Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR LAPS SURG RPR RECURRENT INGUINAL HERNIA

Professional

Both

$2,071.00

Service Code	HCPCS 49651
Min. Negotiated Rate	$367.21
Max. Negotiated Rate	$3,934.25
Rate for Payer: Aetna Commercial	$756.01
Rate for Payer: Aetna Medicare	$1,035.50
Rate for Payer: BCBS Complete	$385.57
Rate for Payer: BCBS Trust/PPO	$3,934.25
Rate for Payer: BCN Commercial	$829.77
Rate for Payer: Cash Price	$1,656.80
Rate for Payer: Cash Price	$1,656.80
Rate for Payer: Meridian Medicaid	$385.57
Rate for Payer: Priority Health Choice Medicaid	$367.21
Rate for Payer: Priority Health Cigna Priority Health	$1,346.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,021.37
Rate for Payer: Priority Health Narrow Network	$1,021.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$656.49
Rate for Payer: UHC Exchange	$656.49
Rate for Payer: UHCCP Medicaid	$367.21

PR LAPS SURG RPR RECURRENT INGUINAL HERNIA

Facility

$2,071.00

Service Code	CPT 49651
Hospital Charge Code	49651
Hospital Revenue Code	960
Min. Negotiated Rate	$1,346.15
Max. Negotiated Rate	$2,071.00
Rate for Payer: Aetna Commercial	$1,863.90
Rate for Payer: ASR ASR	$2,008.87
Rate for Payer: ASR Commercial	$2,008.87
Rate for Payer: BCBS Trust/PPO	$1,687.66
Rate for Payer: BCN Commercial	$1,605.65
Rate for Payer: Cash Price	$1,656.80
Rate for Payer: Cofinity Commercial	$1,946.74
Rate for Payer: Encore Health Key Benefits Commercial	$1,656.80
Rate for Payer: Healthscope Commercial	$2,071.00
Rate for Payer: Healthscope Whirlpool	$2,008.87
Rate for Payer: Mclaren Commercial	$1,863.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,760.35
Rate for Payer: Nomi Health Commercial	$1,698.22
Rate for Payer: Priority Health Cigna Priority Health	$1,346.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,822.48

PR LAPS SURG TRNSXJ VAGUS NRV SLCTV/HILY SLCTV

Professional

Both

$1,595.00

Service Code	HCPCS 43652
Min. Negotiated Rate	$495.23
Max. Negotiated Rate	$1,378.72
Rate for Payer: Aetna Commercial	$1,033.64
Rate for Payer: Aetna Medicare	$797.50
Rate for Payer: BCBS Complete	$519.99
Rate for Payer: BCBS Trust/PPO	$1,018.56
Rate for Payer: BCN Commercial	$1,121.52
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Meridian Medicaid	$519.99
Rate for Payer: Priority Health Choice Medicaid	$495.23
Rate for Payer: Priority Health Cigna Priority Health	$1,036.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,378.72
Rate for Payer: Priority Health Narrow Network	$1,378.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$911.99
Rate for Payer: UHC Exchange	$911.99
Rate for Payer: UHCCP Medicaid	$495.23

PR LAPS SURG TRNSXJ VAGUS NRV TRUNCAL

Professional

Both

$2,587.00

Service Code	HCPCS 43651
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$1,681.55
Rate for Payer: Aetna Commercial	$884.62
Rate for Payer: Aetna Medicare	$1,293.50
Rate for Payer: BCBS Complete	$447.30
Rate for Payer: BCBS Trust/PPO	$806.71
Rate for Payer: BCN Commercial	$962.20
Rate for Payer: Cash Price	$2,069.60
Rate for Payer: Cash Price	$2,069.60
Rate for Payer: Meridian Medicaid	$447.30
Rate for Payer: Priority Health Choice Medicaid	$426.00
Rate for Payer: Priority Health Cigna Priority Health	$1,681.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,184.84
Rate for Payer: Priority Health Narrow Network	$1,184.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$777.73
Rate for Payer: UHC Exchange	$777.73
Rate for Payer: UHCCP Medicaid	$426.00

