Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR CRANFCL ANT CRANIAL FOSSA UNI/BIFRNTL ELEV LOBE

Professional

Both

$7,968.00

Service Code	HCPCS 61583
Min. Negotiated Rate	$841.58
Max. Negotiated Rate	$6,001.73
Rate for Payer: Aetna Commercial	$3,781.58
Rate for Payer: Aetna Medicare	$3,984.00
Rate for Payer: BCBS Complete	$1,990.26
Rate for Payer: BCBS Trust/PPO	$841.58
Rate for Payer: BCN Commercial	$6,001.73
Rate for Payer: Cash Price	$6,374.40
Rate for Payer: Cash Price	$6,374.40
Rate for Payer: Meridian Medicaid	$1,990.26
Rate for Payer: Priority Health Choice Medicaid	$1,895.49
Rate for Payer: Priority Health Cigna Priority Health	$5,179.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,031.43
Rate for Payer: Priority Health Narrow Network	$5,031.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,312.79
Rate for Payer: UHC Exchange	$3,312.79
Rate for Payer: UHCCP Medicaid	$1,895.49

PR CRANIECTOMY CRANIOSYNOSTOSIS BIFRONTAL BONE FLAP

Professional

Both

$3,387.00

Service Code	HCPCS 61557
Min. Negotiated Rate	$1,103.13
Max. Negotiated Rate	$3,460.84
Rate for Payer: Aetna Commercial	$2,174.94
Rate for Payer: Aetna Medicare	$1,693.50
Rate for Payer: BCBS Complete	$1,158.29
Rate for Payer: BCBS Trust/PPO	$2,068.29
Rate for Payer: BCN Commercial	$3,460.84
Rate for Payer: Cash Price	$2,709.60
Rate for Payer: Cash Price	$2,709.60
Rate for Payer: Meridian Medicaid	$1,158.29
Rate for Payer: Priority Health Choice Medicaid	$1,103.13
Rate for Payer: Priority Health Cigna Priority Health	$2,201.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,931.16
Rate for Payer: Priority Health Narrow Network	$2,931.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,944.18
Rate for Payer: UHC Exchange	$1,944.18
Rate for Payer: UHCCP Medicaid	$1,103.13

PR CRANIECTOMY/CRANIOTOMY EXC FOREIGN BODY BRAIN

Professional

Both

$9,394.00

Service Code	HCPCS 61570
Min. Negotiated Rate	$610.19
Max. Negotiated Rate	$6,106.10
Rate for Payer: Aetna Commercial	$2,417.18
Rate for Payer: Aetna Medicare	$4,697.00
Rate for Payer: BCBS Complete	$1,281.51
Rate for Payer: BCBS Trust/PPO	$610.19
Rate for Payer: BCN Commercial	$3,835.07
Rate for Payer: Cash Price	$7,515.20
Rate for Payer: Cash Price	$7,515.20
Rate for Payer: Meridian Medicaid	$1,281.51
Rate for Payer: Priority Health Choice Medicaid	$1,220.49
Rate for Payer: Priority Health Cigna Priority Health	$6,106.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,246.23
Rate for Payer: Priority Health Narrow Network	$3,246.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,147.30
Rate for Payer: UHC Exchange	$2,147.30
Rate for Payer: UHCCP Medicaid	$1,220.49

PR CRANIECTOMY/CRANIOTOMY EXPL INFRATENTORIAL

Professional

Both

$4,188.00

Service Code	HCPCS 61305
Min. Negotiated Rate	$1,101.51
Max. Negotiated Rate	$3,474.28
Rate for Payer: Aetna Commercial	$2,593.13
Rate for Payer: Aetna Medicare	$2,094.00
Rate for Payer: BCBS Complete	$1,372.32
Rate for Payer: BCBS Trust/PPO	$1,101.51
Rate for Payer: BCN Commercial	$2,959.43
Rate for Payer: Cash Price	$3,350.40
Rate for Payer: Cash Price	$3,350.40
Rate for Payer: Meridian Medicaid	$1,372.32
Rate for Payer: Priority Health Choice Medicaid	$1,306.97
Rate for Payer: Priority Health Cigna Priority Health	$2,722.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,474.28
Rate for Payer: Priority Health Narrow Network	$3,474.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,325.42
Rate for Payer: UHC Exchange	$2,325.42
Rate for Payer: UHCCP Medicaid	$1,306.97

