Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD

Professional

Both

$2,600.00

Service Code	HCPCS 53448
Min. Negotiated Rate	$807.77
Max. Negotiated Rate	$2,027.97
Rate for Payer: Aetna Commercial	$1,639.79
Rate for Payer: BCBS Complete	$848.31
Rate for Payer: BCBS Trust/PPO	$807.77
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Cash Price	$2,080.00
Rate for Payer: Mclaren Medicaid	$807.91
Rate for Payer: Meridian Medicaid	$848.31
Rate for Payer: Priority Health Choice Medicaid	$807.91
Rate for Payer: Priority Health Cigna Priority Health	$1,820.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,027.97
Rate for Payer: Priority Health Narrow Network	$2,027.97
Rate for Payer: Priority Health SBD	$2,027.97

PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL

Professional

Both

$2,089.00

Service Code	HCPCS 54411
Min. Negotiated Rate	$653.91
Max. Negotiated Rate	$3,265.16
Rate for Payer: Aetna Commercial	$1,326.02
Rate for Payer: BCBS Complete	$686.61
Rate for Payer: BCBS Trust/PPO	$3,265.16
Rate for Payer: Cash Price	$1,671.20
Rate for Payer: Cash Price	$1,671.20
Rate for Payer: Mclaren Medicaid	$653.91
Rate for Payer: Meridian Medicaid	$686.61
Rate for Payer: Priority Health Choice Medicaid	$653.91
Rate for Payer: Priority Health Cigna Priority Health	$1,462.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,641.60
Rate for Payer: Priority Health Narrow Network	$1,641.60
Rate for Payer: Priority Health SBD	$1,641.60

PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC

Professional

Both

$2,466.00

Service Code	HCPCS 53447
Min. Negotiated Rate	$512.90
Max. Negotiated Rate	$1,726.20
Rate for Payer: Aetna Commercial	$1,035.47
Rate for Payer: BCBS Complete	$538.54
Rate for Payer: BCBS Trust/PPO	$790.34
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Cash Price	$1,972.80
Rate for Payer: Mclaren Medicaid	$512.90
Rate for Payer: Meridian Medicaid	$538.54
Rate for Payer: Priority Health Choice Medicaid	$512.90
Rate for Payer: Priority Health Cigna Priority Health	$1,726.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,285.52
Rate for Payer: Priority Health Narrow Network	$1,285.52
Rate for Payer: Priority Health SBD	$1,285.52

PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD

Professional

Both

$2,245.00

Service Code	HCPCS 54417
Min. Negotiated Rate	$571.69
Max. Negotiated Rate	$2,176.77
Rate for Payer: Aetna Commercial	$1,152.98
Rate for Payer: BCBS Complete	$600.27
Rate for Payer: BCBS Trust/PPO	$2,176.77
Rate for Payer: Cash Price	$1,796.00
Rate for Payer: Cash Price	$1,796.00
Rate for Payer: Mclaren Medicaid	$571.69
Rate for Payer: Meridian Medicaid	$600.27
Rate for Payer: Priority Health Choice Medicaid	$571.69
Rate for Payer: Priority Health Cigna Priority Health	$1,571.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,433.03
Rate for Payer: Priority Health Narrow Network	$1,433.03
Rate for Payer: Priority Health SBD	$1,433.03

PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH

Professional

Both

$1,175.00

Service Code	HCPCS 50387
Min. Negotiated Rate	$51.55
Max. Negotiated Rate	$3,379.54
Rate for Payer: Aetna Commercial	$107.12
Rate for Payer: BCBS Complete	$54.13
Rate for Payer: BCBS Trust/PPO	$3,379.54
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Mclaren Medicaid	$51.55
Rate for Payer: Meridian Medicaid	$54.13
Rate for Payer: Priority Health Choice Medicaid	$51.55
Rate for Payer: Priority Health Cigna Priority Health	$822.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$131.31
Rate for Payer: Priority Health Narrow Network	$131.31
Rate for Payer: Priority Health SBD	$131.31

PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE

Professional

Both

$1,665.00

Service Code	HCPCS 69711
Min. Negotiated Rate	$539.10
Max. Negotiated Rate	$3,026.10
Rate for Payer: Aetna Commercial	$960.92
Rate for Payer: BCBS Complete	$566.06
Rate for Payer: BCBS Trust/PPO	$3,026.10
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Mclaren Medicaid	$539.10
Rate for Payer: Meridian Medicaid	$566.06
Rate for Payer: Priority Health Choice Medicaid	$539.10
Rate for Payer: Priority Health Cigna Priority Health	$1,165.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,195.15
Rate for Payer: Priority Health Narrow Network	$1,195.15
Rate for Payer: Priority Health SBD	$1,195.15

PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS

Professional

Both

$1,123.00

Service Code	HCPCS 19330
Min. Negotiated Rate	$414.50
Max. Negotiated Rate	$797.00
Rate for Payer: Aetna Commercial	$698.31
Rate for Payer: BCBS Complete	$435.22
Rate for Payer: BCBS Trust/PPO	$476.13
Rate for Payer: Cash Price	$898.40
Rate for Payer: Cash Price	$898.40
Rate for Payer: Mclaren Medicaid	$414.50
Rate for Payer: Meridian Medicaid	$435.22
Rate for Payer: Priority Health Choice Medicaid	$414.50
Rate for Payer: Priority Health Cigna Priority Health	$786.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$797.00
Rate for Payer: Priority Health Narrow Network	$797.00
Rate for Payer: Priority Health SBD	$797.00

PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15

Facility

$172.00

Service Code	CPT 11200
Hospital Charge Code	11200
Hospital Revenue Code	521
Min. Negotiated Rate	$75.64
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$146.20
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$111.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$81.34
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$147.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$154.80
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$146.20
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$146.20
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$120.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$108.36
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$83.20
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$75.64
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15

Facility

$172.00

Service Code	CPT 11200
Hospital Charge Code	11200
Hospital Revenue Code	521
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$154.80
Rate for Payer: Aetna Commercial	$146.20
Rate for Payer: Aetna New Business (MI Preferred)	$111.80
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$147.92
Rate for Payer: Healthscope Commercial	$154.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$146.20
Rate for Payer: PHP Commercial	$146.20
Rate for Payer: Priority Health Cigna Priority Health	$120.40
Rate for Payer: Priority Health SBD	$108.36

PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR

Professional

Both

$3,865.00

Service Code	HCPCS 63662
Min. Negotiated Rate	$553.59
Max. Negotiated Rate	$2,705.50
Rate for Payer: Aetna Commercial	$1,089.28
Rate for Payer: BCBS Complete	$581.27
Rate for Payer: BCBS Trust/PPO	$1,468.15
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Mclaren Medicaid	$553.59
Rate for Payer: Meridian Medicaid	$581.27
Rate for Payer: Priority Health Choice Medicaid	$553.59
Rate for Payer: Priority Health Cigna Priority Health	$2,705.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,450.66
Rate for Payer: Priority Health Narrow Network	$1,450.66
Rate for Payer: Priority Health SBD	$1,450.66

PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR

Professional

Both

$1,785.00

Service Code	HCPCS 63661
Min. Negotiated Rate	$211.94
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial	$419.58
Rate for Payer: BCBS Complete	$222.54
Rate for Payer: BCBS Trust/PPO	$409.43
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Mclaren Medicaid	$211.94
Rate for Payer: Meridian Medicaid	$222.54
Rate for Payer: Priority Health Choice Medicaid	$211.94
Rate for Payer: Priority Health Cigna Priority Health	$1,249.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$554.89
Rate for Payer: Priority Health Narrow Network	$554.89
Rate for Payer: Priority Health SBD	$554.89

PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS

Professional

Both

$1,486.00

Service Code	HCPCS 62365
Min. Negotiated Rate	$178.57
Max. Negotiated Rate	$1,040.20
Rate for Payer: Aetna Commercial	$379.91
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCBS Trust/PPO	$178.57
Rate for Payer: Cash Price	$1,188.80
Rate for Payer: Cash Price	$1,188.80
Rate for Payer: Mclaren Medicaid	$192.98
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health	$1,040.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$503.95
Rate for Payer: Priority Health Narrow Network	$503.95
Rate for Payer: Priority Health SBD	$503.95

PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD

Professional

Both

$1,596.00

Service Code	HCPCS 26392
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$1,551.86
Rate for Payer: Aetna Commercial	$1,339.43
Rate for Payer: BCBS Complete	$679.00
Rate for Payer: BCBS Trust/PPO	$77.66
Rate for Payer: Cash Price	$1,276.80
Rate for Payer: Cash Price	$1,276.80
Rate for Payer: Mclaren Medicaid	$646.67
Rate for Payer: Meridian Medicaid	$679.00
Rate for Payer: Priority Health Choice Medicaid	$646.67
Rate for Payer: Priority Health Cigna Priority Health	$1,117.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,551.86
Rate for Payer: Priority Health Narrow Network	$1,551.86
Rate for Payer: Priority Health SBD	$1,551.86

PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL

Professional

Both

$463.00

Service Code	HCPCS 46754
Min. Negotiated Rate	$156.13
Max. Negotiated Rate	$425.10
Rate for Payer: Aetna Commercial	$312.54
Rate for Payer: BCBS Complete	$163.94
Rate for Payer: BCBS Trust/PPO	$396.75
Rate for Payer: Cash Price	$370.40
Rate for Payer: Cash Price	$370.40
Rate for Payer: Mclaren Medicaid	$156.13
Rate for Payer: Meridian Medicaid	$163.94
Rate for Payer: Priority Health Choice Medicaid	$156.13
Rate for Payer: Priority Health Cigna Priority Health	$324.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$425.10
Rate for Payer: Priority Health Narrow Network	$425.10
Rate for Payer: Priority Health SBD	$425.10

PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS

Professional

Both

$1,301.00

Service Code	HCPCS 33235
Min. Negotiated Rate	$399.80
Max. Negotiated Rate	$1,206.11
Rate for Payer: Aetna Commercial	$854.53
Rate for Payer: BCBS Complete	$419.79
Rate for Payer: BCBS Trust/PPO	$1,206.11
Rate for Payer: Cash Price	$1,040.80
Rate for Payer: Cash Price	$1,040.80
Rate for Payer: Mclaren Medicaid	$399.80
Rate for Payer: Meridian Medicaid	$419.79
Rate for Payer: Priority Health Choice Medicaid	$399.80
Rate for Payer: Priority Health Cigna Priority Health	$910.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,003.27
Rate for Payer: Priority Health Narrow Network	$1,003.27
Rate for Payer: Priority Health SBD	$1,003.27

PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ

Facility

$702.00

Service Code	CPT 36590
Hospital Charge Code	36590
Hospital Revenue Code	960
Min. Negotiated Rate	$442.26
Max. Negotiated Rate	$631.80
Rate for Payer: Aetna Commercial	$596.70
Rate for Payer: Aetna New Business (MI Preferred)	$456.30
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cofinity Commercial	$491.40
Rate for Payer: Cofinity Commercial	$603.72
Rate for Payer: Healthscope Commercial	$631.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$596.70
Rate for Payer: PHP Commercial	$596.70
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health SBD	$442.26

PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ

Professional

Both

$702.00

Service Code	HCPCS 36590
Hospital Charge Code	36590
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$1,132.68
Rate for Payer: Aetna Commercial	$252.86
Rate for Payer: BCBS Complete	$125.70
Rate for Payer: BCBS Trust/PPO	$1,132.68
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Mclaren Medicaid	$119.71
Rate for Payer: Meridian Medicaid	$125.70
Rate for Payer: Priority Health Choice Medicaid	$119.71
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$298.97
Rate for Payer: Priority Health Narrow Network	$298.97
Rate for Payer: Priority Health SBD	$298.97

PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ

Facility

$702.00

Service Code	CPT 36590
Hospital Charge Code	36590
Hospital Revenue Code	960
Min. Negotiated Rate	$184.02
Max. Negotiated Rate	$4,461.38
Rate for Payer: Aetna Commercial	$596.70
Rate for Payer: Aetna Medicare	$1,482.04
Rate for Payer: Aetna New Business (MI Preferred)	$456.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,781.30
Rate for Payer: Amish Plain Church Group Commercial	$1,781.30
Rate for Payer: BCBS Complete	$818.54
Rate for Payer: BCBS MAPPO	$1,425.04
Rate for Payer: BCBS Trust/PPO	$659.61
Rate for Payer: BCN Medicare Advantage	$1,425.04
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cofinity Commercial	$491.40
Rate for Payer: Cofinity Commercial	$603.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,425.04
Rate for Payer: Healthscope Commercial	$631.80
Rate for Payer: Mclaren Medicaid	$779.50
Rate for Payer: Mclaren Medicare	$1,425.04
Rate for Payer: Meridian Medicaid	$818.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,496.29
Rate for Payer: MI Amish Medical Board Commercial	$1,638.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$596.70
Rate for Payer: PACE Medicare	$1,353.79
Rate for Payer: PACE SWMI	$1,425.04
Rate for Payer: PHP Commercial	$596.70
Rate for Payer: PHP Medicare Advantage	$1,425.04
Rate for Payer: Priority Health Choice Medicaid	$779.50
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,461.38
Rate for Payer: Priority Health Medicare	$1,425.04
Rate for Payer: Priority Health Narrow Network	$3,569.10
Rate for Payer: Priority Health SBD	$442.26
Rate for Payer: Railroad Medicare Medicare	$1,425.04
Rate for Payer: UHC All Payor (Choice/PPO)	$202.42
Rate for Payer: UHC Dual Complete DSNP	$1,425.04
Rate for Payer: UHC Exchange	$184.02
Rate for Payer: UHC Medicare Advantage	$1,467.79
Rate for Payer: VA VA	$1,425.04

PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ

Professional

Both

$702.00

Service Code	HCPCS 36590
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$1,132.68
Rate for Payer: Aetna Commercial	$252.86
Rate for Payer: BCBS Complete	$125.70
Rate for Payer: BCBS Trust/PPO	$1,132.68
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Mclaren Medicaid	$119.71
Rate for Payer: Meridian Medicaid	$125.70
Rate for Payer: Priority Health Choice Medicaid	$119.71
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$298.97
Rate for Payer: Priority Health Narrow Network	$298.97
Rate for Payer: Priority Health SBD	$298.97

PR RMVL TUN CVC W/O SUBQ PORT/PMP

Facility

$421.00

Service Code	CPT 36589
Hospital Charge Code	36589
Min. Negotiated Rate	$131.96
Max. Negotiated Rate	$1,683.01
Rate for Payer: Aetna Commercial	$357.85
Rate for Payer: Aetna Medicare	$581.33
Rate for Payer: Aetna New Business (MI Preferred)	$273.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$698.71
Rate for Payer: Amish Plain Church Group Commercial	$698.71
Rate for Payer: BCBS Complete	$321.07
Rate for Payer: BCBS MAPPO	$558.97
Rate for Payer: BCBS Trust/PPO	$474.99
Rate for Payer: BCN Medicare Advantage	$558.97
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cofinity Commercial	$362.06
Rate for Payer: Cofinity Commercial	$294.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$558.97
Rate for Payer: Healthscope Commercial	$378.90
Rate for Payer: Mclaren Medicaid	$305.76
Rate for Payer: Mclaren Medicare	$558.97
Rate for Payer: Meridian Medicaid	$321.07
Rate for Payer: Meridian Wellcare - Medicare Advantage	$586.92
Rate for Payer: MI Amish Medical Board Commercial	$642.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$357.85
Rate for Payer: PACE Medicare	$531.02
Rate for Payer: PACE SWMI	$558.97
Rate for Payer: PHP Commercial	$357.85
Rate for Payer: PHP Medicare Advantage	$558.97
Rate for Payer: Priority Health Choice Medicaid	$305.76
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,683.01
Rate for Payer: Priority Health Medicare	$558.97
Rate for Payer: Priority Health Narrow Network	$1,346.40
Rate for Payer: Priority Health SBD	$265.23
Rate for Payer: Railroad Medicare Medicare	$558.97
Rate for Payer: UHC All Payor (Choice/PPO)	$145.16
Rate for Payer: UHC Dual Complete DSNP	$558.97
Rate for Payer: UHC Exchange	$131.96
Rate for Payer: UHC Medicare Advantage	$575.74
Rate for Payer: VA VA	$558.97

