Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR RPR EPIGASTRIC HERNIA REDUCIBLE SPX

Professional

Both

$1,171.00

Service Code	HCPCS 49570
Min. Negotiated Rate	$468.40
Max. Negotiated Rate	$761.15
Rate for Payer: Aetna Medicare	$585.50
Rate for Payer: BCBS Complete	$468.40
Rate for Payer: Cash Price	$936.80
Rate for Payer: Priority Health Cigna Priority Health	$761.15

PR RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH

Professional

Both

$607.00

Service Code	HCPCS 27664
Min. Negotiated Rate	$233.45
Max. Negotiated Rate	$1,815.77
Rate for Payer: Aetna Commercial	$480.09
Rate for Payer: Aetna Medicare	$303.50
Rate for Payer: BCBS Complete	$245.12
Rate for Payer: BCBS Trust/PPO	$1,815.77
Rate for Payer: BCN Commercial	$535.10
Rate for Payer: Cash Price	$485.60
Rate for Payer: Cash Price	$485.60
Rate for Payer: Meridian Medicaid	$245.12
Rate for Payer: Priority Health Choice Medicaid	$233.45
Rate for Payer: Priority Health Cigna Priority Health	$394.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$561.78
Rate for Payer: Priority Health Narrow Network	$561.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$413.57
Rate for Payer: UHC Exchange	$413.57
Rate for Payer: UHCCP Medicaid	$233.45

PR RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH

Professional

Both

$859.00

Service Code	HCPCS 27665
Min. Negotiated Rate	$272.21
Max. Negotiated Rate	$1,815.77
Rate for Payer: Aetna Commercial	$558.66
Rate for Payer: Aetna Medicare	$429.50
Rate for Payer: BCBS Complete	$285.82
Rate for Payer: BCBS Trust/PPO	$1,815.77
Rate for Payer: BCN Commercial	$619.16
Rate for Payer: Cash Price	$687.20
Rate for Payer: Cash Price	$687.20
Rate for Payer: Meridian Medicaid	$285.82
Rate for Payer: Priority Health Choice Medicaid	$272.21
Rate for Payer: Priority Health Cigna Priority Health	$558.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$657.44
Rate for Payer: Priority Health Narrow Network	$657.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$475.54
Rate for Payer: UHC Exchange	$475.54
Rate for Payer: UHCCP Medicaid	$272.21

PR RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH

Professional

Both

$1,088.00

Service Code	HCPCS 27659
Min. Negotiated Rate	$307.57
Max. Negotiated Rate	$1,861.44
Rate for Payer: Aetna Commercial	$625.38
Rate for Payer: Aetna Medicare	$544.00
Rate for Payer: BCBS Complete	$322.95
Rate for Payer: BCBS Trust/PPO	$1,861.44
Rate for Payer: BCN Commercial	$689.52
Rate for Payer: Cash Price	$870.40
Rate for Payer: Cash Price	$870.40
Rate for Payer: Meridian Medicaid	$322.95
Rate for Payer: Priority Health Choice Medicaid	$307.57
Rate for Payer: Priority Health Cigna Priority Health	$707.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$730.22
Rate for Payer: Priority Health Narrow Network	$730.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$564.10
Rate for Payer: UHC Exchange	$564.10
Rate for Payer: UHCCP Medicaid	$307.57

PR RPR HI IMPRF ANUS W/FSTL PRNL/SACROPRNL APPR

Professional

Both

$5,557.00

Service Code	HCPCS 46740
Min. Negotiated Rate	$93.51
Max. Negotiated Rate	$3,889.19
Rate for Payer: Aetna Commercial	$2,917.67
Rate for Payer: Aetna Medicare	$2,778.50
Rate for Payer: BCBS Complete	$1,468.27
Rate for Payer: BCBS Trust/PPO	$93.51
Rate for Payer: BCN Commercial	$3,167.61
Rate for Payer: Cash Price	$4,445.60
Rate for Payer: Cash Price	$4,445.60
Rate for Payer: Meridian Medicaid	$1,468.27
Rate for Payer: Priority Health Choice Medicaid	$1,398.35
Rate for Payer: Priority Health Cigna Priority Health	$3,612.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,889.19
Rate for Payer: Priority Health Narrow Network	$3,889.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,535.21
Rate for Payer: UHC Exchange	$2,535.21
Rate for Payer: UHCCP Medicaid	$1,398.35