PR LAPS SURG W/ASPIR CAVITY/CYST SINGLE/MULTIPLE

Professional

Both

$1,561.00

Service Code	HCPCS 49322
Min. Negotiated Rate	$241.76
Max. Negotiated Rate	$1,014.65
Rate for Payer: Aetna Commercial	$504.97
Rate for Payer: Aetna Medicare	$780.50
Rate for Payer: BCBS Complete	$253.85
Rate for Payer: BCBS Trust/PPO	$572.15
Rate for Payer: BCN Commercial	$548.78
Rate for Payer: Cash Price	$1,248.80
Rate for Payer: Cash Price	$1,248.80
Rate for Payer: Meridian Medicaid	$253.85
Rate for Payer: Priority Health Choice Medicaid	$241.76
Rate for Payer: Priority Health Cigna Priority Health	$1,014.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$674.15
Rate for Payer: Priority Health Narrow Network	$674.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$450.69
Rate for Payer: UHC Exchange	$450.69
Rate for Payer: UHCCP Medicaid	$241.76

PR LAPS SURG W/DRG LYMPHOCELE PRTL CAVITY

Professional

Both

$1,945.00

Service Code	HCPCS 49323
Min. Negotiated Rate	$336.53
Max. Negotiated Rate	$1,264.25
Rate for Payer: Aetna Commercial	$853.34
Rate for Payer: Aetna Medicare	$972.50
Rate for Payer: BCBS Complete	$433.88
Rate for Payer: BCBS Trust/PPO	$336.53
Rate for Payer: BCN Commercial	$930.93
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Meridian Medicaid	$433.88
Rate for Payer: Priority Health Choice Medicaid	$413.22
Rate for Payer: Priority Health Cigna Priority Health	$1,264.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,148.44
Rate for Payer: Priority Health Narrow Network	$1,148.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$773.35
Rate for Payer: UHC Exchange	$773.35
Rate for Payer: UHCCP Medicaid	$413.22

PR LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY

Professional

Both

$2,772.00

Service Code	HCPCS 58571
Min. Negotiated Rate	$74.49
Max. Negotiated Rate	$1,801.80
Rate for Payer: Aetna Commercial	$1,077.28
Rate for Payer: Aetna Medicare	$1,386.00
Rate for Payer: BCBS Complete	$612.35
Rate for Payer: BCBS Trust/PPO	$74.49
Rate for Payer: BCN Commercial	$1,329.21
Rate for Payer: Cash Price	$2,217.60
Rate for Payer: Cash Price	$2,217.60
Rate for Payer: Meridian Medicaid	$612.35
Rate for Payer: Priority Health Choice Medicaid	$583.19
Rate for Payer: Priority Health Cigna Priority Health	$1,801.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,360.66
Rate for Payer: Priority Health Narrow Network	$1,360.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,168.16
Rate for Payer: UHC Exchange	$1,168.16
Rate for Payer: UHCCP Medicaid	$583.19

PR LAPS TX ECTOPIC PREG W/O SALPING&/OOPHORECTOMY

Professional

Both

$1,475.00

Service Code	HCPCS 59150
Min. Negotiated Rate	$284.23
Max. Negotiated Rate	$1,167.45
Rate for Payer: Aetna Commercial	$865.98
Rate for Payer: Aetna Medicare	$737.50
Rate for Payer: BCBS Complete	$535.65
Rate for Payer: BCBS Trust/PPO	$284.23
Rate for Payer: BCN Commercial	$1,167.45
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Cash Price	$1,180.00
Rate for Payer: Meridian Medicaid	$535.65
Rate for Payer: Priority Health Choice Medicaid	$510.14
Rate for Payer: Priority Health Cigna Priority Health	$958.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,118.76
Rate for Payer: Priority Health Narrow Network	$1,118.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$878.77
Rate for Payer: UHC Exchange	$878.77
Rate for Payer: UHCCP Medicaid	$510.14

