Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES

Professional

Both

$39.00

Service Code	HCPCS 80300
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

CHG DRUG SCREEN MULT CLASSES

Professional

Both

$31.00

Service Code	HCPCS 80100
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH

Professional

Both

$39.00

Service Code	HCPCS 80104
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

CHG DRUG SCREEN SINGL CLASS

Professional

Both

$31.00

Service Code	HCPCS 80101
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE

Professional

Both

$39.00

Service Code	HCPCS 80305
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$2,169.73
Rate for Payer: Aetna Commercial	$11.97
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$2,169.73
Rate for Payer: BCN Commercial	$9.45
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.65
Rate for Payer: Priority Health Narrow Network	$12.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.47
Rate for Payer: UHC Exchange	$5.47

CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE

Professional

Both

$82.00

Service Code	HCPCS 80307
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$2,739.76
Rate for Payer: Aetna Commercial	$59.03
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: BCBS Trust/PPO	$2,739.76
Rate for Payer: BCN Commercial	$62.14
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$53.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.25
Rate for Payer: Priority Health Narrow Network	$62.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$29.15
Rate for Payer: UHC Exchange	$29.15

CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS

Professional

Both

$27.00

Service Code	HCPCS 80306
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$1,676.30
Rate for Payer: Aetna Commercial	$16.28
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCBS Trust/PPO	$1,676.30
Rate for Payer: BCN Commercial	$12.86
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Priority Health Cigna Priority Health	$17.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$16.98
Rate for Payer: Priority Health Narrow Network	$16.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.28
Rate for Payer: UHC Exchange	$7.28

CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL

Professional

Both

$27.00

Service Code	HCPCS 77081
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$1,182.34
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Commercial	$35.90
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCBS Complete	$6.26
Rate for Payer: BCBS Complete	$6.26
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: BCBS Trust/PPO	$1,182.34
Rate for Payer: BCN Commercial	$45.94
Rate for Payer: BCN Commercial	$45.94
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$128.80
Rate for Payer: Meridian Medicaid	$6.26
Rate for Payer: Meridian Medicaid	$6.26
Rate for Payer: Priority Health Choice Medicaid	$5.96
Rate for Payer: Priority Health Choice Medicaid	$5.96
Rate for Payer: Priority Health Cigna Priority Health	$17.55
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.30
Rate for Payer: UHC Exchange	$23.30
Rate for Payer: UHC Exchange	$23.30
Rate for Payer: UHCCP Medicaid	$5.96
Rate for Payer: UHCCP Medicaid	$5.96

CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL

Professional

Both

$171.00

Service Code	HCPCS 77080
Min. Negotiated Rate	$5.96
Max. Negotiated Rate	$6,131.98
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Medicare	$119.50
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS Complete	$6.26
Rate for Payer: BCBS Complete	$6.26
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: BCBS Trust/PPO	$6,131.98
Rate for Payer: BCN Commercial	$55.71
Rate for Payer: BCN Commercial	$55.71
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$191.20
Rate for Payer: Cash Price	$136.80
Rate for Payer: Meridian Medicaid	$6.26
Rate for Payer: Meridian Medicaid	$6.26
Rate for Payer: Priority Health Choice Medicaid	$5.96
Rate for Payer: Priority Health Choice Medicaid	$5.96
Rate for Payer: Priority Health Cigna Priority Health	$155.35
Rate for Payer: Priority Health Cigna Priority Health	$111.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: Priority Health Narrow Network	$14.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$78.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$78.76
Rate for Payer: UHC Exchange	$78.76
Rate for Payer: UHC Exchange	$78.76
Rate for Payer: UHCCP Medicaid	$5.96
Rate for Payer: UHCCP Medicaid	$5.96

CHG DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ

Professional

Both

$212.00

Service Code	HCPCS 76988
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$137.80
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: BCBS Complete	$40.26
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Meridian Medicaid	$40.26
Rate for Payer: Priority Health Choice Medicaid	$38.34
Rate for Payer: Priority Health Cigna Priority Health	$137.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.87
Rate for Payer: Priority Health Narrow Network	$91.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$72.59
Rate for Payer: UHC Exchange	$72.59
Rate for Payer: UHCCP Medicaid	$38.34

CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING

Professional

Both

$320.00

Service Code	HCPCS 76506
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$1,651.99
Rate for Payer: Aetna Commercial	$133.74
Rate for Payer: Aetna Medicare	$160.00
Rate for Payer: BCBS Complete	$20.13
Rate for Payer: BCBS Trust/PPO	$1,651.99
Rate for Payer: BCN Commercial	$166.64
Rate for Payer: Cash Price	$256.00
Rate for Payer: Cash Price	$256.00
Rate for Payer: Meridian Medicaid	$20.13
Rate for Payer: Priority Health Choice Medicaid	$19.17
Rate for Payer: Priority Health Cigna Priority Health	$208.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.21
Rate for Payer: Priority Health Narrow Network	$47.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$124.08
Rate for Payer: UHC Exchange	$124.08
Rate for Payer: UHCCP Medicaid	$19.17

CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING

Professional

Both

$278.00

Service Code	HCPCS 76825
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$384.59
Rate for Payer: Aetna Commercial	$314.31
Rate for Payer: Aetna Medicare	$139.00
Rate for Payer: BCBS Complete	$52.11
Rate for Payer: BCBS Trust/PPO	$244.94
Rate for Payer: BCN Commercial	$384.59
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Meridian Medicaid	$52.11
Rate for Payer: Priority Health Choice Medicaid	$49.63
Rate for Payer: Priority Health Cigna Priority Health	$180.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.10
Rate for Payer: Priority Health Narrow Network	$120.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$223.62
Rate for Payer: UHC Exchange	$223.62
Rate for Payer: UHCCP Medicaid	$49.63

CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD

Professional

Both

$131.00

Service Code	HCPCS 76826
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$273.66
Rate for Payer: Aetna Commercial	$187.89
Rate for Payer: Aetna Medicare	$65.50
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCBS Trust/PPO	$273.66
Rate for Payer: BCN Commercial	$230.17
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health	$85.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.53
Rate for Payer: Priority Health Narrow Network	$59.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$126.29
Rate for Payer: UHC Exchange	$126.29
Rate for Payer: UHCCP Medicaid	$24.71

CHG ENDOVASC REPAIR AAA

Professional

Both

$512.00

Service Code	HCPCS 75952
Min. Negotiated Rate	$204.80
Max. Negotiated Rate	$332.80
Rate for Payer: Aetna Medicare	$256.00
Rate for Payer: BCBS Complete	$204.80
Rate for Payer: Cash Price	$409.60
Rate for Payer: Priority Health Cigna Priority Health	$332.80

CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I

Professional

Both

$593.00

Service Code	HCPCS 75957
Min. Negotiated Rate	$178.71
Max. Negotiated Rate	$2,167.55
Rate for Payer: Aetna Commercial	$345.53
Rate for Payer: Aetna Medicare	$296.50
Rate for Payer: BCBS Complete	$187.65
Rate for Payer: BCBS Trust/PPO	$399.39
Rate for Payer: BCN Commercial	$629.42
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Meridian Medicaid	$187.65
Rate for Payer: Priority Health Choice Medicaid	$178.71
Rate for Payer: Priority Health Cigna Priority Health	$385.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$431.15
Rate for Payer: Priority Health Narrow Network	$431.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,167.55
Rate for Payer: UHC Exchange	$2,167.55
Rate for Payer: UHCCP Medicaid	$178.71

CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I

Professional

Both

$693.00

Service Code	HCPCS 75956
Min. Negotiated Rate	$208.53
Max. Negotiated Rate	$1,659.82
Rate for Payer: Aetna Commercial	$403.09
Rate for Payer: Aetna Medicare	$346.50
Rate for Payer: BCBS Complete	$218.96
Rate for Payer: BCBS Trust/PPO	$514.56
Rate for Payer: BCN Commercial	$691.96
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Meridian Medicaid	$218.96
Rate for Payer: Priority Health Choice Medicaid	$208.53
Rate for Payer: Priority Health Cigna Priority Health	$450.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$501.97
Rate for Payer: Priority Health Narrow Network	$501.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,659.82
Rate for Payer: UHC Exchange	$1,659.82
Rate for Payer: UHCCP Medicaid	$208.53

CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING

Professional

Both

$335.00

Service Code	HCPCS 76818
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$250.41
Rate for Payer: Aetna Commercial	$134.54
Rate for Payer: Aetna Medicare	$167.50
Rate for Payer: BCBS Complete	$33.10
Rate for Payer: BCBS Trust/PPO	$250.41
Rate for Payer: BCN Commercial	$171.04
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Meridian Medicaid	$33.10
Rate for Payer: Priority Health Choice Medicaid	$31.52
Rate for Payer: Priority Health Cigna Priority Health	$217.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.97
Rate for Payer: Priority Health Narrow Network	$75.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$127.80
Rate for Payer: UHC Exchange	$127.80
Rate for Payer: UHCCP Medicaid	$31.52

CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING

Professional

Both

$230.00

Service Code	HCPCS 76819
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$173.81
Rate for Payer: Aetna Commercial	$99.52
Rate for Payer: Aetna Medicare	$115.00
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCBS Trust/PPO	$173.81
Rate for Payer: BCN Commercial	$123.15
Rate for Payer: Cash Price	$184.00
Rate for Payer: Cash Price	$184.00
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health	$149.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.43
Rate for Payer: Priority Health Narrow Network	$55.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.32
Rate for Payer: UHC Exchange	$97.32
Rate for Payer: UHCCP Medicaid	$23.00

CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON

Professional

Both

$300.00

Service Code	HCPCS 77003
Min. Negotiated Rate	$17.89
Max. Negotiated Rate	$909.73
Rate for Payer: Aetna Commercial	$119.48
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: BCBS Complete	$18.78
Rate for Payer: BCBS Trust/PPO	$909.73
Rate for Payer: BCN Commercial	$155.40
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Meridian Medicaid	$18.78
Rate for Payer: Priority Health Choice Medicaid	$17.89
Rate for Payer: Priority Health Cigna Priority Health	$195.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43.62
Rate for Payer: Priority Health Narrow Network	$43.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$63.50
Rate for Payer: UHC Exchange	$63.50
Rate for Payer: UHCCP Medicaid	$17.89

CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT

Professional

Both

$149.00

Service Code	HCPCS 77001
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$147.58
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Commercial	$116.38
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$12.08
Rate for Payer: BCBS Complete	$12.08
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: BCN Commercial	$147.58
Rate for Payer: BCN Commercial	$147.58
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Meridian Medicaid	$12.08
Rate for Payer: Meridian Medicaid	$12.08
Rate for Payer: Priority Health Choice Medicaid	$11.50
Rate for Payer: Priority Health Choice Medicaid	$11.50
Rate for Payer: Priority Health Cigna Priority Health	$96.85
Rate for Payer: Priority Health Cigna Priority Health	$111.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.20
Rate for Payer: Priority Health Narrow Network	$27.20
Rate for Payer: Priority Health Narrow Network	$27.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$113.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$113.10
Rate for Payer: UHC Exchange	$113.10
Rate for Payer: UHC Exchange	$113.10
Rate for Payer: UHCCP Medicaid	$11.50
Rate for Payer: UHCCP Medicaid	$11.50

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$114.00

Service Code	HCPCS 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$17.67
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: BCN Commercial	$171.04
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Meridian Medicaid	$17.67
Rate for Payer: Priority Health Choice Medicaid	$16.83
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.55
Rate for Payer: Priority Health Narrow Network	$40.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$76.29
Rate for Payer: UHC Exchange	$76.29
Rate for Payer: UHCCP Medicaid	$16.83

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$114.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$378.27
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: ASR ASR	$110.58
Rate for Payer: ASR Commercial	$110.58
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS Trust/PPO	$93.35
Rate for Payer: BCN Commercial	$88.38
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Encore Health Key Benefits Commercial	$91.20
Rate for Payer: Healthscope Commercial	$114.00
Rate for Payer: Healthscope Whirlpool	$110.58
Rate for Payer: Mclaren Commercial	$102.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.90
Rate for Payer: Nomi Health Commercial	$93.48
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$378.27
Rate for Payer: Priority Health Narrow Network	$302.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.32

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Facility

$114.00

Service Code	CPT 77002
Hospital Charge Code	77002
Min. Negotiated Rate	$74.10
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$102.60
Rate for Payer: ASR ASR	$110.58
Rate for Payer: ASR Commercial	$110.58
Rate for Payer: BCBS Trust/PPO	$92.90
Rate for Payer: BCN Commercial	$88.38
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Encore Health Key Benefits Commercial	$91.20
Rate for Payer: Healthscope Commercial	$114.00
Rate for Payer: Healthscope Whirlpool	$110.58
Rate for Payer: Mclaren Commercial	$102.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.90
Rate for Payer: Nomi Health Commercial	$93.48
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.32

CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON

Professional

Both

$114.00

Service Code	HCPCS 77002
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$1,036.52
Rate for Payer: Aetna Commercial	$132.23
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$17.67
Rate for Payer: BCBS Trust/PPO	$1,036.52
Rate for Payer: BCN Commercial	$171.04
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Meridian Medicaid	$17.67
Rate for Payer: Priority Health Choice Medicaid	$16.83
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40.55
Rate for Payer: Priority Health Narrow Network	$40.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$76.29
Rate for Payer: UHC Exchange	$76.29
Rate for Payer: UHCCP Medicaid	$16.83

CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME

Professional

Both

$67.00

Service Code	HCPCS 76001
Min. Negotiated Rate	$26.80
Max. Negotiated Rate	$43.55
Rate for Payer: Aetna Medicare	$33.50
Rate for Payer: BCBS Complete	$26.80
Rate for Payer: Cash Price	$53.60
Rate for Payer: Priority Health Cigna Priority Health	$43.55

Know your out-of-pocket cost for care.

All Charges