Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$3,586.00

Service Code	HCPCS 27758
Min. Negotiated Rate	$583.19
Max. Negotiated Rate	$2,330.90
Rate for Payer: Aetna Commercial	$1,195.54
Rate for Payer: Aetna Medicare	$1,793.00
Rate for Payer: BCBS Complete	$612.35
Rate for Payer: BCBS Trust/PPO	$623.39
Rate for Payer: BCN Commercial	$1,316.50
Rate for Payer: Cash Price	$2,868.80
Rate for Payer: Cash Price	$2,868.80
Rate for Payer: Meridian Medicaid	$612.35
Rate for Payer: Priority Health Choice Medicaid	$583.19
Rate for Payer: Priority Health Cigna Priority Health	$2,330.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,382.57
Rate for Payer: Priority Health Narrow Network	$1,382.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,022.09
Rate for Payer: UHC Exchange	$1,022.09
Rate for Payer: UHCCP Medicaid	$583.19

PROPYLTHIOURACIL 50 MG TABLET

Facility

$252.48

Service Code	NDC 00228234810
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$100.99
Max. Negotiated Rate	$252.48
Rate for Payer: Aetna Commercial	$227.23
Rate for Payer: Aetna Medicare	$126.24
Rate for Payer: ASR ASR	$244.91
Rate for Payer: ASR Commercial	$244.91
Rate for Payer: BCBS Complete	$100.99
Rate for Payer: BCBS Trust/PPO	$206.76
Rate for Payer: BCN Commercial	$195.75
Rate for Payer: Cash Price	$201.98
Rate for Payer: Cofinity Commercial	$237.33
Rate for Payer: Encore Health Key Benefits Commercial	$201.98
Rate for Payer: Healthscope Commercial	$252.48
Rate for Payer: Healthscope Whirlpool	$244.91
Rate for Payer: Mclaren Commercial	$227.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.61
Rate for Payer: Nomi Health Commercial	$207.03
Rate for Payer: Priority Health Cigna Priority Health	$164.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.22
Rate for Payer: Priority Health Narrow Network	$176.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$222.18

PROPYLTHIOURACIL 50 MG TABLET

Facility

$245.53

Service Code	NDC 68084096425
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$159.59
Max. Negotiated Rate	$245.53
Rate for Payer: Aetna Commercial	$220.98
Rate for Payer: ASR ASR	$238.16
Rate for Payer: ASR Commercial	$238.16
Rate for Payer: BCBS Trust/PPO	$200.08
Rate for Payer: BCN Commercial	$190.36
Rate for Payer: Cash Price	$196.43
Rate for Payer: Cofinity Commercial	$230.80
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$245.53
Rate for Payer: Healthscope Whirlpool	$238.16
Rate for Payer: Mclaren Commercial	$220.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Nomi Health Commercial	$201.33
Rate for Payer: Priority Health Cigna Priority Health	$159.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.07

PROPYLTHIOURACIL 50 MG TABLET

Facility

$252.48

Service Code	NDC 00228234810
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$164.11
Max. Negotiated Rate	$252.48
Rate for Payer: Aetna Commercial	$227.23
Rate for Payer: ASR ASR	$244.91
Rate for Payer: ASR Commercial	$244.91
Rate for Payer: BCBS Trust/PPO	$205.75
Rate for Payer: BCN Commercial	$195.75
Rate for Payer: Cash Price	$201.98
Rate for Payer: Cofinity Commercial	$237.33
Rate for Payer: Encore Health Key Benefits Commercial	$201.98
Rate for Payer: Healthscope Commercial	$252.48
Rate for Payer: Healthscope Whirlpool	$244.91
Rate for Payer: Mclaren Commercial	$227.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.61
Rate for Payer: Nomi Health Commercial	$207.03
Rate for Payer: Priority Health Cigna Priority Health	$164.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$222.18