PR LAPS TX ECTOPIC PREG W/SALPING&/OOPHORECTOMY

Professional

Both

$1,390.00

Service Code	HCPCS 59151
Min. Negotiated Rate	$447.47
Max. Negotiated Rate	$1,142.04
Rate for Payer: Aetna Commercial	$844.79
Rate for Payer: Aetna Medicare	$695.00
Rate for Payer: BCBS Complete	$523.56
Rate for Payer: BCBS Trust/PPO	$447.47
Rate for Payer: BCN Commercial	$1,142.04
Rate for Payer: Cash Price	$1,112.00
Rate for Payer: Cash Price	$1,112.00
Rate for Payer: Meridian Medicaid	$523.56
Rate for Payer: Priority Health Choice Medicaid	$498.63
Rate for Payer: Priority Health Cigna Priority Health	$903.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,094.54
Rate for Payer: Priority Health Narrow Network	$1,094.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$858.69
Rate for Payer: UHC Exchange	$858.69
Rate for Payer: UHCCP Medicaid	$498.63

PR LAPS URTRONEOCSTOST W/CSTSC&URTRL STENT PLMT

Professional

Both

$2,890.00

Service Code	HCPCS 50947
Min. Negotiated Rate	$879.26
Max. Negotiated Rate	$5,304.13
Rate for Payer: Aetna Commercial	$1,780.49
Rate for Payer: Aetna Medicare	$1,445.00
Rate for Payer: BCBS Complete	$923.22
Rate for Payer: BCBS Trust/PPO	$5,304.13
Rate for Payer: BCN Commercial	$1,985.98
Rate for Payer: Cash Price	$2,312.00
Rate for Payer: Cash Price	$2,312.00
Rate for Payer: Meridian Medicaid	$923.22
Rate for Payer: Priority Health Choice Medicaid	$879.26
Rate for Payer: Priority Health Cigna Priority Health	$1,878.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,188.99
Rate for Payer: Priority Health Narrow Network	$2,188.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,665.96
Rate for Payer: UHC Exchange	$1,665.96
Rate for Payer: UHCCP Medicaid	$879.26

PR LAPS URTRONEOCSTOST W/O CSTSC&URTRL STENT PLMT

Professional

Both

$2,617.00

Service Code	HCPCS 50948
Min. Negotiated Rate	$812.60
Max. Negotiated Rate	$2,539.54
Rate for Payer: Aetna Commercial	$1,642.77
Rate for Payer: Aetna Medicare	$1,308.50
Rate for Payer: BCBS Complete	$853.23
Rate for Payer: BCBS Trust/PPO	$2,539.54
Rate for Payer: BCN Commercial	$1,828.14
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Cash Price	$2,093.60
Rate for Payer: Meridian Medicaid	$853.23
Rate for Payer: Priority Health Choice Medicaid	$812.60
Rate for Payer: Priority Health Cigna Priority Health	$1,701.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,007.38
Rate for Payer: Priority Health Narrow Network	$2,007.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,549.44
Rate for Payer: UHC Exchange	$1,549.44
Rate for Payer: UHCCP Medicaid	$812.60

PR LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR

Professional

Both

$3,230.00

Service Code	HCPCS 58554
Min. Negotiated Rate	$639.24
Max. Negotiated Rate	$2,099.50
Rate for Payer: Aetna Commercial	$1,567.07
Rate for Payer: Aetna Medicare	$1,615.00
Rate for Payer: BCBS Complete	$876.49
Rate for Payer: BCBS Trust/PPO	$639.24
Rate for Payer: BCN Commercial	$1,906.82
Rate for Payer: Cash Price	$2,584.00
Rate for Payer: Cash Price	$2,584.00
Rate for Payer: Meridian Medicaid	$876.49
Rate for Payer: Priority Health Choice Medicaid	$834.75
Rate for Payer: Priority Health Cigna Priority Health	$2,099.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,947.48
Rate for Payer: Priority Health Narrow Network	$1,947.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,505.91
Rate for Payer: UHC Exchange	$1,505.91
Rate for Payer: UHCCP Medicaid	$834.75