PR RPR HI IMPRF ANUS W/FSTL TABDL & SACROPRNL

Professional

Both

$5,147.00

Service Code	HCPCS 46742
Min. Negotiated Rate	$477.58
Max. Negotiated Rate	$4,488.18
Rate for Payer: Aetna Commercial	$3,377.01
Rate for Payer: Aetna Medicare	$2,573.50
Rate for Payer: BCBS Complete	$1,692.58
Rate for Payer: BCBS Trust/PPO	$477.58
Rate for Payer: BCN Commercial	$3,656.28
Rate for Payer: Cash Price	$4,117.60
Rate for Payer: Cash Price	$4,117.60
Rate for Payer: Meridian Medicaid	$1,692.58
Rate for Payer: Priority Health Choice Medicaid	$1,611.98
Rate for Payer: Priority Health Cigna Priority Health	$3,345.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,488.18
Rate for Payer: Priority Health Narrow Network	$4,488.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,972.83
Rate for Payer: UHC Exchange	$2,972.83
Rate for Payer: UHCCP Medicaid	$1,611.98

PR RPR HI IMPRF ANUS W/O FSTL PRNL/SACROPRNL APPR

Professional

Both

$3,879.00

Service Code	HCPCS 46730
Min. Negotiated Rate	$105.13
Max. Negotiated Rate	$3,566.44
Rate for Payer: Aetna Commercial	$2,672.39
Rate for Payer: Aetna Medicare	$1,939.50
Rate for Payer: BCBS Complete	$1,346.82
Rate for Payer: BCBS Trust/PPO	$105.13
Rate for Payer: BCN Commercial	$2,905.18
Rate for Payer: Cash Price	$3,103.20
Rate for Payer: Cash Price	$3,103.20
Rate for Payer: Meridian Medicaid	$1,346.82
Rate for Payer: Priority Health Choice Medicaid	$1,282.69
Rate for Payer: Priority Health Cigna Priority Health	$2,521.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,566.44
Rate for Payer: Priority Health Narrow Network	$3,566.44
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,258.75
Rate for Payer: UHC Exchange	$2,258.75
Rate for Payer: UHCCP Medicaid	$1,282.69

PR RPR HYPOSPADIAS COMPLCTJS CLSR INC/EXC SIMPLE

Professional

Both

$1,985.00

Service Code	HCPCS 54340
Min. Negotiated Rate	$365.93
Max. Negotiated Rate	$2,917.27
Rate for Payer: Aetna Commercial	$730.32
Rate for Payer: Aetna Medicare	$992.50
Rate for Payer: BCBS Complete	$384.23
Rate for Payer: BCBS Trust/PPO	$2,917.27
Rate for Payer: BCN Commercial	$822.94
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Cash Price	$1,588.00
Rate for Payer: Meridian Medicaid	$384.23
Rate for Payer: Priority Health Choice Medicaid	$365.93
Rate for Payer: Priority Health Cigna Priority Health	$1,290.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$910.21
Rate for Payer: Priority Health Narrow Network	$910.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$679.57
Rate for Payer: UHC Exchange	$679.57
Rate for Payer: UHCCP Medicaid	$365.93

PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR

Professional

Both

$7,548.00

Service Code	HCPCS 33660
Min. Negotiated Rate	$1,104.62
Max. Negotiated Rate	$4,906.20
Rate for Payer: Aetna Commercial	$2,358.28
Rate for Payer: Aetna Medicare	$3,774.00
Rate for Payer: BCBS Complete	$1,159.85
Rate for Payer: BCBS Trust/PPO	$1,131.09
Rate for Payer: BCN Commercial	$2,516.20
Rate for Payer: Cash Price	$6,038.40
Rate for Payer: Cash Price	$6,038.40
Rate for Payer: Meridian Medicaid	$1,159.85
Rate for Payer: Priority Health Choice Medicaid	$1,104.62
Rate for Payer: Priority Health Cigna Priority Health	$4,906.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,750.07
Rate for Payer: Priority Health Narrow Network	$2,750.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,311.13
Rate for Payer: UHC Exchange	$2,311.13
Rate for Payer: UHCCP Medicaid	$1,104.62

