	$1,450.42
Rate for Payer: Encore Health Key Benefits Commercial	$1,234.40
Rate for Payer: Healthscope Commercial	$1,543.00
Rate for Payer: Healthscope Whirlpool	$1,496.71
Rate for Payer: Mclaren Commercial	$1,388.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,311.55
Rate for Payer: Nomi Health Commercial	$1,265.26
Rate for Payer: Priority Health Cigna Priority Health	$1,002.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,357.84

Know your out-of-pocket cost for care.

All Charges