Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC

Professional

Both

$1,612.00

Service Code	HCPCS 57426
Min. Negotiated Rate	$559.98
Max. Negotiated Rate	$1,306.09
Rate for Payer: Aetna Commercial	$1,034.70
Rate for Payer: Aetna Medicare	$806.00
Rate for Payer: BCBS Complete	$587.98
Rate for Payer: BCBS Trust/PPO	$628.68
Rate for Payer: BCN Commercial	$1,275.45
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Cash Price	$1,289.60
Rate for Payer: Meridian Medicaid	$587.98
Rate for Payer: Priority Health Choice Medicaid	$559.98
Rate for Payer: Priority Health Cigna Priority Health	$1,047.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,306.09
Rate for Payer: Priority Health Narrow Network	$1,306.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$999.32
Rate for Payer: UHC Exchange	$999.32
Rate for Payer: UHCCP Medicaid	$559.98

PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV

Professional

Both

$2,230.00

Service Code	HCPCS 64569
Min. Negotiated Rate	$484.98
Max. Negotiated Rate	$1,449.50
Rate for Payer: Aetna Commercial	$983.52
Rate for Payer: Aetna Medicare	$1,115.00
Rate for Payer: BCBS Complete	$529.38
Rate for Payer: BCBS Trust/PPO	$484.98
Rate for Payer: BCN Commercial	$1,132.26
Rate for Payer: Cash Price	$1,784.00
Rate for Payer: Cash Price	$1,784.00
Rate for Payer: Meridian Medicaid	$529.38
Rate for Payer: Priority Health Choice Medicaid	$504.17
Rate for Payer: Priority Health Cigna Priority Health	$1,449.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,335.34
Rate for Payer: Priority Health Narrow Network	$1,335.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$829.27
Rate for Payer: UHC Exchange	$829.27
Rate for Payer: UHCCP Medicaid	$504.17

PR REVISION STAPEDECTOMY/STAPEDOTOMY

Professional

Both

$3,917.00

Service Code	HCPCS 69662
Min. Negotiated Rate	$735.06
Max. Negotiated Rate	$3,121.20
Rate for Payer: Aetna Commercial	$1,316.73
Rate for Payer: Aetna Medicare	$1,958.50
Rate for Payer: BCBS Complete	$771.81
Rate for Payer: BCBS Trust/PPO	$3,121.20
Rate for Payer: BCN Commercial	$1,704.51
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Cash Price	$3,133.60
Rate for Payer: Meridian Medicaid	$771.81
Rate for Payer: Priority Health Choice Medicaid	$735.06
Rate for Payer: Priority Health Cigna Priority Health	$2,546.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,696.48
Rate for Payer: Priority Health Narrow Network	$1,696.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,286.23
Rate for Payer: UHC Exchange	$1,286.23
Rate for Payer: UHCCP Medicaid	$735.06

PR REVISION TRACHEOSTOMY SCAR

Professional

Both

$697.00

Service Code	HCPCS 31830
Min. Negotiated Rate	$237.07
Max. Negotiated Rate	$982.11
Rate for Payer: Aetna Commercial	$454.84
Rate for Payer: Aetna Medicare	$348.50
Rate for Payer: BCBS Complete	$248.92
Rate for Payer: BCBS Trust/PPO	$982.11
Rate for Payer: BCN Commercial	$733.51
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cash Price	$557.60
Rate for Payer: Meridian Medicaid	$248.92
Rate for Payer: Priority Health Choice Medicaid	$237.07
Rate for Payer: Priority Health Cigna Priority Health	$453.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$516.77
Rate for Payer: Priority Health Narrow Network	$516.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$378.06
Rate for Payer: UHC Exchange	$378.06
Rate for Payer: UHCCP Medicaid	$237.07

