Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR MASTECTOMY SIMPLE COMPLETE

Professional

Both

$1,891.00

Service Code	HCPCS 19303
Min. Negotiated Rate	$619.19
Max. Negotiated Rate	$1,401.52
Rate for Payer: Aetna Commercial	$1,051.23
Rate for Payer: Aetna Medicare	$945.50
Rate for Payer: BCBS Complete	$650.15
Rate for Payer: BCBS Trust/PPO	$1,316.25
Rate for Payer: BCN Commercial	$1,401.52
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Cash Price	$1,512.80
Rate for Payer: Meridian Medicaid	$650.15
Rate for Payer: Priority Health Choice Medicaid	$619.19
Rate for Payer: Priority Health Cigna Priority Health	$1,229.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,303.98
Rate for Payer: Priority Health Narrow Network	$1,303.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,040.56
Rate for Payer: UHC Exchange	$1,040.56
Rate for Payer: UHCCP Medicaid	$619.19

PR MASTECTOMY, SUBCUTANEOUS

Professional

Both

$1,102.00

Service Code	HCPCS 19304
Hospital Charge Code	19304
Min. Negotiated Rate	$440.80
Max. Negotiated Rate	$716.30
Rate for Payer: Aetna Medicare	$551.00
Rate for Payer: BCBS Complete	$440.80
Rate for Payer: Cash Price	$881.60
Rate for Payer: Priority Health Cigna Priority Health	$716.30

PR MASTECTOMY, SUBCUTANEOUS

Professional

Both

$1,102.00

Service Code	HCPCS 19304
Min. Negotiated Rate	$440.80
Max. Negotiated Rate	$716.30
Rate for Payer: Aetna Medicare	$551.00
Rate for Payer: BCBS Complete	$440.80
Rate for Payer: Cash Price	$881.60
Rate for Payer: Priority Health Cigna Priority Health	$716.30

PR MASTECTOMY, SUBCUTANEOUS

Facility

$1,102.00

Service Code	CPT 19304
Hospital Charge Code	19304
Hospital Revenue Code	960
Min. Negotiated Rate	$716.30
Max. Negotiated Rate	$1,102.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: ASR ASR	$1,068.94
Rate for Payer: ASR Commercial	$1,068.94
Rate for Payer: BCBS Trust/PPO	$898.02
Rate for Payer: BCN Commercial	$854.38
Rate for Payer: Cash Price	$881.60
Rate for Payer: Cofinity Commercial	$1,035.88
Rate for Payer: Encore Health Key Benefits Commercial	$881.60
Rate for Payer: Healthscope Commercial	$1,102.00
Rate for Payer: Healthscope Whirlpool	$1,068.94
Rate for Payer: Mclaren Commercial	$991.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$936.70
Rate for Payer: Nomi Health Commercial	$903.64
Rate for Payer: Priority Health Cigna Priority Health	$716.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$969.76

PR MASTECTOMY, SUBCUTANEOUS

Facility

$1,102.00

Service Code	CPT 19304
Hospital Charge Code	19304
Hospital Revenue Code	960
Min. Negotiated Rate	$440.80
Max. Negotiated Rate	$1,102.00
Rate for Payer: Aetna Commercial	$991.80
Rate for Payer: Aetna Medicare	$551.00
Rate for Payer: ASR ASR	$1,068.94
Rate for Payer: ASR Commercial	$1,068.94
Rate for Payer: BCBS Complete	$440.80
Rate for Payer: BCBS Trust/PPO	$902.43
Rate for Payer: BCN Commercial	$854.38
Rate for Payer: Cash Price	$881.60
Rate for Payer: Cofinity Commercial	$1,035.88
Rate for Payer: Encore Health Key Benefits Commercial	$881.60
Rate for Payer: Healthscope Commercial	$1,102.00
Rate for Payer: Healthscope Whirlpool	$1,068.94
Rate for Payer: Mclaren Commercial	$991.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$936.70
Rate for Payer: Nomi Health Commercial	$903.64
Rate for Payer: Priority Health Cigna Priority Health	$716.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$965.57
Rate for Payer: Priority Health Narrow Network	$772.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$969.76

PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

Professional

Both

$2,044.00

Service Code	HCPCS 19307
Hospital Charge Code	19307
Min. Negotiated Rate	$760.62
Max. Negotiated Rate	$18,089.98
Rate for Payer: Aetna Commercial	$1,296.93
Rate for Payer: Aetna Medicare	$1,022.00
Rate for Payer: BCBS Complete	$798.65
Rate for Payer: BCBS Trust/PPO	$18,089.98
Rate for Payer: BCN Commercial	$1,727.47
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Meridian Medicaid	$798.65
Rate for Payer: Priority Health Choice Medicaid	$760.62
Rate for Payer: Priority Health Cigna Priority Health	$1,328.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,605.14
Rate for Payer: Priority Health Narrow Network	$1,605.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,237.96
Rate for Payer: UHC Exchange	$1,237.96
Rate for Payer: UHCCP Medicaid	$760.62

PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

Professional

Both

$2,044.00

Service Code	HCPCS 19307
Min. Negotiated Rate	$760.62
Max. Negotiated Rate	$18,089.98
Rate for Payer: Aetna Commercial	$1,296.93
Rate for Payer: Aetna Medicare	$1,022.00
Rate for Payer: BCBS Complete	$798.65
Rate for Payer: BCBS Trust/PPO	$18,089.98
Rate for Payer: BCN Commercial	$1,727.47
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Meridian Medicaid	$798.65
Rate for Payer: Priority Health Choice Medicaid	$760.62
Rate for Payer: Priority Health Cigna Priority Health	$1,328.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,605.14
Rate for Payer: Priority Health Narrow Network	$1,605.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,237.96
Rate for Payer: UHC Exchange	$1,237.96
Rate for Payer: UHCCP Medicaid	$760.62

PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

Facility

$2,044.00

Service Code	CPT 19307
Hospital Charge Code	19307
Hospital Revenue Code	960
Min. Negotiated Rate	$1,328.60
Max. Negotiated Rate	$2,044.00
Rate for Payer: Aetna Commercial	$1,839.60
Rate for Payer: ASR ASR	$1,982.68
Rate for Payer: ASR Commercial	$1,982.68
Rate for Payer: BCBS Trust/PPO	$1,665.66
Rate for Payer: BCN Commercial	$1,584.71
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cofinity Commercial	$1,921.36
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.20
Rate for Payer: Healthscope Commercial	$2,044.00
Rate for Payer: Healthscope Whirlpool	$1,982.68
Rate for Payer: Mclaren Commercial	$1,839.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.40
Rate for Payer: Nomi Health Commercial	$1,676.08
Rate for Payer: Priority Health Cigna Priority Health	$1,328.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,798.72

PR MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN

Facility

$2,044.00

Service Code	CPT 19307
Hospital Charge Code	19307
Hospital Revenue Code	960
Min. Negotiated Rate	$1,328.60
Max. Negotiated Rate	$9,903.88
Rate for Payer: Aetna Commercial	$1,839.60
Rate for Payer: Aetna Medicare	$6,389.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,987.00
Rate for Payer: Amish Plain Church Group Commercial	$7,987.00
Rate for Payer: ASR ASR	$1,982.68
Rate for Payer: ASR Commercial	$1,982.68
Rate for Payer: BCBS Complete	$3,596.07
Rate for Payer: BCBS MAPPO	$6,389.60
Rate for Payer: BCBS Trust/PPO	$1,673.83
Rate for Payer: BCN Commercial	$1,584.71
Rate for Payer: BCN Medicare Advantage	$6,389.60
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cofinity Commercial	$1,921.36
Rate for Payer: Encore Health Key Benefits Commercial	$1,635.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,389.60
Rate for Payer: Healthscope Commercial	$2,044.00
Rate for Payer: Healthscope Whirlpool	$1,982.68
Rate for Payer: Humana Choice PPO Medicare	$6,389.60
Rate for Payer: Mclaren Commercial	$1,839.60
Rate for Payer: Mclaren Medicaid	$3,424.83
Rate for Payer: Mclaren Medicare	$6,389.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,709.08
Rate for Payer: Meridian Medicaid	$3,596.07
Rate for Payer: MI Amish Medical Board Commercial	$7,348.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,737.40
Rate for Payer: Nomi Health Commercial	$1,676.08
Rate for Payer: PACE Medicare	$6,070.12
Rate for Payer: PACE SWMI	$6,389.60
Rate for Payer: PHP Commercial	$7,028.56
Rate for Payer: PHP Medicaid	$3,424.83
Rate for Payer: PHP Medicare Advantage	$6,389.60
Rate for Payer: Priority Health Choice Medicaid	$3,424.83
Rate for Payer: Priority Health Cigna Priority Health	$1,328.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,790.95
Rate for Payer: Priority Health Medicare	$6,389.60
Rate for Payer: Priority Health Narrow Network	$1,432.84
Rate for Payer: Railroad Medicare Medicare	$6,389.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,798.72
Rate for Payer: UHC Dual Complete DSNP	$6,389.60
Rate for Payer: UHC Exchange	$9,903.88
Rate for Payer: UHC Medicare Advantage	$6,389.60
Rate for Payer: UHCCP DNSP	$6,389.60
Rate for Payer: UHCCP Medicaid	$3,424.83
Rate for Payer: VA VA	$6,389.60