PR CRANIECTOMY/CRANIOTOMY EXPL SUPRATENTORIAL

Professional

Both

$5,463.00

Service Code	HCPCS 61304
Min. Negotiated Rate	$797.20
Max. Negotiated Rate	$3,550.95
Rate for Payer: Aetna Commercial	$2,122.58
Rate for Payer: Aetna Medicare	$2,731.50
Rate for Payer: BCBS Complete	$1,122.94
Rate for Payer: BCBS Trust/PPO	$797.20
Rate for Payer: BCN Commercial	$3,350.34
Rate for Payer: Cash Price	$4,370.40
Rate for Payer: Cash Price	$4,370.40
Rate for Payer: Meridian Medicaid	$1,122.94
Rate for Payer: Priority Health Choice Medicaid	$1,069.47
Rate for Payer: Priority Health Cigna Priority Health	$3,550.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,843.00
Rate for Payer: Priority Health Narrow Network	$2,843.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,897.94
Rate for Payer: UHC Exchange	$1,897.94
Rate for Payer: UHCCP Medicaid	$1,069.47

PR CRANIECTOMY/CRANIOTOMY TX PENETRATNG WOUND BRAIN

Professional

Both

$8,983.00

Service Code	HCPCS 61571
Min. Negotiated Rate	$723.24
Max. Negotiated Rate	$5,838.95
Rate for Payer: Aetna Commercial	$2,572.96
Rate for Payer: Aetna Medicare	$4,491.50
Rate for Payer: BCBS Complete	$1,363.15
Rate for Payer: BCBS Trust/PPO	$723.24
Rate for Payer: BCN Commercial	$2,939.39
Rate for Payer: Cash Price	$7,186.40
Rate for Payer: Cash Price	$7,186.40
Rate for Payer: Meridian Medicaid	$1,363.15
Rate for Payer: Priority Health Choice Medicaid	$1,298.24
Rate for Payer: Priority Health Cigna Priority Health	$5,838.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,451.54
Rate for Payer: Priority Health Narrow Network	$3,451.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,308.13
Rate for Payer: UHC Exchange	$2,308.13
Rate for Payer: UHCCP Medicaid	$1,298.24

PR CRANIECTOMY FOR OSTEOMYELITIS

Professional

Both

$5,360.00

Service Code	HCPCS 61501
Min. Negotiated Rate	$264.68
Max. Negotiated Rate	$3,484.00
Rate for Payer: Aetna Commercial	$1,448.08
Rate for Payer: Aetna Medicare	$2,680.00
Rate for Payer: BCBS Complete	$772.04
Rate for Payer: BCBS Trust/PPO	$264.68
Rate for Payer: BCN Commercial	$2,316.50
Rate for Payer: Cash Price	$4,288.00
Rate for Payer: Cash Price	$4,288.00
Rate for Payer: Meridian Medicaid	$772.04
Rate for Payer: Priority Health Choice Medicaid	$735.28
Rate for Payer: Priority Health Cigna Priority Health	$3,484.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,951.84
Rate for Payer: Priority Health Narrow Network	$1,951.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,326.67
Rate for Payer: UHC Exchange	$1,326.67
Rate for Payer: UHCCP Medicaid	$735.28

PR CRANIECTOMY SUBOCCIPITAL SECTION 1/> CRANIAL NRV

Professional

Both

$6,301.00

Service Code	HCPCS 61460
Min. Negotiated Rate	$1,018.03
Max. Negotiated Rate	$4,310.97
Rate for Payer: Aetna Commercial	$2,721.64
Rate for Payer: Aetna Medicare	$3,150.50
Rate for Payer: BCBS Complete	$1,440.31
Rate for Payer: BCBS Trust/PPO	$1,018.03
Rate for Payer: BCN Commercial	$4,310.97
Rate for Payer: Cash Price	$5,040.80
Rate for Payer: Cash Price	$5,040.80
Rate for Payer: Meridian Medicaid	$1,440.31
Rate for Payer: Priority Health Choice Medicaid	$1,371.72
Rate for Payer: Priority Health Cigna Priority Health	$4,095.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,647.74
Rate for Payer: Priority Health Narrow Network	$3,647.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,420.18
Rate for Payer: UHC Exchange	$2,420.18
Rate for Payer: UHCCP Medicaid	$1,371.72