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,636.00

Service Code	HCPCS 49525
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,063.40
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: Aetna Medicare	$818.00
Rate for Payer: BCBS Complete	$391.17
Rate for Payer: BCBS Trust/PPO	$515.62
Rate for Payer: BCN Commercial	$842.48
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Meridian Medicaid	$391.17
Rate for Payer: Priority Health Choice Medicaid	$372.54
Rate for Payer: Priority Health Cigna Priority Health	$1,063.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,034.50
Rate for Payer: Priority Health Narrow Network	$1,034.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$681.29
Rate for Payer: UHC Exchange	$681.29
Rate for Payer: UHCCP Medicaid	$372.54

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,636.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$1,063.40
Max. Negotiated Rate	$1,636.00
Rate for Payer: Aetna Commercial	$1,472.40
Rate for Payer: ASR ASR	$1,586.92
Rate for Payer: ASR Commercial	$1,586.92
Rate for Payer: BCBS Trust/PPO	$1,333.18
Rate for Payer: BCN Commercial	$1,268.39
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cofinity Commercial	$1,537.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,308.80
Rate for Payer: Healthscope Commercial	$1,636.00
Rate for Payer: Healthscope Whirlpool	$1,586.92
Rate for Payer: Mclaren Commercial	$1,472.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,390.60
Rate for Payer: Nomi Health Commercial	$1,341.52
Rate for Payer: Priority Health Cigna Priority Health	$1,063.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,439.68

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,636.00

Service Code	HCPCS 49525
Hospital Charge Code	49525
Min. Negotiated Rate	$372.54
Max. Negotiated Rate	$1,063.40
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: Aetna Medicare	$818.00
Rate for Payer: BCBS Complete	$391.17
Rate for Payer: BCBS Trust/PPO	$515.62
Rate for Payer: BCN Commercial	$842.48
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Meridian Medicaid	$391.17
Rate for Payer: Priority Health Choice Medicaid	$372.54
Rate for Payer: Priority Health Cigna Priority Health	$1,063.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,034.50
Rate for Payer: Priority Health Narrow Network	$1,034.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$681.29
Rate for Payer: UHC Exchange	$681.29
Rate for Payer: UHCCP Medicaid	$372.54

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,636.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$1,063.40
Max. Negotiated Rate	$5,359.44
Rate for Payer: Aetna Commercial	$1,472.40
Rate for Payer: Aetna Medicare	$3,457.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,322.12
Rate for Payer: Amish Plain Church Group Commercial	$4,322.12
Rate for Payer: ASR ASR	$1,586.92
Rate for Payer: ASR Commercial	$1,586.92
Rate for Payer: BCBS Complete	$1,945.99
Rate for Payer: BCBS MAPPO	$3,457.70
Rate for Payer: BCBS Trust/PPO	$1,339.72
Rate for Payer: BCN Commercial	$1,268.39
Rate for Payer: BCN Medicare Advantage	$3,457.70
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cofinity Commercial	$1,537.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,308.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,457.70
Rate for Payer: Healthscope Commercial	$1,636.00
Rate for Payer: Healthscope Whirlpool	$1,586.92
Rate for Payer: Humana Choice PPO Medicare	$3,457.70
Rate for Payer: Mclaren Commercial	$1,472.40
Rate for Payer: Mclaren Medicaid	$1,853.33
Rate for Payer: Mclaren Medicare	$3,457.70
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,630.58
Rate for Payer: Meridian Medicaid	$1,945.99
Rate for Payer: MI Amish Medical Board Commercial	$3,976.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,390.60
Rate for Payer: Nomi Health Commercial	$1,341.52
Rate for Payer: PACE Medicare	$3,284.82
Rate for Payer: PACE SWMI	$3,457.70
Rate for Payer: PHP Commercial	$3,803.47
Rate for Payer: PHP Medicaid	$1,853.33
Rate for Payer: PHP Medicare Advantage	$3,457.70
Rate for Payer: Priority Health Choice Medicaid	$1,853.33
Rate for Payer: Priority Health Cigna Priority Health	$1,063.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,433.46
Rate for Payer: Priority Health Medicare	$3,457.70
Rate for Payer: Priority Health Narrow Network	$1,146.84
Rate for Payer: Railroad Medicare Medicare	$3,457.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,439.68
Rate for Payer: UHC Dual Complete DSNP	$3,457.70
Rate for Payer: UHC Exchange	$5,359.44
Rate for Payer: UHC Medicare Advantage	$3,457.70
Rate for Payer: UHCCP DNSP	$3,457.70
Rate for Payer: UHCCP Medicaid	$1,853.33
Rate for Payer: VA VA	$3,457.70

PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM

Professional

Both

$928.00

Service Code	HCPCS 12046
Min. Negotiated Rate	$205.33
Max. Negotiated Rate	$1,305.00
Rate for Payer: Aetna Commercial	$343.64
Rate for Payer: Aetna Medicare	$464.00
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: BCBS Trust/PPO	$1,305.00
Rate for Payer: BCN Commercial	$734.48
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cash Price	$742.40
Rate for Payer: Meridian Medicaid	$215.60
Rate for Payer: Priority Health Choice Medicaid	$205.33
Rate for Payer: Priority Health Cigna Priority Health	$603.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$432.55
Rate for Payer: Priority Health Narrow Network	$432.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$311.66
Rate for Payer: UHC Exchange	$311.66
Rate for Payer: UHCCP Medicaid	$205.33

PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG

Professional

Both

$216.00

Service Code	HCPCS 41250
Min. Negotiated Rate	$99.68
Max. Negotiated Rate	$1,744.97
Rate for Payer: Aetna Commercial	$203.77
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS Complete	$104.66
Rate for Payer: BCBS Trust/PPO	$1,744.97
Rate for Payer: BCN Commercial	$420.26
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Meridian Medicaid	$104.66
Rate for Payer: Priority Health Choice Medicaid	$99.68
Rate for Payer: Priority Health Cigna Priority Health	$140.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.81
Rate for Payer: Priority Health Narrow Network	$276.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$173.26
Rate for Payer: UHC Exchange	$173.26
Rate for Payer: UHCCP Medicaid	$99.68

PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX

Professional

Both

$1,084.00

Service Code	HCPCS 41252
Min. Negotiated Rate	$134.83
Max. Negotiated Rate	$704.60
Rate for Payer: Aetna Commercial	$276.83
Rate for Payer: Aetna Medicare	$542.00
Rate for Payer: BCBS Complete	$141.57
Rate for Payer: BCBS Trust/PPO	$370.34
Rate for Payer: BCN Commercial	$484.76
Rate for Payer: Cash Price	$867.20
Rate for Payer: Cash Price	$867.20
Rate for Payer: Meridian Medicaid	$141.57
Rate for Payer: Priority Health Choice Medicaid	$134.83
Rate for Payer: Priority Health Cigna Priority Health	$704.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$375.26
Rate for Payer: Priority Health Narrow Network	$375.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$256.88
Rate for Payer: UHC Exchange	$256.88
Rate for Payer: UHCCP Medicaid	$134.83

PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH

Professional

Both

$3,409.00

Service Code	HCPCS 49606
Min. Negotiated Rate	$731.02
Max. Negotiated Rate	$2,215.85
Rate for Payer: Aetna Commercial	$1,535.48
Rate for Payer: Aetna Medicare	$1,704.50
Rate for Payer: BCBS Complete	$767.57
Rate for Payer: BCBS Trust/PPO	$2,106.86
Rate for Payer: BCN Commercial	$1,659.06
Rate for Payer: Cash Price	$2,727.20
Rate for Payer: Cash Price	$2,727.20
Rate for Payer: Meridian Medicaid	$767.57
Rate for Payer: Priority Health Choice Medicaid	$731.02
Rate for Payer: Priority Health Cigna Priority Health	$2,215.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,034.38
Rate for Payer: Priority Health Narrow Network	$2,034.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,369.45
Rate for Payer: UHC Exchange	$1,369.45
Rate for Payer: UHCCP Medicaid	$731.02

PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH

Professional

Both

$9,119.00

Service Code	HCPCS 49605
Min. Negotiated Rate	$2,106.86
Max. Negotiated Rate	$8,749.64
Rate for Payer: Aetna Commercial	$6,672.97
Rate for Payer: Aetna Medicare	$4,559.50
Rate for Payer: BCBS Complete	$3,294.82
Rate for Payer: BCBS Trust/PPO	$2,106.86
Rate for Payer: BCN Commercial	$7,143.98
Rate for Payer: Cash Price	$7,295.20
Rate for Payer: Cash Price	$7,295.20
Rate for Payer: Meridian Medicaid	$3,294.82
Rate for Payer: Priority Health Choice Medicaid	$3,137.92
Rate for Payer: Priority Health Cigna Priority Health	$5,927.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,749.64
Rate for Payer: Priority Health Narrow Network	$8,749.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6,088.15
Rate for Payer: UHC Exchange	$6,088.15
Rate for Payer: UHCCP Medicaid	$3,137.92

PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX

Professional

Both

$758.00

Service Code	HCPCS 40654
Min. Negotiated Rate	$277.54
Max. Negotiated Rate	$861.54
Rate for Payer: Aetna Commercial	$555.88
Rate for Payer: Aetna Medicare	$379.00
Rate for Payer: BCBS Complete	$291.42
Rate for Payer: BCBS Trust/PPO	$842.64
Rate for Payer: BCN Commercial	$861.54
Rate for Payer: Cash Price	$606.40
Rate for Payer: Cash Price	$606.40
Rate for Payer: Meridian Medicaid	$291.42
Rate for Payer: Priority Health Choice Medicaid	$277.54
Rate for Payer: Priority Health Cigna Priority Health	$492.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$770.79
Rate for Payer: Priority Health Narrow Network	$770.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$510.00
Rate for Payer: UHC Exchange	$510.00
Rate for Payer: UHCCP Medicaid	$277.54

PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK

Professional

Both

$1,188.00

Service Code	HCPCS 46715
Min. Negotiated Rate	$231.40
Max. Negotiated Rate	$1,001.08
Rate for Payer: Aetna Commercial	$747.32
Rate for Payer: Aetna Medicare	$594.00
Rate for Payer: BCBS Complete	$379.09
Rate for Payer: BCBS Trust/PPO	$231.40
Rate for Payer: BCN Commercial	$816.58
Rate for Payer: Cash Price	$950.40
Rate for Payer: Cash Price	$950.40
Rate for Payer: Meridian Medicaid	$379.09
Rate for Payer: Priority Health Choice Medicaid	$361.04
Rate for Payer: Priority Health Cigna Priority Health	$772.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,001.08
Rate for Payer: Priority Health Narrow Network	$1,001.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$572.43
Rate for Payer: UHC Exchange	$572.43
Rate for Payer: UHCCP Medicaid	$361.04

PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA

Professional

Both

$2,992.00

Service Code	HCPCS 46716
Min. Negotiated Rate	$117.81
Max. Negotiated Rate	$2,222.91
Rate for Payer: Aetna Commercial	$1,651.96
Rate for Payer: Aetna Medicare	$1,496.00
Rate for Payer: BCBS Complete	$841.38
Rate for Payer: BCBS Trust/PPO	$117.81
Rate for Payer: BCN Commercial	$1,807.62
Rate for Payer: Cash Price	$2,393.60
Rate for Payer: Cash Price	$2,393.60
Rate for Payer: Meridian Medicaid	$841.38
Rate for Payer: Priority Health Choice Medicaid	$801.31
Rate for Payer: Priority Health Cigna Priority Health	$1,944.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,222.91
Rate for Payer: Priority Health Narrow Network	$2,222.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,392.59
Rate for Payer: UHC Exchange	$1,392.59
Rate for Payer: UHCCP Medicaid	$801.31

PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ

Professional

Both

$10,278.00

Service Code	HCPCS 39503
Min. Negotiated Rate	$516.15
Max. Negotiated Rate	$9,094.20
Rate for Payer: Aetna Commercial	$5,982.65
Rate for Payer: Aetna Medicare	$5,139.00
Rate for Payer: BCBS Complete	$3,830.67
Rate for Payer: BCBS Trust/PPO	$516.15
Rate for Payer: BCN Commercial	$8,336.35
Rate for Payer: Cash Price	$8,222.40
Rate for Payer: Cash Price	$8,222.40
Rate for Payer: Meridian Medicaid	$3,830.67
Rate for Payer: Priority Health Choice Medicaid	$3,648.26
Rate for Payer: Priority Health Cigna Priority Health	$6,680.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,094.20
Rate for Payer: Priority Health Narrow Network	$9,094.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6,860.85
Rate for Payer: UHC Exchange	$6,860.85
Rate for Payer: UHCCP Medicaid	$3,648.26

PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$1,165.00

Service Code	HCPCS 53449
Min. Negotiated Rate	$319.62
Max. Negotiated Rate	$977.86
Rate for Payer: Aetna Commercial	$786.57
Rate for Payer: Aetna Medicare	$582.50
Rate for Payer: BCBS Complete	$413.75
Rate for Payer: BCBS Trust/PPO	$319.62
Rate for Payer: BCN Commercial	$887.44
Rate for Payer: Cash Price	$932.00
Rate for Payer: Cash Price	$932.00
Rate for Payer: Meridian Medicaid	$413.75
Rate for Payer: Priority Health Choice Medicaid	$394.05
Rate for Payer: Priority Health Cigna Priority Health	$757.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$977.86
Rate for Payer: Priority Health Narrow Network	$977.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$737.29
Rate for Payer: UHC Exchange	$737.29
Rate for Payer: UHCCP Medicaid	$394.05

PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE

Professional

Both

$3,865.00

Service Code	HCPCS 27472
Min. Negotiated Rate	$522.49
Max. Negotiated Rate	$2,512.25
Rate for Payer: Aetna Commercial	$1,690.24
Rate for Payer: Aetna Medicare	$1,932.50
Rate for Payer: BCBS Complete	$859.27
Rate for Payer: BCBS Trust/PPO	$522.49
Rate for Payer: BCN Commercial	$1,850.62
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Meridian Medicaid	$859.27
Rate for Payer: Priority Health Choice Medicaid	$818.35
Rate for Payer: Priority Health Cigna Priority Health	$2,512.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,940.28
Rate for Payer: Priority Health Narrow Network	$1,940.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,472.42
Rate for Payer: UHC Exchange	$1,472.42
Rate for Payer: UHCCP Medicaid	$818.35

PR RPR NON/MAL FEMUR DSTL H/N W/O GRF

Professional

Both

$2,927.00

Service Code	HCPCS 27470
Min. Negotiated Rate	$266.79
Max. Negotiated Rate	$1,902.55
Rate for Payer: Aetna Commercial	$1,574.91
Rate for Payer: Aetna Medicare	$1,463.50
Rate for Payer: BCBS Complete	$802.68
Rate for Payer: BCBS Trust/PPO	$266.79
Rate for Payer: BCN Commercial	$1,728.95
Rate for Payer: Cash Price	$2,341.60
Rate for Payer: Cash Price	$2,341.60
Rate for Payer: Meridian Medicaid	$802.68
Rate for Payer: Priority Health Choice Medicaid	$764.46
Rate for Payer: Priority Health Cigna Priority Health	$1,902.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,814.59
Rate for Payer: Priority Health Narrow Network	$1,814.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,364.26
Rate for Payer: UHC Exchange	$1,364.26
Rate for Payer: UHCCP Medicaid	$764.46

Know your out-of-pocket cost for care.

All Charges