PR MASTOIDECTOMY COMPLETE

Professional

Both

$2,704.00

Service Code	HCPCS 69502
Min. Negotiated Rate	$603.00
Max. Negotiated Rate	$4,242.78
Rate for Payer: Aetna Commercial	$1,083.82
Rate for Payer: Aetna Medicare	$1,352.00
Rate for Payer: BCBS Complete	$633.15
Rate for Payer: BCBS Trust/PPO	$4,242.78
Rate for Payer: BCN Commercial	$1,393.22
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Meridian Medicaid	$633.15
Rate for Payer: Priority Health Choice Medicaid	$603.00
Rate for Payer: Priority Health Cigna Priority Health	$1,757.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,385.68
Rate for Payer: Priority Health Narrow Network	$1,385.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,072.52
Rate for Payer: UHC Exchange	$1,072.52
Rate for Payer: UHCCP Medicaid	$603.00

PR MASTOID OBLITERATION SEPARATE PROCEDURE

Professional

Both

$3,479.00

Service Code	HCPCS 69670
Min. Negotiated Rate	$602.79
Max. Negotiated Rate	$3,570.25
Rate for Payer: Aetna Commercial	$1,073.89
Rate for Payer: Aetna Medicare	$1,739.50
Rate for Payer: BCBS Complete	$632.93
Rate for Payer: BCBS Trust/PPO	$3,570.25
Rate for Payer: BCN Commercial	$1,394.20
Rate for Payer: Cash Price	$2,783.20
Rate for Payer: Cash Price	$2,783.20
Rate for Payer: Meridian Medicaid	$632.93
Rate for Payer: Priority Health Choice Medicaid	$602.79
Rate for Payer: Priority Health Cigna Priority Health	$2,261.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,385.20
Rate for Payer: Priority Health Narrow Network	$1,385.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,037.07
Rate for Payer: UHC Exchange	$1,037.07
Rate for Payer: UHCCP Medicaid	$602.79

PR MASTOPEXY

Professional

Both

$1,938.00

Service Code	HCPCS 19316
Min. Negotiated Rate	$293.06
Max. Negotiated Rate	$1,259.70
Rate for Payer: Aetna Commercial	$856.33
Rate for Payer: Aetna Medicare	$969.00
Rate for Payer: BCBS Complete	$538.10
Rate for Payer: BCBS Trust/PPO	$293.06
Rate for Payer: BCN Commercial	$1,159.64
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Meridian Medicaid	$538.10
Rate for Payer: Priority Health Choice Medicaid	$512.48
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,077.32
Rate for Payer: Priority Health Narrow Network	$1,077.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$815.52
Rate for Payer: UHC Exchange	$815.52
Rate for Payer: UHCCP Medicaid	$512.48

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Facility

$814.00

Service Code	CPT 19020
Hospital Charge Code	19020
Min. Negotiated Rate	$529.10
Max. Negotiated Rate	$2,460.59
Rate for Payer: Aetna Commercial	$732.60
Rate for Payer: Aetna Medicare	$1,587.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,984.35
Rate for Payer: Amish Plain Church Group Commercial	$1,984.35
Rate for Payer: ASR ASR	$789.58
Rate for Payer: ASR Commercial	$789.58
Rate for Payer: BCBS Complete	$893.43
Rate for Payer: BCBS MAPPO	$1,587.48
Rate for Payer: BCBS Trust/PPO	$666.58
Rate for Payer: BCN Commercial	$631.09
Rate for Payer: BCN Medicare Advantage	$1,587.48
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cofinity Commercial	$765.16
Rate for Payer: Encore Health Key Benefits Commercial	$651.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,587.48
Rate for Payer: Healthscope Commercial	$814.00
Rate for Payer: Healthscope Whirlpool	$789.58
Rate for Payer: Humana Choice PPO Medicare	$1,587.48
Rate for Payer: Mclaren Commercial	$732.60
Rate for Payer: Mclaren Medicaid	$850.89
Rate for Payer: Mclaren Medicare	$1,587.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,666.85
Rate for Payer: Meridian Medicaid	$893.43
Rate for Payer: MI Amish Medical Board Commercial	$1,825.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$691.90
Rate for Payer: Nomi Health Commercial	$667.48
Rate for Payer: PACE Medicare	$1,508.11
Rate for Payer: PACE SWMI	$1,587.48
Rate for Payer: PHP Commercial	$1,746.23
Rate for Payer: PHP Medicaid	$850.89
Rate for Payer: PHP Medicare Advantage	$1,587.48
Rate for Payer: Priority Health Choice Medicaid	$850.89
Rate for Payer: Priority Health Cigna Priority Health	$529.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$713.23
Rate for Payer: Priority Health Medicare	$1,587.48
Rate for Payer: Priority Health Narrow Network	$570.61
Rate for Payer: Railroad Medicare Medicare	$1,587.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$716.32
Rate for Payer: UHC Dual Complete DSNP	$1,587.48
Rate for Payer: UHC Exchange	$2,460.59
Rate for Payer: UHC Medicare Advantage	$1,587.48
Rate for Payer: UHCCP DNSP	$1,587.48
Rate for Payer: UHCCP Medicaid	$850.89
Rate for Payer: VA VA	$1,587.48