PR REVIS PERITONEAL-VENOUS SHUNT

Professional

Both

$2,060.00

Service Code	HCPCS 49426
Min. Negotiated Rate	$433.46
Max. Negotiated Rate	$1,339.00
Rate for Payer: Aetna Commercial	$903.18
Rate for Payer: Aetna Medicare	$1,030.00
Rate for Payer: BCBS Complete	$455.13
Rate for Payer: BCBS Trust/PPO	$1,314.94
Rate for Payer: BCN Commercial	$982.73
Rate for Payer: Cash Price	$1,648.00
Rate for Payer: Cash Price	$1,648.00
Rate for Payer: Meridian Medicaid	$455.13
Rate for Payer: Priority Health Choice Medicaid	$433.46
Rate for Payer: Priority Health Cigna Priority Health	$1,339.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,206.92
Rate for Payer: Priority Health Narrow Network	$1,206.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$777.38
Rate for Payer: UHC Exchange	$777.38
Rate for Payer: UHCCP Medicaid	$433.46

PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT

Professional

Both

$4,192.00

Service Code	HCPCS 23474
Min. Negotiated Rate	$341.30
Max. Negotiated Rate	$2,724.80
Rate for Payer: Aetna Commercial	$2,333.04
Rate for Payer: Aetna Medicare	$2,096.00
Rate for Payer: BCBS Complete	$1,173.49
Rate for Payer: BCBS Trust/PPO	$341.30
Rate for Payer: BCN Commercial	$2,535.75
Rate for Payer: Cash Price	$3,353.60
Rate for Payer: Cash Price	$3,353.60
Rate for Payer: Meridian Medicaid	$1,173.49
Rate for Payer: Priority Health Choice Medicaid	$1,117.61
Rate for Payer: Priority Health Cigna Priority Health	$2,724.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,652.18
Rate for Payer: Priority Health Narrow Network	$2,652.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,294.27
Rate for Payer: UHC Exchange	$2,294.27
Rate for Payer: UHCCP Medicaid	$1,117.61

PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT

Professional

Both

$3,586.00

Service Code	HCPCS 23473
Min. Negotiated Rate	$225.83
Max. Negotiated Rate	$2,457.28
Rate for Payer: Aetna Commercial	$2,162.95
Rate for Payer: Aetna Medicare	$1,793.00
Rate for Payer: BCBS Complete	$1,087.39
Rate for Payer: BCBS Trust/PPO	$225.83
Rate for Payer: BCN Commercial	$2,349.07
Rate for Payer: Cash Price	$2,868.80
Rate for Payer: Cash Price	$2,868.80
Rate for Payer: Meridian Medicaid	$1,087.39
Rate for Payer: Priority Health Choice Medicaid	$1,035.61
Rate for Payer: Priority Health Cigna Priority Health	$2,330.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,457.28
Rate for Payer: Priority Health Narrow Network	$2,457.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,122.82
Rate for Payer: UHC Exchange	$2,122.82
Rate for Payer: UHCCP Medicaid	$1,035.61

PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT

Professional

Both

$2,083.00

Service Code	HCPCS 25449
Min. Negotiated Rate	$671.38
Max. Negotiated Rate	$3,253.04
Rate for Payer: Aetna Commercial	$1,378.02
Rate for Payer: Aetna Medicare	$1,041.50
Rate for Payer: BCBS Complete	$704.95
Rate for Payer: BCBS Trust/PPO	$3,253.04
Rate for Payer: BCN Commercial	$1,516.36
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Meridian Medicaid	$704.95
Rate for Payer: Priority Health Choice Medicaid	$671.38
Rate for Payer: Priority Health Cigna Priority Health	$1,353.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,589.17
Rate for Payer: Priority Health Narrow Network	$1,589.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,193.69
Rate for Payer: UHC Exchange	$1,193.69
Rate for Payer: UHCCP Medicaid	$671.38

PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX

Professional

Both

$2,125.00

Service Code	HCPCS 44345
Min. Negotiated Rate	$674.57
Max. Negotiated Rate	$1,878.08
Rate for Payer: Aetna Commercial	$1,408.79
Rate for Payer: Aetna Medicare	$1,062.50
Rate for Payer: BCBS Complete	$708.30
Rate for Payer: BCBS Trust/PPO	$697.88
Rate for Payer: BCN Commercial	$1,530.54
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Meridian Medicaid	$708.30
Rate for Payer: Priority Health Choice Medicaid	$674.57
Rate for Payer: Priority Health Cigna Priority Health	$1,381.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,878.08
Rate for Payer: Priority Health Narrow Network	$1,878.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,263.61
Rate for Payer: UHC Exchange	$1,263.61
Rate for Payer: UHCCP Medicaid	$674.57

PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX

Professional

Both

$1,114.00

Service Code	HCPCS 44340
Min. Negotiated Rate	$249.89
Max. Negotiated Rate	$1,133.52
Rate for Payer: Aetna Commercial	$833.87
Rate for Payer: Aetna Medicare	$557.00
Rate for Payer: BCBS Complete	$425.16
Rate for Payer: BCBS Trust/PPO	$249.89
Rate for Payer: BCN Commercial	$918.23
Rate for Payer: Cash Price	$891.20
Rate for Payer: Cash Price	$891.20
Rate for Payer: Meridian Medicaid	$425.16
Rate for Payer: Priority Health Choice Medicaid	$404.91
Rate for Payer: Priority Health Cigna Priority Health	$724.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,133.52
Rate for Payer: Priority Health Narrow Network	$1,133.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$731.16
Rate for Payer: UHC Exchange	$731.16
Rate for Payer: UHCCP Medicaid	$404.91

PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX

Professional

Both

$2,861.00

Service Code	HCPCS 44346
Min. Negotiated Rate	$758.49
Max. Negotiated Rate	$2,111.95
Rate for Payer: Aetna Commercial	$1,590.78
Rate for Payer: Aetna Medicare	$1,430.50
Rate for Payer: BCBS Complete	$796.41
Rate for Payer: BCBS Trust/PPO	$785.58
Rate for Payer: BCN Commercial	$1,720.63
Rate for Payer: Cash Price	$2,288.80
Rate for Payer: Cash Price	$2,288.80
Rate for Payer: Meridian Medicaid	$796.41
Rate for Payer: Priority Health Choice Medicaid	$758.49
Rate for Payer: Priority Health Cigna Priority Health	$1,859.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,111.95
Rate for Payer: Priority Health Narrow Network	$2,111.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,421.70
Rate for Payer: UHC Exchange	$1,421.70
Rate for Payer: UHCCP Medicaid	$758.49

PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF

Professional

Both

$2,619.00

Service Code	HCPCS 35884
Min. Negotiated Rate	$774.47
Max. Negotiated Rate	$1,929.99
Rate for Payer: Aetna Commercial	$1,667.74
Rate for Payer: Aetna Medicare	$1,309.50
Rate for Payer: BCBS Complete	$813.19
Rate for Payer: BCBS Trust/PPO	$926.64
Rate for Payer: BCN Commercial	$1,765.59
Rate for Payer: Cash Price	$2,095.20
Rate for Payer: Cash Price	$2,095.20
Rate for Payer: Meridian Medicaid	$813.19
Rate for Payer: Priority Health Choice Medicaid	$774.47
Rate for Payer: Priority Health Cigna Priority Health	$1,702.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,929.99
Rate for Payer: Priority Health Narrow Network	$1,929.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,705.89
Rate for Payer: UHC Exchange	$1,705.89
Rate for Payer: UHCCP Medicaid	$774.47

PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF

Professional

Both

$2,362.00

Service Code	HCPCS 35883
Min. Negotiated Rate	$745.07
Max. Negotiated Rate	$1,861.38
Rate for Payer: Aetna Commercial	$1,617.26
Rate for Payer: Aetna Medicare	$1,181.00
Rate for Payer: BCBS Complete	$782.32
Rate for Payer: BCBS Trust/PPO	$876.98
Rate for Payer: BCN Commercial	$1,707.44
Rate for Payer: Cash Price	$1,889.60
Rate for Payer: Cash Price	$1,889.60
Rate for Payer: Meridian Medicaid	$782.32
Rate for Payer: Priority Health Choice Medicaid	$745.07
Rate for Payer: Priority Health Cigna Priority Health	$1,535.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,861.38
Rate for Payer: Priority Health Narrow Network	$1,861.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,620.95
Rate for Payer: UHC Exchange	$1,620.95
Rate for Payer: UHCCP Medicaid	$745.07

PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY

Professional

Both

$5,384.00

Service Code	HCPCS 43860
Min. Negotiated Rate	$163.77
Max. Negotiated Rate	$3,499.60
Rate for Payer: Aetna Commercial	$2,208.98
Rate for Payer: Aetna Medicare	$2,692.00
Rate for Payer: BCBS Complete	$1,102.59
Rate for Payer: BCBS Trust/PPO	$163.77
Rate for Payer: BCN Commercial	$2,385.23
Rate for Payer: Cash Price	$4,307.20
Rate for Payer: Cash Price	$4,307.20
Rate for Payer: Meridian Medicaid	$1,102.59
Rate for Payer: Priority Health Choice Medicaid	$1,050.09
Rate for Payer: Priority Health Cigna Priority Health	$3,499.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,923.91
Rate for Payer: Priority Health Narrow Network	$2,923.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,984.43
Rate for Payer: UHC Exchange	$1,984.43
Rate for Payer: UHCCP Medicaid	$1,050.09

PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX

Professional

Both

$2,587.00

Service Code	HCPCS 44314
Min. Negotiated Rate	$249.89
Max. Negotiated Rate	$1,794.56
Rate for Payer: Aetna Commercial	$1,349.17
Rate for Payer: Aetna Medicare	$1,293.50
Rate for Payer: BCBS Complete	$674.75
Rate for Payer: BCBS Trust/PPO	$249.89
Rate for Payer: BCN Commercial	$1,462.12
Rate for Payer: Cash Price	$2,069.60
Rate for Payer: Cash Price	$2,069.60
Rate for Payer: Meridian Medicaid	$674.75
Rate for Payer: Priority Health Choice Medicaid	$642.62
Rate for Payer: Priority Health Cigna Priority Health	$1,681.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,794.56
Rate for Payer: Priority Health Narrow Network	$1,794.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,219.48
Rate for Payer: UHC Exchange	$1,219.48
Rate for Payer: UHCCP Medicaid	$642.62

PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX

Professional

Both

$1,238.00

Service Code	HCPCS 44312
Min. Negotiated Rate	$212.38
Max. Negotiated Rate	$1,072.68
Rate for Payer: Aetna Commercial	$799.15
Rate for Payer: Aetna Medicare	$619.00
Rate for Payer: BCBS Complete	$403.69
Rate for Payer: BCBS Trust/PPO	$212.38
Rate for Payer: BCN Commercial	$870.33
Rate for Payer: Cash Price	$990.40
Rate for Payer: Cash Price	$990.40
Rate for Payer: Meridian Medicaid	$403.69
Rate for Payer: Priority Health Choice Medicaid	$384.47
Rate for Payer: Priority Health Cigna Priority Health	$804.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,072.68
Rate for Payer: Priority Health Narrow Network	$1,072.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$713.91
Rate for Payer: UHC Exchange	$713.91
Rate for Payer: UHCCP Medicaid	$384.47

PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR

Professional

Both

$4,128.00

Service Code	HCPCS 63664
Min. Negotiated Rate	$580.21
Max. Negotiated Rate	$2,683.20
Rate for Payer: Aetna Commercial	$1,132.94
Rate for Payer: Aetna Medicare	$2,064.00
Rate for Payer: BCBS Complete	$609.22
Rate for Payer: BCBS Trust/PPO	$1,703.77
Rate for Payer: BCN Commercial	$1,305.75
Rate for Payer: Cash Price	$3,302.40
Rate for Payer: Cash Price	$3,302.40
Rate for Payer: Meridian Medicaid	$609.22
Rate for Payer: Priority Health Choice Medicaid	$580.21
Rate for Payer: Priority Health Cigna Priority Health	$2,683.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,538.38
Rate for Payer: Priority Health Narrow Network	$1,538.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$869.77
Rate for Payer: UHC Exchange	$869.77
Rate for Payer: UHCCP Medicaid	$580.21

PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR

Professional

Both

$4,817.00

Service Code	HCPCS 63663
Min. Negotiated Rate	$289.25
Max. Negotiated Rate	$3,131.05
Rate for Payer: Aetna Commercial	$582.45
Rate for Payer: Aetna Medicare	$2,408.50
Rate for Payer: BCBS Complete	$303.71
Rate for Payer: BCBS Trust/PPO	$1,526.26
Rate for Payer: BCN Commercial	$1,321.38
Rate for Payer: Cash Price	$3,853.60
Rate for Payer: Cash Price	$3,853.60
Rate for Payer: Meridian Medicaid	$303.71
Rate for Payer: Priority Health Choice Medicaid	$289.25
Rate for Payer: Priority Health Cigna Priority Health	$3,131.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$771.18
Rate for Payer: Priority Health Narrow Network	$771.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$562.58
Rate for Payer: UHC Exchange	$562.58
Rate for Payer: UHCCP Medicaid	$289.25

PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP

Professional

Both

$1,825.00

Service Code	HCPCS 35879
Min. Negotiated Rate	$576.80
Max. Negotiated Rate	$1,898.71
Rate for Payer: Aetna Commercial	$1,239.03
Rate for Payer: Aetna Medicare	$912.50
Rate for Payer: BCBS Complete	$605.64
Rate for Payer: BCBS Trust/PPO	$1,898.71
Rate for Payer: BCN Commercial	$1,316.01
Rate for Payer: Cash Price	$1,460.00
Rate for Payer: Cash Price	$1,460.00
Rate for Payer: Meridian Medicaid	$605.64
Rate for Payer: Priority Health Choice Medicaid	$576.80
Rate for Payer: Priority Health Cigna Priority Health	$1,186.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,435.40
Rate for Payer: Priority Health Narrow Network	$1,435.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,253.43
Rate for Payer: UHC Exchange	$1,253.43
Rate for Payer: UHCCP Medicaid	$576.80

PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS

Professional

Both

$2,119.00

Service Code	HCPCS 35881
Min. Negotiated Rate	$639.85
Max. Negotiated Rate	$1,789.35
Rate for Payer: Aetna Commercial	$1,373.12
Rate for Payer: Aetna Medicare	$1,059.50
Rate for Payer: BCBS Complete	$671.84
Rate for Payer: BCBS Trust/PPO	$1,789.35
Rate for Payer: BCN Commercial	$1,460.66
Rate for Payer: Cash Price	$1,695.20
Rate for Payer: Cash Price	$1,695.20
Rate for Payer: Meridian Medicaid	$671.84
Rate for Payer: Priority Health Choice Medicaid	$639.85
Rate for Payer: Priority Health Cigna Priority Health	$1,377.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,604.51
Rate for Payer: Priority Health Narrow Network	$1,604.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,388.69
Rate for Payer: UHC Exchange	$1,388.69
Rate for Payer: UHCCP Medicaid	$639.85

PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY

Professional

Both

$2,087.00

Service Code	HCPCS 69601
Min. Negotiated Rate	$650.08
Max. Negotiated Rate	$2,276.44
Rate for Payer: Aetna Commercial	$1,166.54
Rate for Payer: Aetna Medicare	$1,043.50
Rate for Payer: BCBS Complete	$682.58
Rate for Payer: BCBS Trust/PPO	$2,276.44
Rate for Payer: BCN Commercial	$1,503.17
Rate for Payer: Cash Price	$1,669.60
Rate for Payer: Cash Price	$1,669.60
Rate for Payer: Meridian Medicaid	$682.58
Rate for Payer: Priority Health Choice Medicaid	$650.08
Rate for Payer: Priority Health Cigna Priority Health	$1,356.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,493.17
Rate for Payer: Priority Health Narrow Network	$1,493.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,154.83
Rate for Payer: UHC Exchange	$1,154.83
Rate for Payer: UHCCP Medicaid	$650.08

