Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INSJ ELTRD CAR VEN SYS ATTCH PREV PM/DFB PLS GEN

Professional

Both

$1,668.00

Service Code	HCPCS 33224
Min. Negotiated Rate	$281.59
Max. Negotiated Rate	$1,251.00
Rate for Payer: Aetna Commercial	$692.69
Rate for Payer: Aetna Medicare	$834.00
Rate for Payer: BCBS Complete	$295.67
Rate for Payer: BCN Commercial	$748.96
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Cash Price	$1,334.40
Rate for Payer: Mclaren Medicaid	$281.59
Rate for Payer: Meridian Medicaid	$295.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,251.00
Rate for Payer: Priority Health Choice Medicaid	$281.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$805.41
Rate for Payer: Priority Health Narrow/Tiered Network	$805.41
Rate for Payer: UHC Medicaid	$281.59
Rate for Payer: UHCCP Medicaid	$281.59

PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN

Professional

Both

$1,016.00

Service Code	HCPCS 33225
Min. Negotiated Rate	$251.55
Max. Negotiated Rate	$762.00
Rate for Payer: Aetna Commercial	$629.62
Rate for Payer: Aetna Medicare	$508.00
Rate for Payer: BCBS Complete	$264.13
Rate for Payer: BCN Commercial	$675.27
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Mclaren Medicaid	$251.55
Rate for Payer: Meridian Medicaid	$264.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$762.00
Rate for Payer: Priority Health Choice Medicaid	$251.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$726.16
Rate for Payer: Priority Health Narrow/Tiered Network	$726.16
Rate for Payer: UHC Medicaid	$251.55
Rate for Payer: UHCCP Medicaid	$251.55

PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS

Professional

Both

$8,451.00

Service Code	HCPCS 33335
Min. Negotiated Rate	$1,128.05
Max. Negotiated Rate	$6,338.25
Rate for Payer: Aetna Commercial	$2,508.48
Rate for Payer: Aetna Medicare	$4,225.50
Rate for Payer: BCBS Complete	$1,184.45
Rate for Payer: BCN Commercial	$2,740.89
Rate for Payer: Cash Price	$6,760.80
Rate for Payer: Cash Price	$6,760.80
Rate for Payer: Mclaren Medicaid	$1,128.05
Rate for Payer: Meridian Medicaid	$1,184.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,338.25
Rate for Payer: Priority Health Choice Medicaid	$1,128.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,947.48
Rate for Payer: Priority Health Narrow/Tiered Network	$2,947.48
Rate for Payer: UHC Medicaid	$1,128.05
Rate for Payer: UHCCP Medicaid	$1,128.05

PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$3,211.00

Service Code	HCPCS 53445
Min. Negotiated Rate	$439.63
Max. Negotiated Rate	$2,408.25
Rate for Payer: Aetna Commercial	$968.30
Rate for Payer: Aetna Medicare	$1,605.50
Rate for Payer: BCBS Complete	$461.61
Rate for Payer: BCN Commercial	$1,135.89
Rate for Payer: Cash Price	$2,568.80
Rate for Payer: Cash Price	$2,568.80
Rate for Payer: Mclaren Medicaid	$439.63
Rate for Payer: Meridian Medicaid	$461.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,408.25
Rate for Payer: Priority Health Choice Medicaid	$439.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,237.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,237.35
Rate for Payer: UHC Medicaid	$439.63
Rate for Payer: UHCCP Medicaid	$439.63

PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN

Professional

Both

$1,399.00

Service Code	HCPCS 33970
Min. Negotiated Rate	$200.43
Max. Negotiated Rate	$1,049.25
Rate for Payer: Aetna Commercial	$474.61
Rate for Payer: Aetna Medicare	$699.50
Rate for Payer: BCBS Complete	$210.45
Rate for Payer: BCN Commercial	$515.41
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Cash Price	$1,119.20
Rate for Payer: Mclaren Medicaid	$200.43
Rate for Payer: Meridian Medicaid	$210.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,049.25
Rate for Payer: Priority Health Choice Medicaid	$200.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$554.26
Rate for Payer: Priority Health Narrow/Tiered Network	$554.26
Rate for Payer: UHC Medicaid	$200.43
Rate for Payer: UHCCP Medicaid	$200.43

PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID

Professional

Both

$417.00

Service Code	HCPCS 49418
Min. Negotiated Rate	$111.40
Max. Negotiated Rate	$359.20
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: Aetna Medicare	$208.50
Rate for Payer: BCBS Complete	$116.97
Rate for Payer: BCN Commercial	$294.81
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cash Price	$333.60
Rate for Payer: Mclaren Medicaid	$111.40
Rate for Payer: Meridian Medicaid	$116.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.75
Rate for Payer: Priority Health Choice Medicaid	$111.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$359.20
Rate for Payer: Priority Health Narrow/Tiered Network	$359.20
Rate for Payer: UHC Medicaid	$111.40
Rate for Payer: UHCCP Medicaid	$111.40

PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE

Professional

Both

$844.00

Service Code	HCPCS 57267
Min. Negotiated Rate	$139.73
Max. Negotiated Rate	$633.00
Rate for Payer: Aetna Commercial	$302.10
Rate for Payer: Aetna Medicare	$422.00
Rate for Payer: BCBS Complete	$146.72
Rate for Payer: BCN Commercial	$371.99
Rate for Payer: Cash Price	$675.20
Rate for Payer: Cash Price	$675.20
Rate for Payer: Mclaren Medicaid	$139.73
Rate for Payer: Meridian Medicaid	$146.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$633.00
Rate for Payer: Priority Health Choice Medicaid	$139.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$376.75
Rate for Payer: Priority Health Narrow/Tiered Network	$376.75
Rate for Payer: UHC Medicaid	$139.73
Rate for Payer: UHCCP Medicaid	$139.73

PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH

Professional

Both

$1,510.00

Service Code	HCPCS 54405
Min. Negotiated Rate	$464.77
Max. Negotiated Rate	$1,318.19
Rate for Payer: Aetna Commercial	$1,038.16
Rate for Payer: Aetna Medicare	$755.00
Rate for Payer: BCBS Complete	$488.01
Rate for Payer: BCN Commercial	$1,210.10
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Mclaren Medicaid	$464.77
Rate for Payer: Meridian Medicaid	$488.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,132.50
Rate for Payer: Priority Health Choice Medicaid	$464.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,318.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,318.19
Rate for Payer: UHC Medicaid	$464.77
Rate for Payer: UHCCP Medicaid	$464.77

PR INSJ NON-NDWELLG BLADDER CATHETER

Professional

Both

$167.00

Service Code	HCPCS 51701
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$125.25
Rate for Payer: Aetna Commercial	$32.78
Rate for Payer: Aetna Medicare	$83.50
Rate for Payer: BCBS Complete	$14.76
Rate for Payer: BCN Commercial	$29.45
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Mclaren Medicaid	$14.06
Rate for Payer: Meridian Medicaid	$14.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.25
Rate for Payer: Priority Health Choice Medicaid	$14.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.68
Rate for Payer: Priority Health Narrow/Tiered Network	$40.68
Rate for Payer: UHC Medicaid	$14.06
Rate for Payer: UHCCP Medicaid	$14.06

PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y

Professional

Both

$1,033.00

Service Code	HCPCS 36555
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$774.75
Rate for Payer: Aetna Commercial	$113.71
Rate for Payer: Aetna Medicare	$516.50
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCN Commercial	$124.00
Rate for Payer: Cash Price	$826.40
Rate for Payer: Cash Price	$826.40
Rate for Payer: Mclaren Medicaid	$50.48
Rate for Payer: Meridian Medicaid	$53.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$774.75
Rate for Payer: Priority Health Choice Medicaid	$50.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.34
Rate for Payer: Priority Health Narrow/Tiered Network	$133.34
Rate for Payer: UHC Medicaid	$50.48
Rate for Payer: UHCCP Medicaid	$50.48

PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/>

Professional

Both

$885.00

Service Code	HCPCS 36556
Min. Negotiated Rate	$49.42
Max. Negotiated Rate	$663.75
Rate for Payer: Aetna Commercial	$113.58
Rate for Payer: Aetna Medicare	$442.50
Rate for Payer: BCBS Complete	$51.89
Rate for Payer: BCN Commercial	$124.00
Rate for Payer: Cash Price	$708.00
Rate for Payer: Cash Price	$708.00
Rate for Payer: Mclaren Medicaid	$49.42
Rate for Payer: Meridian Medicaid	$51.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$663.75
Rate for Payer: Priority Health Choice Medicaid	$49.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.34
Rate for Payer: Priority Health Narrow/Tiered Network	$133.34
Rate for Payer: UHC Medicaid	$49.42
Rate for Payer: UHCCP Medicaid	$49.42

PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID

Professional

Both

$1,644.00

Service Code	HCPCS 54400
Min. Negotiated Rate	$309.28
Max. Negotiated Rate	$1,233.00
Rate for Payer: Aetna Commercial	$681.16
Rate for Payer: Aetna Medicare	$822.00
Rate for Payer: BCBS Complete	$324.74
Rate for Payer: BCN Commercial	$799.76
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Mclaren Medicaid	$309.28
Rate for Payer: Meridian Medicaid	$324.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,233.00
Rate for Payer: Priority Health Choice Medicaid	$309.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$871.19
Rate for Payer: Priority Health Narrow/Tiered Network	$871.19
Rate for Payer: UHC Medicaid	$309.28
Rate for Payer: UHCCP Medicaid	$309.28

PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY

Professional

Both

$924.00

Service Code	HCPCS 33990
Min. Negotiated Rate	$199.58
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna Commercial	$486.27
Rate for Payer: Aetna Medicare	$462.00
Rate for Payer: BCBS Complete	$209.56
Rate for Payer: BCN Commercial	$525.87
Rate for Payer: Cash Price	$739.20
Rate for Payer: Cash Price	$739.20
Rate for Payer: Mclaren Medicaid	$199.58
Rate for Payer: Meridian Medicaid	$209.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$693.00
Rate for Payer: Priority Health Choice Medicaid	$199.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$565.51
Rate for Payer: Priority Health Narrow/Tiered Network	$565.51
Rate for Payer: UHC Medicaid	$199.58
Rate for Payer: UHCCP Medicaid	$199.58

PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS

Professional

Both

$3,481.00

Service Code	HCPCS 33991
Min. Negotiated Rate	$265.19
Max. Negotiated Rate	$2,610.75
Rate for Payer: Aetna Commercial	$635.02
Rate for Payer: Aetna Medicare	$1,740.50
Rate for Payer: BCBS Complete	$278.45
Rate for Payer: BCN Commercial	$661.32
Rate for Payer: Cash Price	$2,784.80
Rate for Payer: Cash Price	$2,784.80
Rate for Payer: Mclaren Medicaid	$265.19
Rate for Payer: Meridian Medicaid	$278.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,610.75
Rate for Payer: Priority Health Choice Medicaid	$265.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$711.16
Rate for Payer: Priority Health Narrow/Tiered Network	$711.16
Rate for Payer: UHC Medicaid	$265.19
Rate for Payer: UHCCP Medicaid	$265.19

PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>

Facility

$1,785.00

Service Code	CPT 36571
Hospital Charge Code	36571
Hospital Revenue Code	960
Min. Negotiated Rate	$314.70
Max. Negotiated Rate	$1,606.50
Rate for Payer: Aetna Commercial	$1,517.25
Rate for Payer: Aetna Medicare	$464.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$557.81
Rate for Payer: Amish Plain Church Group Commercial	$557.81
Rate for Payer: BCBS Complete	$330.40
Rate for Payer: BCBS MAPPO	$446.25
Rate for Payer: BCBS Trust/PPO	$1,467.45
Rate for Payer: BCN Commercial	$1,467.45
Rate for Payer: BCN Medicare Advantage	$446.25
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cofinity Commercial	$1,535.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,428.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$446.25
Rate for Payer: Healthscope Commercial	$1,606.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,338.75
Rate for Payer: Mclaren Medicaid	$314.70
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$468.56
Rate for Payer: Meridian Medicaid	$330.40
Rate for Payer: MI Amish Medical Board Commercial	$513.19
Rate for Payer: Molina Medicare/Medicaid	$490.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,517.25
Rate for Payer: Nomi Health Commercial	$1,463.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.75
Rate for Payer: PACE Senior Care Partners	$423.94
Rate for Payer: PACE SWMI	$446.25
Rate for Payer: PHP Commercial	$1,517.25
Rate for Payer: PHP Medicare Advantage	$446.25
Rate for Payer: Priority Health Choice Medicaid	$314.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,552.95
Rate for Payer: Priority Health Medicare	$450.71
Rate for Payer: Priority Health Narrow/Tiered Network	$1,242.36
Rate for Payer: Railroad Medicare Medicare	$446.25
Rate for Payer: UHC Core	$1,490.47
Rate for Payer: UHC Exchange	$446.25
Rate for Payer: UHC Medicaid	$314.70
Rate for Payer: UHC Medicare Advantage	$446.25
Rate for Payer: UHCCP Medicaid	$314.70
Rate for Payer: VA VA	$446.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,338.75

PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>

Facility

$1,785.00

Service Code	CPT 36571
Hospital Charge Code	36571
Hospital Revenue Code	960
Min. Negotiated Rate	$1,242.36
Max. Negotiated Rate	$1,606.50
Rate for Payer: Aetna Commercial	$1,517.25
Rate for Payer: BCBS Trust/PPO	$1,474.23
Rate for Payer: BCN Commercial	$1,474.23
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cofinity Commercial	$1,535.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,428.00
Rate for Payer: Healthscope Commercial	$1,606.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,338.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,517.25
Rate for Payer: Nomi Health Commercial	$1,463.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.75
Rate for Payer: PHP Commercial	$1,517.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,552.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,242.36
Rate for Payer: UHC Core	$1,490.47
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,338.75

PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>

Professional

Both

$1,785.00

Service Code	HCPCS 36571
Hospital Charge Code	36571
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$1,338.75
Rate for Payer: Aetna Commercial	$418.88
Rate for Payer: Aetna Medicare	$892.50
Rate for Payer: BCBS Complete	$196.81
Rate for Payer: BCN Commercial	$464.12
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Mclaren Medicaid	$187.44
Rate for Payer: Meridian Medicaid	$196.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.75
Rate for Payer: Priority Health Choice Medicaid	$187.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$499.10
Rate for Payer: Priority Health Narrow/Tiered Network	$499.10
Rate for Payer: UHC Medicaid	$187.44
Rate for Payer: UHCCP Medicaid	$187.44

PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>

Professional

Both

$1,785.00

Service Code	HCPCS 36571
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$1,338.75
Rate for Payer: Aetna Commercial	$418.88
Rate for Payer: Aetna Medicare	$892.50
Rate for Payer: BCBS Complete	$196.81
Rate for Payer: BCN Commercial	$464.12
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Mclaren Medicaid	$187.44
Rate for Payer: Meridian Medicaid	$196.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.75
Rate for Payer: Priority Health Choice Medicaid	$187.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$499.10
Rate for Payer: Priority Health Narrow/Tiered Network	$499.10
Rate for Payer: UHC Medicaid	$187.44
Rate for Payer: UHCCP Medicaid	$187.44