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Professional

Both

$814.00

Service Code	HCPCS 19020
Hospital Charge Code	19020
Min. Negotiated Rate	$203.42
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$336.67
Rate for Payer: Aetna Medicare	$407.00
Rate for Payer: BCBS Complete	$213.59
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: BCN Commercial	$692.46
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cash Price	$651.20
Rate for Payer: Meridian Medicaid	$213.59
Rate for Payer: Priority Health Choice Medicaid	$203.42
Rate for Payer: Priority Health Cigna Priority Health	$529.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$429.85
Rate for Payer: Priority Health Narrow Network	$429.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$304.47
Rate for Payer: UHC Exchange	$304.47
Rate for Payer: UHCCP Medicaid	$203.42

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Facility

$814.00

Service Code	CPT 19020
Hospital Charge Code	19020
Min. Negotiated Rate	$529.10
Max. Negotiated Rate	$814.00
Rate for Payer: Aetna Commercial	$732.60
Rate for Payer: ASR ASR	$789.58
Rate for Payer: ASR Commercial	$789.58
Rate for Payer: BCBS Trust/PPO	$663.33
Rate for Payer: BCN Commercial	$631.09
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cofinity Commercial	$765.16
Rate for Payer: Encore Health Key Benefits Commercial	$651.20
Rate for Payer: Healthscope Commercial	$814.00
Rate for Payer: Healthscope Whirlpool	$789.58
Rate for Payer: Mclaren Commercial	$732.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$691.90
Rate for Payer: Nomi Health Commercial	$667.48
Rate for Payer: Priority Health Cigna Priority Health	$529.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$716.32

PR MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP

Professional

Both

$814.00

Service Code	HCPCS 19020
Min. Negotiated Rate	$203.42
Max. Negotiated Rate	$6,614.63
Rate for Payer: Aetna Commercial	$336.67
Rate for Payer: Aetna Medicare	$407.00
Rate for Payer: BCBS Complete	$213.59
Rate for Payer: BCBS Trust/PPO	$6,614.63
Rate for Payer: BCN Commercial	$692.46
Rate for Payer: Cash Price	$651.20
Rate for Payer: Cash Price	$651.20
Rate for Payer: Meridian Medicaid	$213.59
Rate for Payer: Priority Health Choice Medicaid	$203.42
Rate for Payer: Priority Health Cigna Priority Health	$529.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$429.85
Rate for Payer: Priority Health Narrow Network	$429.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$304.47
Rate for Payer: UHC Exchange	$304.47
Rate for Payer: UHCCP Medicaid	$203.42

PR MAST RAD W/PECTORAL MUSCLES AXILLARY LYMPH NODES

Professional

Both

$2,416.00

Service Code	HCPCS 19305
Min. Negotiated Rate	$738.90
Max. Negotiated Rate	$2,189.70
Rate for Payer: Aetna Commercial	$1,253.82
Rate for Payer: Aetna Medicare	$1,208.00
Rate for Payer: BCBS Complete	$775.84
Rate for Payer: BCBS Trust/PPO	$2,189.70
Rate for Payer: BCN Commercial	$1,685.94
Rate for Payer: Cash Price	$1,932.80
Rate for Payer: Cash Price	$1,932.80
Rate for Payer: Meridian Medicaid	$775.84
Rate for Payer: Priority Health Choice Medicaid	$738.90
Rate for Payer: Priority Health Cigna Priority Health	$1,570.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,563.61
Rate for Payer: Priority Health Narrow Network	$1,563.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,176.20
Rate for Payer: UHC Exchange	$1,176.20
Rate for Payer: UHCCP Medicaid	$738.90

PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ

Professional

Both

$44.00

Service Code	HCPCS 94200
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$2,544.29
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCBS Complete	$1.78
Rate for Payer: BCBS Trust/PPO	$2,544.29
Rate for Payer: BCN Commercial	$21.51
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Meridian Medicaid	$1.78
Rate for Payer: Priority Health Choice Medicaid	$1.70
Rate for Payer: Priority Health Cigna Priority Health	$28.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.61
Rate for Payer: Priority Health Narrow Network	$3.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.97
Rate for Payer: UHC Exchange	$22.97
Rate for Payer: UHCCP Medicaid	$1.70

PR MAXILLECTOMY W/O ORBITAL EXENTERATION

Professional

Both

$3,304.00

Service Code	HCPCS 31225
Min. Negotiated Rate	$904.98
Max. Negotiated Rate	$2,643.74
Rate for Payer: Aetna Commercial	$2,328.96
Rate for Payer: Aetna Medicare	$1,652.00
Rate for Payer: BCBS Complete	$1,209.27
Rate for Payer: BCBS Trust/PPO	$904.98
Rate for Payer: BCN Commercial	$2,643.74
Rate for Payer: Cash Price	$2,643.20
Rate for Payer: Cash Price	$2,643.20
Rate for Payer: Meridian Medicaid	$1,209.27
Rate for Payer: Priority Health Choice Medicaid	$1,151.69
Rate for Payer: Priority Health Cigna Priority Health	$2,147.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,505.97
Rate for Payer: Priority Health Narrow Network	$2,505.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,049.53
Rate for Payer: UHC Exchange	$2,049.53
Rate for Payer: UHCCP Medicaid	$1,151.69

PR MCCD, INITIAL RATE

Professional

Both

$163.00

Service Code	HCPCS G9001
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1,218.26
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCBS Complete	$65.20
Rate for Payer: BCBS Trust/PPO	$1,218.26
Rate for Payer: BCN Commercial	$136.23
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Priority Health Cigna Priority Health	$105.95

PR MCCD,MAINTENANCE RATE

Professional

Both

$82.00

Service Code	HCPCS G9002
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$884.37
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: BCBS Trust/PPO	$884.37
Rate for Payer: BCN Commercial	$68.13
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$53.30

PR MCCD,PHYS COOR-CARE OVRSGHT

Professional

Both

$87.00

Service Code	HCPCS G9008
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1,823.69
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$43.50
Rate for Payer: BCBS Complete	$34.80
Rate for Payer: BCBS Trust/PPO	$1,823.69
Rate for Payer: BCN Commercial	$50.00
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Priority Health Cigna Priority Health	$56.55

PR MCCD, SCH TEAM CONF

Professional

Both

$41.00

Service Code	HCPCS G9007
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1,852.75
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: BCBS Trust/PPO	$1,852.75
Rate for Payer: BCN Commercial	$28.81
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN

Professional

Both

$236.00

Service Code	HCPCS 36596
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$745.43
Rate for Payer: Aetna Commercial	$57.96
Rate for Payer: Aetna Medicare	$118.00
Rate for Payer: BCBS Complete	$30.42
Rate for Payer: BCBS Trust/PPO	$745.43
Rate for Payer: BCN Commercial	$167.13
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Meridian Medicaid	$30.42
Rate for Payer: Priority Health Choice Medicaid	$28.97
Rate for Payer: Priority Health Cigna Priority Health	$153.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.73
Rate for Payer: Priority Health Narrow Network	$70.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$58.01
Rate for Payer: UHC Exchange	$58.01
Rate for Payer: UHCCP Medicaid	$28.97

PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS

Professional

Both

$1,142.00

Service Code	HCPCS 36595
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$871.31
Rate for Payer: Aetna Commercial	$243.74
Rate for Payer: Aetna Medicare	$571.00
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCBS Trust/PPO	$586.94
Rate for Payer: BCN Commercial	$871.31
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cash Price	$913.60
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health	$742.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$281.33
Rate for Payer: Priority Health Narrow Network	$281.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$245.13
Rate for Payer: UHC Exchange	$245.13
Rate for Payer: UHCCP Medicaid	$113.32

Know your out-of-pocket cost for care.

All Charges