PR REVJ MASTOIDECTOMY RSLTG TYMPANOPLASTY

Professional

Both

$2,239.00

Service Code	HCPCS 69604
Min. Negotiated Rate	$709.50
Max. Negotiated Rate	$1,642.45
Rate for Payer: Aetna Commercial	$1,264.88
Rate for Payer: Aetna Medicare	$1,119.50
Rate for Payer: BCBS Complete	$744.98
Rate for Payer: BCBS Trust/PPO	$1,636.15
Rate for Payer: BCN Commercial	$1,642.45
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Meridian Medicaid	$744.98
Rate for Payer: Priority Health Choice Medicaid	$709.50
Rate for Payer: Priority Health Cigna Priority Health	$1,455.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,631.79
Rate for Payer: Priority Health Narrow Network	$1,631.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,234.77
Rate for Payer: UHC Exchange	$1,234.77
Rate for Payer: UHCCP Medicaid	$709.50

PR REVJ OPN ARVEN FSTL W/O THRMBC DIAL GRF

Professional

Both

$1,224.00

Service Code	HCPCS 36832
Min. Negotiated Rate	$473.93
Max. Negotiated Rate	$1,757.65
Rate for Payer: Aetna Commercial	$1,014.04
Rate for Payer: Aetna Medicare	$612.00
Rate for Payer: BCBS Complete	$497.63
Rate for Payer: BCBS Trust/PPO	$1,757.65
Rate for Payer: BCN Commercial	$1,081.45
Rate for Payer: Cash Price	$979.20
Rate for Payer: Cash Price	$979.20
Rate for Payer: Meridian Medicaid	$497.63
Rate for Payer: Priority Health Choice Medicaid	$473.93
Rate for Payer: Priority Health Cigna Priority Health	$795.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,182.24
Rate for Payer: Priority Health Narrow Network	$1,182.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$762.30
Rate for Payer: UHC Exchange	$762.30
Rate for Payer: UHCCP Medicaid	$473.93

PR REVJ OPN ARVEN FSTL W/THRMBC DIAL GRF

Professional

Both

$2,333.00

Service Code	HCPCS 36833
Min. Negotiated Rate	$505.66
Max. Negotiated Rate	$1,516.45
Rate for Payer: Aetna Commercial	$1,085.98
Rate for Payer: Aetna Medicare	$1,166.50
Rate for Payer: BCBS Complete	$530.94
Rate for Payer: BCBS Trust/PPO	$902.86
Rate for Payer: BCN Commercial	$1,155.23
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Meridian Medicaid	$530.94
Rate for Payer: Priority Health Choice Medicaid	$505.66
Rate for Payer: Priority Health Cigna Priority Health	$1,516.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,260.96
Rate for Payer: Priority Health Narrow Network	$1,260.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$862.06
Rate for Payer: UHC Exchange	$862.06
Rate for Payer: UHCCP Medicaid	$505.66

PR REVJ/RMVL IMPL SPI NPG/RCVR DTCH CONNJ ELTRD RA

Professional

Both

$1,819.00

Service Code	HCPCS 63688
Min. Negotiated Rate	$193.83
Max. Negotiated Rate	$1,182.35
Rate for Payer: Aetna Commercial	$478.21
Rate for Payer: Aetna Medicare	$909.50
Rate for Payer: BCBS Complete	$203.52
Rate for Payer: BCBS Trust/PPO	$917.66
Rate for Payer: BCN Commercial	$547.80
Rate for Payer: Cash Price	$1,455.20
Rate for Payer: Cash Price	$1,455.20
Rate for Payer: Meridian Medicaid	$203.52
Rate for Payer: Priority Health Choice Medicaid	$193.83
Rate for Payer: Priority Health Cigna Priority Health	$1,182.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$516.96
Rate for Payer: Priority Health Narrow Network	$516.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$411.29
Rate for Payer: UHC Exchange	$411.29
Rate for Payer: UHCCP Medicaid	$193.83

Know your out-of-pocket cost for care.

All Charges