Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PROPAFENONE 150 MG TABLET

Facility

$241.30

Service Code	NDC 53489055101
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$152.02
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Cofinity Medicare Advantage	$168.91
Rate for Payer: Encore Health Key Benefits Commercial	$193.04
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$156.84
Rate for Payer: Priority Health SBD	$152.02

PROPAFENONE 150 MG TABLET

Facility

$350.15

Service Code	NDC 59651025601
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$140.06
Max. Negotiated Rate	$315.13
Rate for Payer: Aetna Commercial	$297.63
Rate for Payer: Aetna Medicare	$175.07
Rate for Payer: Aetna New Business (MI Preferred)	$227.60
Rate for Payer: BCBS Complete	$140.06
Rate for Payer: Cash Price	$280.12
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$301.13
Rate for Payer: Cofinity Medicare Advantage	$245.10
Rate for Payer: Encore Health Key Benefits Commercial	$280.12
Rate for Payer: Healthscope Commercial	$315.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.63
Rate for Payer: PHP Commercial	$297.63
Rate for Payer: Priority Health Cigna Priority Health	$227.60
Rate for Payer: Priority Health SBD	$220.59

PROPAFENONE 150 MG TABLET

Facility

$291.36

Service Code	NDC 60687053701
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$116.54
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna Medicare	$145.68
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: BCBS Complete	$116.54
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Cofinity Medicare Advantage	$203.95
Rate for Payer: Encore Health Key Benefits Commercial	$233.09
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$189.38
Rate for Payer: Priority Health SBD	$183.56

PROPAFENONE 150 MG TABLET

Facility

$350.15

Service Code	NDC 59651025601
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$220.59
Max. Negotiated Rate	$315.13
Rate for Payer: Aetna Commercial	$297.63
Rate for Payer: Aetna New Business (MI Preferred)	$227.60
Rate for Payer: Cash Price	$280.12
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$301.13
Rate for Payer: Cofinity Medicare Advantage	$245.10
Rate for Payer: Encore Health Key Benefits Commercial	$280.12
Rate for Payer: Healthscope Commercial	$315.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.63
Rate for Payer: PHP Commercial	$297.63
Rate for Payer: Priority Health Cigna Priority Health	$227.60
Rate for Payer: Priority Health SBD	$220.59

PROPAFENONE 150 MG TABLET

Facility

$291.36

Service Code	NDC 60687053701
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$183.56
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Cofinity Medicare Advantage	$203.95
Rate for Payer: Encore Health Key Benefits Commercial	$233.09
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$189.38
Rate for Payer: Priority Health SBD	$183.56

PROPARACAINE 0.5 % EYE DROPS

Facility

$97.65

Service Code	NDC 61314001601
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$61.52
Max. Negotiated Rate	$87.89
Rate for Payer: Aetna Commercial	$83.00
Rate for Payer: Aetna New Business (MI Preferred)	$63.47
Rate for Payer: Cash Price	$78.12
Rate for Payer: Cofinity Commercial	$68.36
Rate for Payer: Cofinity Commercial	$83.98
Rate for Payer: Cofinity Medicare Advantage	$68.36
Rate for Payer: Encore Health Key Benefits Commercial	$78.12
Rate for Payer: Healthscope Commercial	$87.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.00
Rate for Payer: PHP Commercial	$83.00
Rate for Payer: Priority Health Cigna Priority Health	$63.47
Rate for Payer: Priority Health SBD	$61.52

PROPARACAINE 0.5 % EYE DROPS

Facility

$116.71

Service Code	NDC 24208073006
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$46.68
Max. Negotiated Rate	$105.04
Rate for Payer: Aetna Commercial	$99.20
Rate for Payer: Aetna Medicare	$58.35
Rate for Payer: Aetna New Business (MI Preferred)	$75.86
Rate for Payer: BCBS Complete	$46.68
Rate for Payer: Cash Price	$93.37
Rate for Payer: Cofinity Commercial	$100.37
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Cofinity Medicare Advantage	$81.70
Rate for Payer: Encore Health Key Benefits Commercial	$93.37
Rate for Payer: Healthscope Commercial	$105.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.20
Rate for Payer: PHP Commercial	$99.20
Rate for Payer: Priority Health Cigna Priority Health	$75.86
Rate for Payer: Priority Health SBD	$73.53