PR CRANIECTOMY W/EXCISION TUMOR/OTH BONE LESION SKL

Professional

Both

$2,739.00

Service Code	HCPCS 61500
Min. Negotiated Rate	$534.64
Max. Negotiated Rate	$2,658.85
Rate for Payer: Aetna Commercial	$1,684.10
Rate for Payer: Aetna Medicare	$1,369.50
Rate for Payer: BCBS Complete	$882.52
Rate for Payer: BCBS Trust/PPO	$534.64
Rate for Payer: BCN Commercial	$2,658.85
Rate for Payer: Cash Price	$2,191.20
Rate for Payer: Cash Price	$2,191.20
Rate for Payer: Meridian Medicaid	$882.52
Rate for Payer: Priority Health Choice Medicaid	$840.50
Rate for Payer: Priority Health Cigna Priority Health	$1,780.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,243.02
Rate for Payer: Priority Health Narrow Network	$2,243.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,545.67
Rate for Payer: UHC Exchange	$1,545.67
Rate for Payer: UHCCP Medicaid	$840.50

PR CRANIOFACIAL ANT CRANIAL FOSSA W/O ORBITAL EXNTJ

Professional

Both

$5,312.00

Service Code	HCPCS 61580
Min. Negotiated Rate	$901.81
Max. Negotiated Rate	$4,254.56
Rate for Payer: Aetna Commercial	$3,215.20
Rate for Payer: Aetna Medicare	$2,656.00
Rate for Payer: BCBS Complete	$1,674.03
Rate for Payer: BCBS Trust/PPO	$901.81
Rate for Payer: BCN Commercial	$3,653.84
Rate for Payer: Cash Price	$4,249.60
Rate for Payer: Cash Price	$4,249.60
Rate for Payer: Meridian Medicaid	$1,674.03
Rate for Payer: Priority Health Choice Medicaid	$1,594.31
Rate for Payer: Priority Health Cigna Priority Health	$3,452.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,254.56
Rate for Payer: Priority Health Narrow Network	$4,254.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,811.40
Rate for Payer: UHC Exchange	$2,811.40
Rate for Payer: UHCCP Medicaid	$1,594.31

PR CRANIOPLASTY SKULL DEFECT <5 CM DIAMETER

Professional

Both

$5,342.00

Service Code	HCPCS 62140
Min. Negotiated Rate	$330.72
Max. Negotiated Rate	$3,472.30
Rate for Payer: Aetna Commercial	$1,313.67
Rate for Payer: Aetna Medicare	$2,671.00
Rate for Payer: BCBS Complete	$700.24
Rate for Payer: BCBS Trust/PPO	$330.72
Rate for Payer: BCN Commercial	$2,092.10
Rate for Payer: Cash Price	$4,273.60
Rate for Payer: Cash Price	$4,273.60
Rate for Payer: Meridian Medicaid	$700.24
Rate for Payer: Priority Health Choice Medicaid	$666.90
Rate for Payer: Priority Health Cigna Priority Health	$3,472.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,771.56
Rate for Payer: Priority Health Narrow Network	$1,771.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,197.54
Rate for Payer: UHC Exchange	$1,197.54
Rate for Payer: UHCCP Medicaid	$666.90

PR CRANIOPLASTY SKULL DEFECT >5 CM DIAMETER

Professional

Both

$6,362.00

Service Code	HCPCS 62141
Min. Negotiated Rate	$415.77
Max. Negotiated Rate	$4,135.30
Rate for Payer: Aetna Commercial	$1,476.78
Rate for Payer: Aetna Medicare	$3,181.00
Rate for Payer: BCBS Complete	$785.23
Rate for Payer: BCBS Trust/PPO	$415.77
Rate for Payer: BCN Commercial	$2,339.55
Rate for Payer: Cash Price	$5,089.60
Rate for Payer: Cash Price	$5,089.60
Rate for Payer: Meridian Medicaid	$785.23
Rate for Payer: Priority Health Choice Medicaid	$747.84
Rate for Payer: Priority Health Cigna Priority Health	$4,135.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,983.68
Rate for Payer: Priority Health Narrow Network	$1,983.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,319.35
Rate for Payer: UHC Exchange	$1,319.35
Rate for Payer: UHCCP Medicaid	$747.84