PR RMVL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$421.00

Service Code	HCPCS 36589
Hospital Charge Code	36589
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$1,048.15
Rate for Payer: Aetna Commercial	$183.56
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCBS Trust/PPO	$1,048.15
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cash Price	$336.80
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.90
Rate for Payer: Priority Health Narrow Network	$214.90
Rate for Payer: Priority Health SBD	$214.90

PR RMVL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$421.00

Service Code	HCPCS 36589
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$1,048.15
Rate for Payer: Aetna Commercial	$183.56
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCBS Trust/PPO	$1,048.15
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cash Price	$336.80
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$214.90
Rate for Payer: Priority Health Narrow Network	$214.90
Rate for Payer: Priority Health SBD	$214.90

PR RMVL TUN CVC W/O SUBQ PORT/PMP

Facility

$421.00

Service Code	CPT 36589
Hospital Charge Code	36589
Min. Negotiated Rate	$265.23
Max. Negotiated Rate	$378.90
Rate for Payer: Aetna Commercial	$357.85
Rate for Payer: Aetna New Business (MI Preferred)	$273.65
Rate for Payer: Cash Price	$336.80
Rate for Payer: Cofinity Commercial	$294.70
Rate for Payer: Cofinity Commercial	$362.06
Rate for Payer: Healthscope Commercial	$378.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$357.85
Rate for Payer: PHP Commercial	$357.85
Rate for Payer: Priority Health Cigna Priority Health	$294.70
Rate for Payer: Priority Health SBD	$265.23

PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT

Professional

Both

$394.00

Service Code	HCPCS 11983
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$532.50
Rate for Payer: Aetna Commercial	$113.66
Rate for Payer: BCBS Complete	$68.88
Rate for Payer: BCBS Trust/PPO	$532.50
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Mclaren Medicaid	$65.60
Rate for Payer: Meridian Medicaid	$68.88
Rate for Payer: Priority Health Choice Medicaid	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$275.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$126.60
Rate for Payer: Priority Health Narrow Network	$126.60
Rate for Payer: Priority Health SBD	$126.60

PR RNL EXPL X NECESSITATING OTH SPEC PX

Professional

Both

$2,465.00

Service Code	HCPCS 50010
Min. Negotiated Rate	$449.64
Max. Negotiated Rate	$3,137.57
Rate for Payer: Aetna Commercial	$951.04
Rate for Payer: BCBS Complete	$472.12
Rate for Payer: BCBS Trust/PPO	$3,137.57
Rate for Payer: Cash Price	$1,972.00
Rate for Payer: Cash Price	$1,972.00
Rate for Payer: Mclaren Medicaid	$449.64
Rate for Payer: Meridian Medicaid	$472.12
Rate for Payer: Priority Health Choice Medicaid	$449.64
Rate for Payer: Priority Health Cigna Priority Health	$1,725.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,197.43
Rate for Payer: Priority Health Narrow Network	$1,197.43
Rate for Payer: Priority Health SBD	$1,197.43

Know your out-of-pocket cost for care.

All Charges