PROPARACAINE 0.5 % EYE DROPS

Facility

$97.65

Service Code	NDC 61314001601
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$87.89
Rate for Payer: Aetna Commercial	$83.00
Rate for Payer: Aetna Medicare	$48.83
Rate for Payer: Aetna New Business (MI Preferred)	$63.47
Rate for Payer: BCBS Complete	$39.06
Rate for Payer: Cash Price	$78.12
Rate for Payer: Cofinity Commercial	$68.36
Rate for Payer: Cofinity Commercial	$83.98
Rate for Payer: Cofinity Medicare Advantage	$68.36
Rate for Payer: Encore Health Key Benefits Commercial	$78.12
Rate for Payer: Healthscope Commercial	$87.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.00
Rate for Payer: PHP Commercial	$83.00
Rate for Payer: Priority Health Cigna Priority Health	$63.47
Rate for Payer: Priority Health SBD	$61.52

PROPARACAINE 0.5 % EYE DROPS

Facility

$113.72

Service Code	NDC 17478026312
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Cofinity Medicare Advantage	$79.60
Rate for Payer: Encore Health Key Benefits Commercial	$90.98
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$73.92
Rate for Payer: Priority Health SBD	$71.64

PROPARACAINE 0.5 % EYE DROPS

Facility

$116.71

Service Code	NDC 24208073006
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$73.53
Max. Negotiated Rate	$105.04
Rate for Payer: Aetna Commercial	$99.20
Rate for Payer: Aetna New Business (MI Preferred)	$75.86
Rate for Payer: Cash Price	$93.37
Rate for Payer: Cofinity Commercial	$100.37
Rate for Payer: Cofinity Commercial	$81.70
Rate for Payer: Cofinity Medicare Advantage	$81.70
Rate for Payer: Encore Health Key Benefits Commercial	$93.37
Rate for Payer: Healthscope Commercial	$105.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.20
Rate for Payer: PHP Commercial	$99.20
Rate for Payer: Priority Health Cigna Priority Health	$75.86
Rate for Payer: Priority Health SBD	$73.53

PROPARACAINE 0.5 % EYE DROPS

Facility

$113.72

Service Code	NDC 17478026312
Hospital Charge Code	6644
Hospital Revenue Code	637
Min. Negotiated Rate	$45.49
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial	$96.66
Rate for Payer: Aetna Medicare	$56.86
Rate for Payer: Aetna New Business (MI Preferred)	$73.92
Rate for Payer: BCBS Complete	$45.49
Rate for Payer: Cash Price	$90.98
Rate for Payer: Cofinity Commercial	$79.60
Rate for Payer: Cofinity Commercial	$97.80
Rate for Payer: Cofinity Medicare Advantage	$79.60
Rate for Payer: Encore Health Key Benefits Commercial	$90.98
Rate for Payer: Healthscope Commercial	$102.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.66
Rate for Payer: PHP Commercial	$96.66
Rate for Payer: Priority Health Cigna Priority Health	$73.92
Rate for Payer: Priority Health SBD	$71.64

PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL

Professional

Both

$2,527.00

Service Code	HCPCS 50250
Min. Negotiated Rate	$1,010.80
Max. Negotiated Rate	$2,144.00
Rate for Payer: Aetna Commercial	$1,552.95
Rate for Payer: Aetna Medicare	$1,205.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,668.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,552.95
Rate for Payer: BCBS Complete	$1,010.80
Rate for Payer: BCBS MAPPO	$1,158.92
Rate for Payer: BCN Medicare Advantage	$1,158.92
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cash Price	$2,021.60
Rate for Payer: Cofinity Commercial	$1,668.84
Rate for Payer: Cofinity Commercial	$1,552.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,158.92
Rate for Payer: Healthscope Commercial	$1,854.27
Rate for Payer: Healthscope Commercial	$2,144.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,216.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,642.55
Rate for Payer: Nomi Health Commercial	$1,390.70
Rate for Payer: PACE SWMI	$1,158.92
Rate for Payer: PHP Medicare Advantage	$1,158.92
Rate for Payer: Priority Health Cigna Priority Health	$1,642.55
Rate for Payer: Priority Health Medicare	$1,158.92
Rate for Payer: UHC Dual Complete DSNP	$1,158.92
Rate for Payer: UHC Medicare Advantage	$1,158.92