PR CRANIOPLASTY SKULL DEFECT REPARATIVE BRAIN SURG

Professional

Both

$5,986.00

Service Code	HCPCS 62145
Min. Negotiated Rate	$914.41
Max. Negotiated Rate	$3,890.90
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: Aetna Medicare	$2,993.00
Rate for Payer: BCBS Complete	$960.13
Rate for Payer: BCBS Trust/PPO	$1,261.58
Rate for Payer: BCN Commercial	$2,092.03
Rate for Payer: Cash Price	$4,788.80
Rate for Payer: Cash Price	$4,788.80
Rate for Payer: Meridian Medicaid	$960.13
Rate for Payer: Priority Health Choice Medicaid	$914.41
Rate for Payer: Priority Health Cigna Priority Health	$3,890.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,465.96
Rate for Payer: Priority Health Narrow Network	$2,465.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,637.95
Rate for Payer: UHC Exchange	$1,637.95
Rate for Payer: UHCCP Medicaid	$914.41

PR CRANIOPLASTY W/AUTOGRAFT <5 CM DIAMETER

Professional

Both

$6,377.00

Service Code	HCPCS 62146
Min. Negotiated Rate	$818.56
Max. Negotiated Rate	$4,145.05
Rate for Payer: Aetna Commercial	$1,615.24
Rate for Payer: Aetna Medicare	$3,188.50
Rate for Payer: BCBS Complete	$859.49
Rate for Payer: BCBS Trust/PPO	$1,636.15
Rate for Payer: BCN Commercial	$2,567.33
Rate for Payer: Cash Price	$5,101.60
Rate for Payer: Cash Price	$5,101.60
Rate for Payer: Meridian Medicaid	$859.49
Rate for Payer: Priority Health Choice Medicaid	$818.56
Rate for Payer: Priority Health Cigna Priority Health	$4,145.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,174.76
Rate for Payer: Priority Health Narrow Network	$2,174.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,421.96
Rate for Payer: UHC Exchange	$1,421.96
Rate for Payer: UHCCP Medicaid	$818.56

PR CRANIOPLASTY W/AUTOGRAFT > 5 CM DIAMETER

Professional

Both

$7,296.00

Service Code	HCPCS 62147
Min. Negotiated Rate	$128.38
Max. Negotiated Rate	$4,742.40
Rate for Payer: Aetna Commercial	$1,834.50
Rate for Payer: Aetna Medicare	$3,648.00
Rate for Payer: BCBS Complete	$977.80
Rate for Payer: BCBS Trust/PPO	$128.38
Rate for Payer: BCN Commercial	$2,898.84
Rate for Payer: Cash Price	$5,836.80
Rate for Payer: Cash Price	$5,836.80
Rate for Payer: Meridian Medicaid	$977.80
Rate for Payer: Priority Health Choice Medicaid	$931.24
Rate for Payer: Priority Health Cigna Priority Health	$4,742.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,453.43
Rate for Payer: Priority Health Narrow Network	$2,453.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,683.95
Rate for Payer: UHC Exchange	$1,683.95
Rate for Payer: UHCCP Medicaid	$931.24

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

Professional

Both

$7,866.00

Service Code	HCPCS 61540
Min. Negotiated Rate	$611.24
Max. Negotiated Rate	$5,112.90
Rate for Payer: Aetna Commercial	$2,815.85
Rate for Payer: Aetna Medicare	$3,933.00
Rate for Payer: BCBS Complete	$1,487.27
Rate for Payer: BCBS Trust/PPO	$611.24
Rate for Payer: BCN Commercial	$3,209.63
Rate for Payer: Cash Price	$6,292.80
Rate for Payer: Cash Price	$6,292.80
Rate for Payer: Meridian Medicaid	$1,487.27
Rate for Payer: Priority Health Choice Medicaid	$1,416.45
Rate for Payer: Priority Health Cigna Priority Health	$5,112.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,767.74
Rate for Payer: Priority Health Narrow Network	$3,767.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,537.54
Rate for Payer: UHC Exchange	$2,537.54
Rate for Payer: UHCCP Medicaid	$1,416.45