PR LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/<

Professional

Both

$2,517.00

Service Code	HCPCS 58550
Min. Negotiated Rate	$395.17
Max. Negotiated Rate	$1,636.05
Rate for Payer: Aetna Commercial	$1,055.17
Rate for Payer: Aetna Medicare	$1,258.50
Rate for Payer: BCBS Complete	$594.91
Rate for Payer: BCBS Trust/PPO	$395.17
Rate for Payer: BCN Commercial	$1,292.55
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Meridian Medicaid	$594.91
Rate for Payer: Priority Health Choice Medicaid	$566.58
Rate for Payer: Priority Health Cigna Priority Health	$1,636.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,319.49
Rate for Payer: Priority Health Narrow Network	$1,319.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,010.55
Rate for Payer: UHC Exchange	$1,010.55
Rate for Payer: UHCCP Medicaid	$566.58

PR LAPS W/REVISION INTRAPERITONEAL CATHETER

Professional

Both

$957.00

Service Code	HCPCS 49325
Min. Negotiated Rate	$265.19
Max. Negotiated Rate	$1,351.92
Rate for Payer: Aetna Commercial	$560.36
Rate for Payer: Aetna Medicare	$478.50
Rate for Payer: BCBS Complete	$278.45
Rate for Payer: BCBS Trust/PPO	$1,351.92
Rate for Payer: BCN Commercial	$603.52
Rate for Payer: Cash Price	$765.60
Rate for Payer: Cash Price	$765.60
Rate for Payer: Meridian Medicaid	$278.45
Rate for Payer: Priority Health Choice Medicaid	$265.19
Rate for Payer: Priority Health Cigna Priority Health	$622.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$739.79
Rate for Payer: Priority Health Narrow Network	$739.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$510.14
Rate for Payer: UHC Exchange	$510.14
Rate for Payer: UHCCP Medicaid	$265.19

PR LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES

Professional

Both

$2,509.00

Service Code	HCPCS 58552
Min. Negotiated Rate	$549.43
Max. Negotiated Rate	$1,630.85
Rate for Payer: Aetna Commercial	$1,174.13
Rate for Payer: Aetna Medicare	$1,254.50
Rate for Payer: BCBS Complete	$661.33
Rate for Payer: BCBS Trust/PPO	$549.43
Rate for Payer: BCN Commercial	$1,437.69
Rate for Payer: Cash Price	$2,007.20
Rate for Payer: Cash Price	$2,007.20
Rate for Payer: Meridian Medicaid	$661.33
Rate for Payer: Priority Health Choice Medicaid	$629.84
Rate for Payer: Priority Health Cigna Priority Health	$1,630.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,465.32
Rate for Payer: Priority Health Narrow Network	$1,465.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,121.93
Rate for Payer: UHC Exchange	$1,121.93
Rate for Payer: UHCCP Medicaid	$629.84

PR LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS

Professional

Both

$3,016.00

Service Code	HCPCS 58553
Min. Negotiated Rate	$543.62
Max. Negotiated Rate	$1,960.40
Rate for Payer: Aetna Commercial	$1,347.18
Rate for Payer: Aetna Medicare	$1,508.00
Rate for Payer: BCBS Complete	$752.59
Rate for Payer: BCBS Trust/PPO	$543.62
Rate for Payer: BCN Commercial	$1,640.00
Rate for Payer: Cash Price	$2,412.80
Rate for Payer: Cash Price	$2,412.80
Rate for Payer: Meridian Medicaid	$752.59
Rate for Payer: Priority Health Choice Medicaid	$716.75
Rate for Payer: Priority Health Cigna Priority Health	$1,960.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,671.19
Rate for Payer: Priority Health Narrow Network	$1,671.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,303.19
Rate for Payer: UHC Exchange	$1,303.19
Rate for Payer: UHCCP Medicaid	$716.75