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Facility

$901.00

Service Code	CPT 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$567.63
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna Commercial	$765.85
Rate for Payer: Aetna New Business (MI Preferred)	$585.65
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$630.70
Rate for Payer: Cofinity Commercial	$774.86
Rate for Payer: Cofinity Medicare Advantage	$630.70
Rate for Payer: Encore Health Key Benefits Commercial	$720.80
Rate for Payer: Healthscope Commercial	$810.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.85
Rate for Payer: PHP Commercial	$765.85
Rate for Payer: Priority Health Cigna Priority Health	$585.65
Rate for Payer: Priority Health SBD	$567.63

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Facility

$901.00

Service Code	CPT 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$567.63
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Commercial	$765.85
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Aetna New Business (MI Preferred)	$585.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$774.86
Rate for Payer: Cofinity Commercial	$630.70
Rate for Payer: Cofinity Medicare Advantage	$630.70
Rate for Payer: Encore Health Key Benefits Commercial	$720.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Healthscope Commercial	$810.90
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.85
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Commercial	$765.85
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Cigna Priority Health	$585.65
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Priority Health SBD	$567.63
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,102.59
Rate for Payer: VA VA	$3,734.62

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Professional

Both

$901.00

Service Code	HCPCS 38531
Min. Negotiated Rate	$360.40
Max. Negotiated Rate	$801.85
Rate for Payer: Aetna Commercial	$580.80
Rate for Payer: Aetna Medicare	$450.77
Rate for Payer: Aetna New Business (MI Preferred)	$624.14
Rate for Payer: Aetna New Business (MI Preferred)	$580.80
Rate for Payer: BCBS Complete	$360.40
Rate for Payer: BCBS MAPPO	$433.43
Rate for Payer: BCN Medicare Advantage	$433.43
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$624.14
Rate for Payer: Cofinity Commercial	$580.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$433.43
Rate for Payer: Healthscope Commercial	$801.85
Rate for Payer: Healthscope Commercial	$693.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$455.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.65
Rate for Payer: Nomi Health Commercial	$520.12
Rate for Payer: PACE SWMI	$433.43
Rate for Payer: PHP Medicare Advantage	$433.43
Rate for Payer: Priority Health Cigna Priority Health	$585.65
Rate for Payer: Priority Health Medicare	$433.43
Rate for Payer: UHC Dual Complete DSNP	$433.43
Rate for Payer: UHC Medicare Advantage	$433.43

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Professional

Both

$901.00

Service Code	HCPCS 38531
Hospital Charge Code	38531
Min. Negotiated Rate	$360.40
Max. Negotiated Rate	$801.85
Rate for Payer: Aetna Commercial	$580.80
Rate for Payer: Aetna Medicare	$450.77
Rate for Payer: Aetna New Business (MI Preferred)	$580.80
Rate for Payer: Aetna New Business (MI Preferred)	$624.14
Rate for Payer: BCBS Complete	$360.40
Rate for Payer: BCBS MAPPO	$433.43
Rate for Payer: BCN Medicare Advantage	$433.43
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$624.14
Rate for Payer: Cofinity Commercial	$580.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$433.43
Rate for Payer: Healthscope Commercial	$693.49
Rate for Payer: Healthscope Commercial	$801.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$455.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.65
Rate for Payer: Nomi Health Commercial	$520.12
Rate for Payer: PACE SWMI	$433.43
Rate for Payer: PHP Medicare Advantage	$433.43
Rate for Payer: Priority Health Cigna Priority Health	$585.65
Rate for Payer: Priority Health Medicare	$433.43
Rate for Payer: UHC Dual Complete DSNP	$433.43
Rate for Payer: UHC Medicare Advantage	$433.43

PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA

Professional

Both

$4,782.00

Service Code	HCPCS 32815
Min. Negotiated Rate	$1,912.80
Max. Negotiated Rate	$4,975.33
Rate for Payer: Aetna Commercial	$3,603.76
Rate for Payer: Aetna Medicare	$2,796.94
Rate for Payer: Aetna New Business (MI Preferred)	$3,872.69
Rate for Payer: Aetna New Business (MI Preferred)	$3,603.76
Rate for Payer: BCBS Complete	$1,912.80
Rate for Payer: BCBS MAPPO	$2,689.37
Rate for Payer: BCN Medicare Advantage	$2,689.37
Rate for Payer: Cash Price	$3,825.60
Rate for Payer: Cash Price	$3,825.60
Rate for Payer: Cofinity Commercial	$3,872.69
Rate for Payer: Cofinity Commercial	$3,603.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,689.37
Rate for Payer: Healthscope Commercial	$4,302.99
Rate for Payer: Healthscope Commercial	$4,975.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,823.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,108.30
Rate for Payer: Nomi Health Commercial	$3,227.24
Rate for Payer: PACE SWMI	$2,689.37
Rate for Payer: PHP Medicare Advantage	$2,689.37
Rate for Payer: Priority Health Cigna Priority Health	$3,108.30
Rate for Payer: Priority Health Medicare	$2,689.37
Rate for Payer: UHC Dual Complete DSNP	$2,689.37
Rate for Payer: UHC Medicare Advantage	$2,689.37

PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM

Professional

Both

$4,070.00

Service Code	HCPCS 49188
Min. Negotiated Rate	$1,628.00
Max. Negotiated Rate	$3,586.39
Rate for Payer: Aetna Commercial	$2,597.71
Rate for Payer: Aetna Medicare	$2,016.13
Rate for Payer: Aetna New Business (MI Preferred)	$2,791.57
Rate for Payer: Aetna New Business (MI Preferred)	$2,597.71
Rate for Payer: BCBS Complete	$1,628.00
Rate for Payer: BCBS MAPPO	$1,938.59
Rate for Payer: BCN Medicare Advantage	$1,938.59
Rate for Payer: Cash Price	$3,256.00
Rate for Payer: Cash Price	$3,256.00
Rate for Payer: Cofinity Commercial	$2,791.57
Rate for Payer: Cofinity Commercial	$2,597.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,938.59
Rate for Payer: Healthscope Commercial	$3,586.39
Rate for Payer: Healthscope Commercial	$3,101.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,035.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,645.50
Rate for Payer: Nomi Health Commercial	$2,326.31
Rate for Payer: PACE SWMI	$1,938.59
Rate for Payer: PHP Medicare Advantage	$1,938.59
Rate for Payer: Priority Health Cigna Priority Health	$2,645.50
Rate for Payer: Priority Health Medicare	$1,938.59
Rate for Payer: UHC Dual Complete DSNP	$1,938.59
Rate for Payer: UHC Medicare Advantage	$1,938.59

PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS

Professional

Both

$2,694.00

Service Code	HCPCS 49186
Min. Negotiated Rate	$1,077.60
Max. Negotiated Rate	$2,339.51
Rate for Payer: Aetna Commercial	$1,694.56
Rate for Payer: Aetna Medicare	$1,315.18
Rate for Payer: Aetna New Business (MI Preferred)	$1,821.02
Rate for Payer: Aetna New Business (MI Preferred)	$1,694.56
Rate for Payer: BCBS Complete	$1,077.60
Rate for Payer: BCBS MAPPO	$1,264.60
Rate for Payer: BCN Medicare Advantage	$1,264.60
Rate for Payer: Cash Price	$2,155.20
Rate for Payer: Cash Price	$2,155.20
Rate for Payer: Cofinity Commercial	$1,821.02
Rate for Payer: Cofinity Commercial	$1,694.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,264.60
Rate for Payer: Healthscope Commercial	$2,023.36
Rate for Payer: Healthscope Commercial	$2,339.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,327.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,751.10
Rate for Payer: Nomi Health Commercial	$1,517.52
Rate for Payer: PACE SWMI	$1,264.60
Rate for Payer: PHP Medicare Advantage	$1,264.60
Rate for Payer: Priority Health Cigna Priority Health	$1,751.10
Rate for Payer: Priority Health Medicare	$1,264.60
Rate for Payer: UHC Dual Complete DSNP	$1,264.60
Rate for Payer: UHC Medicare Advantage	$1,264.60

PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB

Professional

Both

$1,287.00

Service Code	HCPCS 35600
Min. Negotiated Rate	$178.14
Max. Negotiated Rate	$836.55
Rate for Payer: Aetna Commercial	$238.71
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$256.52
Rate for Payer: Aetna New Business (MI Preferred)	$238.71
Rate for Payer: BCBS Complete	$514.80
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Cofinity Commercial	$256.52
Rate for Payer: Cofinity Commercial	$238.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$329.56
Rate for Payer: Healthscope Commercial	$285.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$187.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$836.55
Rate for Payer: Nomi Health Commercial	$213.77
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Cigna Priority Health	$836.55
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Medicare Advantage	$178.14

PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN

Professional

Both

$1,938.00

Service Code	HCPCS 64568
Min. Negotiated Rate	$582.74
Max. Negotiated Rate	$1,259.70
Rate for Payer: Aetna Commercial	$780.87
Rate for Payer: Aetna Medicare	$606.05
Rate for Payer: Aetna New Business (MI Preferred)	$839.15
Rate for Payer: Aetna New Business (MI Preferred)	$780.87
Rate for Payer: BCBS Complete	$775.20
Rate for Payer: BCBS MAPPO	$582.74
Rate for Payer: BCN Medicare Advantage	$582.74
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$839.15
Rate for Payer: Cofinity Commercial	$780.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$582.74
Rate for Payer: Healthscope Commercial	$1,078.07
Rate for Payer: Healthscope Commercial	$932.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$611.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,259.70
Rate for Payer: Nomi Health Commercial	$699.29
Rate for Payer: PACE SWMI	$582.74
Rate for Payer: PHP Medicare Advantage	$582.74
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health Medicare	$582.74
Rate for Payer: UHC Dual Complete DSNP	$582.74
Rate for Payer: UHC Medicare Advantage	$582.74

PR OPEN IMPLANTATION NEA PERIPHERAL NERVE

Professional

Both

$995.00

Service Code	HCPCS 64575
Min. Negotiated Rate	$300.08
Max. Negotiated Rate	$646.75
Rate for Payer: Aetna Commercial	$402.11
Rate for Payer: Aetna Medicare	$312.08
Rate for Payer: Aetna New Business (MI Preferred)	$432.12
Rate for Payer: Aetna New Business (MI Preferred)	$402.11
Rate for Payer: BCBS Complete	$398.00
Rate for Payer: BCBS MAPPO	$300.08
Rate for Payer: BCN Medicare Advantage	$300.08
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cofinity Commercial	$432.12
Rate for Payer: Cofinity Commercial	$402.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$300.08
Rate for Payer: Healthscope Commercial	$555.15
Rate for Payer: Healthscope Commercial	$480.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$315.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$646.75
Rate for Payer: Nomi Health Commercial	$360.10
Rate for Payer: PACE SWMI	$300.08
Rate for Payer: PHP Medicare Advantage	$300.08
Rate for Payer: Priority Health Cigna Priority Health	$646.75
Rate for Payer: Priority Health Medicare	$300.08
Rate for Payer: UHC Dual Complete DSNP	$300.08
Rate for Payer: UHC Medicare Advantage	$300.08