PR CRANIOTOMY EXCISION CRANIOPHARYNGIOMA

Professional

Both

$6,696.00

Service Code	HCPCS 61545
Min. Negotiated Rate	$2,070.57
Max. Negotiated Rate	$6,510.19
Rate for Payer: Aetna Commercial	$4,116.77
Rate for Payer: Aetna Medicare	$3,348.00
Rate for Payer: BCBS Complete	$2,174.10
Rate for Payer: BCBS Trust/PPO	$2,713.35
Rate for Payer: BCN Commercial	$6,510.19
Rate for Payer: Cash Price	$5,356.80
Rate for Payer: Cash Price	$5,356.80
Rate for Payer: Meridian Medicaid	$2,174.10
Rate for Payer: Priority Health Choice Medicaid	$2,070.57
Rate for Payer: Priority Health Cigna Priority Health	$4,352.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,505.73
Rate for Payer: Priority Health Narrow Network	$5,505.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,697.87
Rate for Payer: UHC Exchange	$3,697.87
Rate for Payer: UHCCP Medicaid	$2,070.57

PR CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE

Professional

Both

$5,612.00

Service Code	HCPCS 62121
Min. Negotiated Rate	$998.12
Max. Negotiated Rate	$3,647.80
Rate for Payer: Aetna Commercial	$2,019.44
Rate for Payer: Aetna Medicare	$2,806.00
Rate for Payer: BCBS Complete	$1,048.03
Rate for Payer: BCBS Trust/PPO	$1,394.18
Rate for Payer: BCN Commercial	$2,295.32
Rate for Payer: Cash Price	$4,489.60
Rate for Payer: Cash Price	$4,489.60
Rate for Payer: Meridian Medicaid	$1,048.03
Rate for Payer: Priority Health Choice Medicaid	$998.12
Rate for Payer: Priority Health Cigna Priority Health	$3,647.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,678.65
Rate for Payer: Priority Health Narrow Network	$2,678.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,995.26
Rate for Payer: UHC Exchange	$1,995.26
Rate for Payer: UHCCP Medicaid	$998.12

PR CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY

Professional

Both

$7,067.00

Service Code	HCPCS 61537
Min. Negotiated Rate	$1,595.37
Max. Negotiated Rate	$4,593.55
Rate for Payer: Aetna Commercial	$3,184.49
Rate for Payer: Aetna Medicare	$3,533.50
Rate for Payer: BCBS Complete	$1,675.14
Rate for Payer: BCBS Trust/PPO	$2,057.20
Rate for Payer: BCN Commercial	$3,618.66
Rate for Payer: Cash Price	$5,653.60
Rate for Payer: Cash Price	$5,653.60
Rate for Payer: Meridian Medicaid	$1,675.14
Rate for Payer: Priority Health Choice Medicaid	$1,595.37
Rate for Payer: Priority Health Cigna Priority Health	$4,593.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,242.62
Rate for Payer: Priority Health Narrow Network	$4,242.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,847.34
Rate for Payer: UHC Exchange	$2,847.34
Rate for Payer: UHCCP Medicaid	$1,595.37

PR CRICOPHARYNGEAL MYOTOMY

Professional

Both

$2,284.00

Service Code	HCPCS 43030
Min. Negotiated Rate	$226.11
Max. Negotiated Rate	$1,484.60
Rate for Payer: Aetna Commercial	$688.64
Rate for Payer: Aetna Medicare	$1,142.00
Rate for Payer: BCBS Complete	$355.82
Rate for Payer: BCBS Trust/PPO	$226.11
Rate for Payer: BCN Commercial	$768.69
Rate for Payer: Cash Price	$1,827.20
Rate for Payer: Cash Price	$1,827.20
Rate for Payer: Meridian Medicaid	$355.82
Rate for Payer: Priority Health Choice Medicaid	$338.88
Rate for Payer: Priority Health Cigna Priority Health	$1,484.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$945.61
Rate for Payer: Priority Health Narrow Network	$945.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$640.88
Rate for Payer: UHC Exchange	$640.88
Rate for Payer: UHCCP Medicaid	$338.88

PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN

Professional

Both

$216.00

Service Code	HCPCS 99292
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$1,875.47
Rate for Payer: Aetna Commercial	$109.66
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS Complete	$71.12
Rate for Payer: BCBS Trust/PPO	$1,875.47
Rate for Payer: BCN Commercial	$173.48
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Meridian Medicaid	$71.12
Rate for Payer: Priority Health Choice Medicaid	$67.73
Rate for Payer: Priority Health Cigna Priority Health	$140.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$142.68
Rate for Payer: Priority Health Narrow Network	$142.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$121.17
Rate for Payer: UHC Exchange	$121.17
Rate for Payer: UHCCP Medicaid	$67.73

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

Professional

Both

$476.00

Service Code	HCPCS 99291
Min. Negotiated Rate	$135.47
Max. Negotiated Rate	$1,522.56
Rate for Payer: Aetna Commercial	$218.32
Rate for Payer: Aetna Medicare	$238.00
Rate for Payer: BCBS Complete	$142.24
Rate for Payer: BCBS Trust/PPO	$1,522.56
Rate for Payer: BCN Commercial	$397.30
Rate for Payer: Cash Price	$380.80
Rate for Payer: Cash Price	$380.80
Rate for Payer: Meridian Medicaid	$142.24
Rate for Payer: Priority Health Choice Medicaid	$135.47
Rate for Payer: Priority Health Cigna Priority Health	$309.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$414.84
Rate for Payer: Priority Health Narrow Network	$414.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$241.89
Rate for Payer: UHC Exchange	$241.89
Rate for Payer: UHCCP Medicaid	$135.47

PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN

Professional

Both

$582.00

Service Code	HCPCS 99466
Min. Negotiated Rate	$168.10
Max. Negotiated Rate	$378.30
Rate for Payer: Aetna Commercial	$234.41
Rate for Payer: Aetna Medicare	$291.00
Rate for Payer: BCBS Complete	$232.80
Rate for Payer: BCBS Trust/PPO	$168.10
Rate for Payer: BCN Commercial	$334.26
Rate for Payer: Cash Price	$465.60
Rate for Payer: Cash Price	$465.60
Rate for Payer: Priority Health Cigna Priority Health	$378.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$308.27
Rate for Payer: Priority Health Narrow Network	$308.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$286.54
Rate for Payer: UHC Exchange	$286.54

PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN

Professional

Both

$243.00

Service Code	HCPCS 99467
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$169.08
Rate for Payer: Aetna Commercial	$117.37
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS Complete	$97.20
Rate for Payer: BCBS Trust/PPO	$137.11
Rate for Payer: BCN Commercial	$169.08
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Priority Health Cigna Priority Health	$157.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.80
Rate for Payer: Priority Health Narrow Network	$154.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$131.78
Rate for Payer: UHC Exchange	$131.78

PR CRNEC/CRNOT DCMPRV W/WO DURAPLASTY W/O LOBECTOMY

Professional

Both

$5,018.00

Service Code	HCPCS 61322
Min. Negotiated Rate	$569.51
Max. Negotiated Rate	$4,124.89
Rate for Payer: Aetna Commercial	$3,074.11
Rate for Payer: Aetna Medicare	$2,509.00
Rate for Payer: BCBS Complete	$1,626.83
Rate for Payer: BCBS Trust/PPO	$569.51
Rate for Payer: BCN Commercial	$3,510.17
Rate for Payer: Cash Price	$4,014.40
Rate for Payer: Cash Price	$4,014.40
Rate for Payer: Meridian Medicaid	$1,626.83
Rate for Payer: Priority Health Choice Medicaid	$1,549.36
Rate for Payer: Priority Health Cigna Priority Health	$3,261.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,124.89
Rate for Payer: Priority Health Narrow Network	$4,124.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,733.34
Rate for Payer: UHC Exchange	$2,733.34
Rate for Payer: UHCCP Medicaid	$1,549.36

Know your out-of-pocket cost for care.

All Charges