PROPYLTHIOURACIL 50 MG TABLET

Facility

$8.19

Service Code	NDC 68084096495
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$8.19
Rate for Payer: Aetna Commercial	$7.37
Rate for Payer: ASR ASR	$7.94
Rate for Payer: ASR Commercial	$7.94
Rate for Payer: BCBS Trust/PPO	$6.67
Rate for Payer: BCN Commercial	$6.35
Rate for Payer: Cash Price	$6.55
Rate for Payer: Cofinity Commercial	$7.70
Rate for Payer: Encore Health Key Benefits Commercial	$6.55
Rate for Payer: Healthscope Commercial	$8.19
Rate for Payer: Healthscope Whirlpool	$7.94
Rate for Payer: Mclaren Commercial	$7.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.96
Rate for Payer: Nomi Health Commercial	$6.72
Rate for Payer: Priority Health Cigna Priority Health	$5.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.21

PROPYLTHIOURACIL 50 MG TABLET

Facility

$245.53

Service Code	NDC 68084096425
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$98.21
Max. Negotiated Rate	$245.53
Rate for Payer: Aetna Commercial	$220.98
Rate for Payer: Aetna Medicare	$122.76
Rate for Payer: ASR ASR	$238.16
Rate for Payer: ASR Commercial	$238.16
Rate for Payer: BCBS Complete	$98.21
Rate for Payer: BCBS Trust/PPO	$201.06
Rate for Payer: BCN Commercial	$190.36
Rate for Payer: Cash Price	$196.43
Rate for Payer: Cofinity Commercial	$230.80
Rate for Payer: Encore Health Key Benefits Commercial	$196.42
Rate for Payer: Healthscope Commercial	$245.53
Rate for Payer: Healthscope Whirlpool	$238.16
Rate for Payer: Mclaren Commercial	$220.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.70
Rate for Payer: Nomi Health Commercial	$201.33
Rate for Payer: Priority Health Cigna Priority Health	$159.59
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$215.13
Rate for Payer: Priority Health Narrow Network	$172.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$216.07

PROPYLTHIOURACIL 50 MG TABLET

Facility

$8.19

Service Code	NDC 68084096495
Hospital Charge Code	6662
Hospital Revenue Code	637
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$8.19
Rate for Payer: Aetna Commercial	$7.37
Rate for Payer: Aetna Medicare	$4.10
Rate for Payer: ASR ASR	$7.94
Rate for Payer: ASR Commercial	$7.94
Rate for Payer: BCBS Complete	$3.28
Rate for Payer: BCBS Trust/PPO	$6.71
Rate for Payer: BCN Commercial	$6.35
Rate for Payer: Cash Price	$6.55
Rate for Payer: Cofinity Commercial	$7.70
Rate for Payer: Encore Health Key Benefits Commercial	$6.55
Rate for Payer: Healthscope Commercial	$8.19
Rate for Payer: Healthscope Whirlpool	$7.94
Rate for Payer: Mclaren Commercial	$7.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.96
Rate for Payer: Nomi Health Commercial	$6.72
Rate for Payer: Priority Health Cigna Priority Health	$5.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.18
Rate for Payer: Priority Health Narrow Network	$5.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.21

PR ORAL DEXAMETHASONE

Professional

Both

$1.00

Service Code	HCPCS J8540
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna Commercial	$0.09
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.07
Rate for Payer: UHC Exchange	$0.07

PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC

Professional

Both

$28.00

Service Code	HCPCS 90712
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$18.20
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$18.20

PR ORAL PRESCRIP DRUG NON CHEMO

Professional

Both

$4.00

Service Code	HCPCS J8499
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST

Professional

Both

$168.00

Service Code	HCPCS 95933
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$120.21
Rate for Payer: Aetna Commercial	$92.26
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: BCBS Complete	$20.58
Rate for Payer: BCBS Trust/PPO	$63.40
Rate for Payer: BCN Commercial	$120.21
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Meridian Medicaid	$20.58
Rate for Payer: Priority Health Choice Medicaid	$19.60
Rate for Payer: Priority Health Cigna Priority Health	$109.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.61
Rate for Payer: Priority Health Narrow Network	$41.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$68.80
Rate for Payer: UHC Exchange	$68.80
Rate for Payer: UHCCP Medicaid	$19.60

PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ

Professional

Both

$7,956.00

Service Code	HCPCS 61584
Min. Negotiated Rate	$420.53
Max. Negotiated Rate	$5,935.30
Rate for Payer: Aetna Commercial	$3,731.75
Rate for Payer: Aetna Medicare	$3,978.00
Rate for Payer: BCBS Complete	$1,951.79
Rate for Payer: BCBS Trust/PPO	$420.53
Rate for Payer: BCN Commercial	$5,935.30
Rate for Payer: Cash Price	$6,364.80
Rate for Payer: Cash Price	$6,364.80
Rate for Payer: Meridian Medicaid	$1,951.79
Rate for Payer: Priority Health Choice Medicaid	$1,858.85
Rate for Payer: Priority Health Cigna Priority Health	$5,171.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,960.91
Rate for Payer: Priority Health Narrow Network	$4,960.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,250.88
Rate for Payer: UHC Exchange	$3,250.88
Rate for Payer: UHCCP Medicaid	$1,858.85

PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE

Professional

Both

$5,759.00

Service Code	HCPCS 61592
Min. Negotiated Rate	$397.28
Max. Negotiated Rate	$6,472.23
Rate for Payer: Aetna Commercial	$4,118.86
Rate for Payer: Aetna Medicare	$2,879.50
Rate for Payer: BCBS Complete	$2,141.45
Rate for Payer: BCBS Trust/PPO	$397.28
Rate for Payer: BCN Commercial	$6,472.23
Rate for Payer: Cash Price	$4,607.20
Rate for Payer: Cash Price	$4,607.20
Rate for Payer: Meridian Medicaid	$2,141.45
Rate for Payer: Priority Health Choice Medicaid	$2,039.48
Rate for Payer: Priority Health Cigna Priority Health	$3,743.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,463.65
Rate for Payer: Priority Health Narrow Network	$5,463.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,642.49
Rate for Payer: UHC Exchange	$3,642.49
Rate for Payer: UHCCP Medicaid	$2,039.48

PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN

Professional

Both

$3,588.00

Service Code	HCPCS 67445
Min. Negotiated Rate	$348.68
Max. Negotiated Rate	$2,661.32
Rate for Payer: Aetna Commercial	$1,975.12
Rate for Payer: Aetna Medicare	$1,794.00
Rate for Payer: BCBS Complete	$1,006.42
Rate for Payer: BCBS Trust/PPO	$348.68
Rate for Payer: BCN Commercial	$2,217.13
Rate for Payer: Cash Price	$2,870.40
Rate for Payer: Cash Price	$2,870.40
Rate for Payer: Meridian Medicaid	$1,006.42
Rate for Payer: Priority Health Choice Medicaid	$958.50
Rate for Payer: Priority Health Cigna Priority Health	$2,332.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,661.32
Rate for Payer: Priority Health Narrow Network	$2,661.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,520.08
Rate for Payer: UHC Exchange	$1,520.08
Rate for Payer: UHCCP Medicaid	$958.50

PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY

Professional

Both

$1,662.00

Service Code	HCPCS 67400
Min. Negotiated Rate	$359.77
Max. Negotiated Rate	$1,809.71
Rate for Payer: Aetna Commercial	$1,329.81
Rate for Payer: Aetna Medicare	$831.00
Rate for Payer: BCBS Complete	$682.80
Rate for Payer: BCBS Trust/PPO	$359.77
Rate for Payer: BCN Commercial	$1,509.04
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Meridian Medicaid	$682.80
Rate for Payer: Priority Health Choice Medicaid	$650.29
Rate for Payer: Priority Health Cigna Priority Health	$1,080.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,809.71
Rate for Payer: Priority Health Narrow Network	$1,809.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$988.14
Rate for Payer: UHC Exchange	$988.14
Rate for Payer: UHCCP Medicaid	$650.29

PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY

Professional

Both

$2,652.00

Service Code	HCPCS 67413
Min. Negotiated Rate	$604.07
Max. Negotiated Rate	$1,723.80
Rate for Payer: Aetna Commercial	$1,231.62
Rate for Payer: Aetna Medicare	$1,326.00
Rate for Payer: BCBS Complete	$634.27
Rate for Payer: BCN Commercial	$1,407.88
Rate for Payer: Cash Price	$2,121.60
Rate for Payer: Cash Price	$2,121.60
Rate for Payer: Meridian Medicaid	$634.27
Rate for Payer: Priority Health Choice Medicaid	$604.07
Rate for Payer: Priority Health Cigna Priority Health	$1,723.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,682.19
Rate for Payer: Priority Health Narrow Network	$1,682.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$914.95
Rate for Payer: UHC Exchange	$914.95
Rate for Payer: UHCCP Medicaid	$604.07

PR ORCHIECTOMY PARTIAL

Professional

Both

$1,103.00

Service Code	HCPCS 54522
Min. Negotiated Rate	$377.44
Max. Negotiated Rate	$1,501.96
Rate for Payer: Aetna Commercial	$755.38
Rate for Payer: Aetna Medicare	$551.50
Rate for Payer: BCBS Complete	$396.31
Rate for Payer: BCBS Trust/PPO	$1,501.96
Rate for Payer: BCN Commercial	$848.84
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Meridian Medicaid	$396.31
Rate for Payer: Priority Health Choice Medicaid	$377.44
Rate for Payer: Priority Health Cigna Priority Health	$716.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$937.38
Rate for Payer: Priority Health Narrow Network	$937.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$697.46
Rate for Payer: UHC Exchange	$697.46
Rate for Payer: UHCCP Medicaid	$377.44

PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH

Professional

Both

$969.00

Service Code	HCPCS 54530
Min. Negotiated Rate	$328.23
Max. Negotiated Rate	$2,667.39
Rate for Payer: Aetna Commercial	$650.96
Rate for Payer: Aetna Medicare	$484.50
Rate for Payer: BCBS Complete	$344.64
Rate for Payer: BCBS Trust/PPO	$2,667.39
Rate for Payer: BCN Commercial	$736.93
Rate for Payer: Cash Price	$775.20
Rate for Payer: Cash Price	$775.20
Rate for Payer: Meridian Medicaid	$344.64
Rate for Payer: Priority Health Choice Medicaid	$328.23
Rate for Payer: Priority Health Cigna Priority Health	$629.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$814.88
Rate for Payer: Priority Health Narrow Network	$814.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$607.59
Rate for Payer: UHC Exchange	$607.59
Rate for Payer: UHCCP Medicaid	$328.23

PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL

Professional

Both

$1,401.00

Service Code	HCPCS 54535
Min. Negotiated Rate	$476.91
Max. Negotiated Rate	$3,333.04
Rate for Payer: Aetna Commercial	$955.05
Rate for Payer: Aetna Medicare	$700.50
Rate for Payer: BCBS Complete	$500.76
Rate for Payer: BCBS Trust/PPO	$3,333.04
Rate for Payer: BCN Commercial	$1,073.63
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Meridian Medicaid	$500.76
Rate for Payer: Priority Health Choice Medicaid	$476.91
Rate for Payer: Priority Health Cigna Priority Health	$910.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,185.57
Rate for Payer: Priority Health Narrow Network	$1,185.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$885.98
Rate for Payer: UHC Exchange	$885.98
Rate for Payer: UHCCP Medicaid	$476.91

PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH

Professional

Both

$615.00

Service Code	HCPCS 54520
Min. Negotiated Rate	$211.94
Max. Negotiated Rate	$2,233.12
Rate for Payer: Aetna Commercial	$419.79
Rate for Payer: Aetna Medicare	$307.50
Rate for Payer: BCBS Complete	$222.54
Rate for Payer: BCBS Trust/PPO	$2,233.12
Rate for Payer: BCN Commercial	$475.49
Rate for Payer: Cash Price	$492.00
Rate for Payer: Cash Price	$492.00
Rate for Payer: Meridian Medicaid	$222.54
Rate for Payer: Priority Health Choice Medicaid	$211.94
Rate for Payer: Priority Health Cigna Priority Health	$399.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$526.74
Rate for Payer: Priority Health Narrow Network	$526.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$389.00
Rate for Payer: UHC Exchange	$389.00
Rate for Payer: UHCCP Medicaid	$211.94

PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS

Professional

Both

$1,499.00

Service Code	HCPCS 54650
Min. Negotiated Rate	$457.31
Max. Negotiated Rate	$2,517.35
Rate for Payer: Aetna Commercial	$913.59
Rate for Payer: Aetna Medicare	$749.50
Rate for Payer: BCBS Complete	$480.18
Rate for Payer: BCBS Trust/PPO	$2,517.35
Rate for Payer: BCN Commercial	$1,028.66
Rate for Payer: Cash Price	$1,199.20
Rate for Payer: Cash Price	$1,199.20
Rate for Payer: Meridian Medicaid	$480.18
Rate for Payer: Priority Health Choice Medicaid	$457.31
Rate for Payer: Priority Health Cigna Priority Health	$974.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,136.58
Rate for Payer: Priority Health Narrow Network	$1,136.58
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$848.54
Rate for Payer: UHC Exchange	$848.54
Rate for Payer: UHCCP Medicaid	$457.31

PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH

Professional

Both

$1,756.00

Service Code	HCPCS 54640
Min. Negotiated Rate	$278.18
Max. Negotiated Rate	$2,048.75
Rate for Payer: Aetna Commercial	$557.83
Rate for Payer: Aetna Medicare	$878.00
Rate for Payer: BCBS Complete	$292.09
Rate for Payer: BCBS Trust/PPO	$2,048.75
Rate for Payer: BCN Commercial	$623.55
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Meridian Medicaid	$292.09
Rate for Payer: Priority Health Choice Medicaid	$278.18
Rate for Payer: Priority Health Cigna Priority Health	$1,141.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$688.11
Rate for Payer: Priority Health Narrow Network	$688.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$563.58
Rate for Payer: UHC Exchange	$563.58
Rate for Payer: UHCCP Medicaid	$278.18

PR ORPHENADRINE INJECTION

Professional

Both

$30.00

Service Code	HCPCS J2360
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Commercial	$10.00
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS Trust/PPO	$9.88
Rate for Payer: BCN Commercial	$5.01
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Priority Health Cigna Priority Health	$19.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$9.09
Rate for Payer: UHC Exchange	$9.09

PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS

Professional

Both

$72.00

Service Code	HCPCS 97760
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$466.49
Rate for Payer: Aetna Commercial	$35.53
Rate for Payer: Aetna Medicare	$36.00
Rate for Payer: BCBS Complete	$28.80
Rate for Payer: BCBS Trust/PPO	$466.49
Rate for Payer: BCN Commercial	$70.86
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Priority Health Cigna Priority Health	$46.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.25
Rate for Payer: Priority Health Narrow Network	$77.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$33.00
Rate for Payer: UHC Exchange	$33.00

PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN

Professional

Both

$106.00

Service Code	HCPCS 97763
Min. Negotiated Rate	$42.40
Max. Negotiated Rate	$674.11
Rate for Payer: Aetna Commercial	$57.97
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCBS Complete	$42.40
Rate for Payer: BCBS Trust/PPO	$674.11
Rate for Payer: BCN Commercial	$77.70
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Priority Health Cigna Priority Health	$68.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.25
Rate for Payer: Priority Health Narrow Network	$77.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$49.36
Rate for Payer: UHC Exchange	$49.36

Know your out-of-pocket cost for care.

All Charges