PR OPEN IMPLANTATION NEA SACRAL NERVE

Professional

Both

$1,517.00

Service Code	HCPCS 64581
Min. Negotiated Rate	$606.80
Max. Negotiated Rate	$1,166.35
Rate for Payer: Aetna Commercial	$844.82
Rate for Payer: Aetna Medicare	$655.68
Rate for Payer: Aetna New Business (MI Preferred)	$907.86
Rate for Payer: Aetna New Business (MI Preferred)	$844.82
Rate for Payer: BCBS Complete	$606.80
Rate for Payer: BCBS MAPPO	$630.46
Rate for Payer: BCN Medicare Advantage	$630.46
Rate for Payer: Cash Price	$1,213.60
Rate for Payer: Cash Price	$1,213.60
Rate for Payer: Cofinity Commercial	$907.86
Rate for Payer: Cofinity Commercial	$844.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$630.46
Rate for Payer: Healthscope Commercial	$1,008.74
Rate for Payer: Healthscope Commercial	$1,166.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$661.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$986.05
Rate for Payer: Nomi Health Commercial	$756.55
Rate for Payer: PACE SWMI	$630.46
Rate for Payer: PHP Medicare Advantage	$630.46
Rate for Payer: Priority Health Cigna Priority Health	$986.05
Rate for Payer: Priority Health Medicare	$630.46
Rate for Payer: UHC Dual Complete DSNP	$630.46
Rate for Payer: UHC Medicare Advantage	$630.46

PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR

Professional

Both

$1,751.00

Service Code	HCPCS 64582
Min. Negotiated Rate	$700.40
Max. Negotiated Rate	$1,481.11
Rate for Payer: Aetna Commercial	$1,072.80
Rate for Payer: Aetna Medicare	$832.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,152.86
Rate for Payer: Aetna New Business (MI Preferred)	$1,072.80
Rate for Payer: BCBS Complete	$700.40
Rate for Payer: BCBS MAPPO	$800.60
Rate for Payer: BCN Medicare Advantage	$800.60
Rate for Payer: Cash Price	$1,400.80
Rate for Payer: Cash Price	$1,400.80
Rate for Payer: Cofinity Commercial	$1,152.86
Rate for Payer: Cofinity Commercial	$1,072.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$800.60
Rate for Payer: Healthscope Commercial	$1,481.11
Rate for Payer: Healthscope Commercial	$1,280.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$840.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,138.15
Rate for Payer: Nomi Health Commercial	$960.72
Rate for Payer: PACE SWMI	$800.60
Rate for Payer: PHP Medicare Advantage	$800.60
Rate for Payer: Priority Health Cigna Priority Health	$1,138.15
Rate for Payer: Priority Health Medicare	$800.60
Rate for Payer: UHC Dual Complete DSNP	$800.60
Rate for Payer: UHC Medicare Advantage	$800.60

PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL

Professional

Both

$640.00

Service Code	HCPCS 37239
Min. Negotiated Rate	$143.88
Max. Negotiated Rate	$416.00
Rate for Payer: Aetna Commercial	$192.80
Rate for Payer: Aetna Medicare	$149.64
Rate for Payer: Aetna New Business (MI Preferred)	$207.19
Rate for Payer: Aetna New Business (MI Preferred)	$192.80
Rate for Payer: BCBS Complete	$256.00
Rate for Payer: BCBS MAPPO	$143.88
Rate for Payer: BCN Medicare Advantage	$143.88
Rate for Payer: Cash Price	$512.00
Rate for Payer: Cash Price	$512.00
Rate for Payer: Cofinity Commercial	$207.19
Rate for Payer: Cofinity Commercial	$192.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$143.88
Rate for Payer: Healthscope Commercial	$230.21
Rate for Payer: Healthscope Commercial	$266.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$151.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$416.00
Rate for Payer: Nomi Health Commercial	$172.66
Rate for Payer: PACE SWMI	$143.88
Rate for Payer: PHP Medicare Advantage	$143.88
Rate for Payer: Priority Health Cigna Priority Health	$416.00
Rate for Payer: Priority Health Medicare	$143.88
Rate for Payer: UHC Dual Complete DSNP	$143.88
Rate for Payer: UHC Medicare Advantage	$143.88

Know your out-of-pocket cost for care.

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