PR LAPT RPR PARAESOPH HIATAL HERNIA W/MESH

Professional

Both

$2,625.00

Service Code	HCPCS 43333
Min. Negotiated Rate	$806.84
Max. Negotiated Rate	$2,246.17
Rate for Payer: Aetna Commercial	$1,704.43
Rate for Payer: Aetna Medicare	$1,312.50
Rate for Payer: BCBS Complete	$847.18
Rate for Payer: BCBS Trust/PPO	$856.37
Rate for Payer: BCN Commercial	$1,827.16
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Meridian Medicaid	$847.18
Rate for Payer: Priority Health Choice Medicaid	$806.84
Rate for Payer: Priority Health Cigna Priority Health	$1,706.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,246.17
Rate for Payer: Priority Health Narrow Network	$2,246.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,739.45
Rate for Payer: UHC Exchange	$1,739.45
Rate for Payer: UHCCP Medicaid	$806.84

PR LAPT STG/RESTG OVARIAN TUBAL/PRIM MAL 2ND LOOK

Professional

Both

$2,150.00

Service Code	HCPCS 58960
Min. Negotiated Rate	$603.32
Max. Negotiated Rate	$1,494.09
Rate for Payer: Aetna Commercial	$1,162.17
Rate for Payer: Aetna Medicare	$1,075.00
Rate for Payer: BCBS Complete	$674.31
Rate for Payer: BCBS Trust/PPO	$603.32
Rate for Payer: BCN Commercial	$1,456.26
Rate for Payer: Cash Price	$1,720.00
Rate for Payer: Cash Price	$1,720.00
Rate for Payer: Meridian Medicaid	$674.31
Rate for Payer: Priority Health Choice Medicaid	$642.20
Rate for Payer: Priority Health Cigna Priority Health	$1,397.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,494.09
Rate for Payer: Priority Health Narrow Network	$1,494.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,056.48
Rate for Payer: UHC Exchange	$1,056.48
Rate for Payer: UHCCP Medicaid	$642.20

PR LAPT W/ASPIR &/NJX HEPATC PARASITIC CYST/ABSCESS

Professional

Both

$2,415.00

Service Code	HCPCS 47015
Min. Negotiated Rate	$241.96
Max. Negotiated Rate	$2,087.48
Rate for Payer: Aetna Commercial	$1,577.30
Rate for Payer: Aetna Medicare	$1,207.50
Rate for Payer: BCBS Complete	$787.25
Rate for Payer: BCBS Trust/PPO	$241.96
Rate for Payer: BCN Commercial	$1,703.05
Rate for Payer: Cash Price	$1,932.00
Rate for Payer: Cash Price	$1,932.00
Rate for Payer: Meridian Medicaid	$787.25
Rate for Payer: Priority Health Choice Medicaid	$749.76
Rate for Payer: Priority Health Cigna Priority Health	$1,569.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,087.48
Rate for Payer: Priority Health Narrow Network	$2,087.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,380.93
Rate for Payer: UHC Exchange	$1,380.93
Rate for Payer: UHCCP Medicaid	$749.76

PR LAP,W/CHOLANGIOGRAPHY,BIOPSY

Professional

Both

$2,159.00

Service Code	HCPCS 47561
Min. Negotiated Rate	$863.60
Max. Negotiated Rate	$1,403.35
Rate for Payer: Aetna Medicare	$1,079.50
Rate for Payer: BCBS Complete	$863.60
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Priority Health Cigna Priority Health	$1,403.35

PR LAP,W/CHOLANGIOGRAPHY,W/O BX

Professional

Both

$487.00

Service Code	HCPCS 47560
Min. Negotiated Rate	$194.80
Max. Negotiated Rate	$316.55
Rate for Payer: Aetna Medicare	$243.50
Rate for Payer: BCBS Complete	$194.80
Rate for Payer: Cash Price	$389.60
Rate for Payer: Priority Health Cigna Priority Health	$316.55

PR LARGSC ARYTENOIDECTOMY MICROSCOPE/TELESCOPE

Professional

Both

$793.00

Service Code	HCPCS 31561
Min. Negotiated Rate	$216.62
Max. Negotiated Rate	$1,441.20
Rate for Payer: Aetna Commercial	$432.48
Rate for Payer: Aetna Medicare	$396.50
Rate for Payer: BCBS Complete	$227.45
Rate for Payer: BCBS Trust/PPO	$1,441.20
Rate for Payer: BCN Commercial	$494.54
Rate for Payer: Cash Price	$634.40
Rate for Payer: Cash Price	$634.40
Rate for Payer: Meridian Medicaid	$227.45
Rate for Payer: Priority Health Choice Medicaid	$216.62
Rate for Payer: Priority Health Cigna Priority Health	$515.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$470.42
Rate for Payer: Priority Health Narrow Network	$470.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$397.60
Rate for Payer: UHC Exchange	$397.60
Rate for Payer: UHCCP Medicaid	$216.62

PR LARGSC EXC TUM&/STRPG CORDS/EPIGL MCRSCP/TLSCP

Professional

Both

$1,210.00

Service Code	HCPCS 31541
Min. Negotiated Rate	$167.42
Max. Negotiated Rate	$1,146.94
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: Aetna Medicare	$605.00
Rate for Payer: BCBS Complete	$175.79
Rate for Payer: BCBS Trust/PPO	$1,146.94
Rate for Payer: BCN Commercial	$382.15
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Meridian Medicaid	$175.79
Rate for Payer: Priority Health Choice Medicaid	$167.42
Rate for Payer: Priority Health Cigna Priority Health	$786.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$362.89
Rate for Payer: Priority Health Narrow Network	$362.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$306.46
Rate for Payer: UHC Exchange	$306.46
Rate for Payer: UHCCP Medicaid	$167.42

PR LARGSC MICRO/TELESCOPE RMVL LES VOCAL CORD FLAP

Professional

Both

$1,331.00

Service Code	HCPCS 31545
Min. Negotiated Rate	$229.61
Max. Negotiated Rate	$1,178.11
Rate for Payer: Aetna Commercial	$459.09
Rate for Payer: Aetna Medicare	$665.50
Rate for Payer: BCBS Complete	$241.09
Rate for Payer: BCBS Trust/PPO	$1,178.11
Rate for Payer: BCN Commercial	$523.86
Rate for Payer: Cash Price	$1,064.80
Rate for Payer: Cash Price	$1,064.80
Rate for Payer: Meridian Medicaid	$241.09
Rate for Payer: Priority Health Choice Medicaid	$229.61
Rate for Payer: Priority Health Cigna Priority Health	$865.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$498.68
Rate for Payer: Priority Health Narrow Network	$498.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$419.88
Rate for Payer: UHC Exchange	$419.88
Rate for Payer: UHCCP Medicaid	$229.61

PR LARGSC W/NJX VOCAL CORD THER W/MICRO/TELESCOPE

Professional

Both

$1,108.00

Service Code	HCPCS 31571
Min. Negotiated Rate	$158.69
Max. Negotiated Rate	$745.43
Rate for Payer: Aetna Commercial	$315.31
Rate for Payer: Aetna Medicare	$554.00
Rate for Payer: BCBS Complete	$166.62
Rate for Payer: BCBS Trust/PPO	$745.43
Rate for Payer: BCN Commercial	$360.16
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cash Price	$886.40
Rate for Payer: Meridian Medicaid	$166.62
Rate for Payer: Priority Health Choice Medicaid	$158.69
Rate for Payer: Priority Health Cigna Priority Health	$720.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.43
Rate for Payer: Priority Health Narrow Network	$343.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$289.16
Rate for Payer: UHC Exchange	$289.16
Rate for Payer: UHCCP Medicaid	$158.69

Know your out-of-pocket cost for care.

All Charges