PR INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR

Professional

Both

$3,179.00

Service Code	HCPCS 36570
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$2,384.25
Rate for Payer: Aetna Commercial	$445.12
Rate for Payer: Aetna Medicare	$1,589.50
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$498.98
Rate for Payer: Cash Price	$2,543.20
Rate for Payer: Cash Price	$2,543.20
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,384.25
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$536.58
Rate for Payer: Priority Health Narrow/Tiered Network	$536.58
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY

Professional

Both

$1,727.00

Service Code	HCPCS 19342
Min. Negotiated Rate	$442.83
Max. Negotiated Rate	$1,295.25
Rate for Payer: Aetna Commercial	$822.56
Rate for Payer: Aetna Medicare	$863.50
Rate for Payer: BCBS Complete	$464.97
Rate for Payer: BCN Commercial	$1,152.83
Rate for Payer: Cash Price	$1,381.60
Rate for Payer: Cash Price	$1,381.60
Rate for Payer: Mclaren Medicaid	$442.83
Rate for Payer: Meridian Medicaid	$464.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,295.25
Rate for Payer: Priority Health Choice Medicaid	$442.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,055.13
Rate for Payer: Priority Health Narrow/Tiered Network	$1,055.13
Rate for Payer: UHC Medicaid	$442.83
Rate for Payer: UHCCP Medicaid	$442.83

PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS

Professional

Both

$1,947.00

Service Code	HCPCS 61886
Min. Negotiated Rate	$593.84
Max. Negotiated Rate	$1,871.29
Rate for Payer: Aetna Commercial	$1,112.99
Rate for Payer: Aetna Medicare	$973.50
Rate for Payer: BCBS Complete	$623.53
Rate for Payer: BCN Commercial	$1,871.29
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Cash Price	$1,557.60
Rate for Payer: Mclaren Medicaid	$593.84
Rate for Payer: Meridian Medicaid	$623.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,460.25
Rate for Payer: Priority Health Choice Medicaid	$593.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,573.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,573.23
Rate for Payer: UHC Medicaid	$593.84
Rate for Payer: UHCCP Medicaid	$593.84

PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR

Professional

Both

$1,704.00

Service Code	HCPCS 61885
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$1,278.00
Rate for Payer: Aetna Commercial	$671.13
Rate for Payer: Aetna Medicare	$852.00
Rate for Payer: BCBS Complete	$373.27
Rate for Payer: BCN Commercial	$1,122.08
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Mclaren Medicaid	$355.50
Rate for Payer: Meridian Medicaid	$373.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,278.00
Rate for Payer: Priority Health Choice Medicaid	$355.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$943.36
Rate for Payer: Priority Health Narrow/Tiered Network	$943.36
Rate for Payer: UHC Medicaid	$355.50
Rate for Payer: UHCCP Medicaid	$355.50

PR INSJ/RPLCMT ICDS W/SUBSTERNAL ELECTRODE

Professional

Both

$920.00

Service Code	HCPCS 0571T
Min. Negotiated Rate	$368.00
Max. Negotiated Rate	$29,977.58
Rate for Payer: Aetna Commercial	$612.82
Rate for Payer: Aetna Medicare	$460.00
Rate for Payer: BCBS Complete	$368.00
Rate for Payer: BCN Commercial	$29,977.58
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,311.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,311.55

PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR

Professional

Both

$1,954.00

Service Code	HCPCS 33249
Min. Negotiated Rate	$508.86
Max. Negotiated Rate	$1,465.50
Rate for Payer: Aetna Commercial	$1,231.48
Rate for Payer: Aetna Medicare	$977.00
Rate for Payer: BCBS Complete	$534.30
Rate for Payer: BCN Commercial	$1,340.57
Rate for Payer: Cash Price	$1,563.20
Rate for Payer: Cash Price	$1,563.20
Rate for Payer: Mclaren Medicaid	$508.86
Rate for Payer: Meridian Medicaid	$534.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,465.50
Rate for Payer: Priority Health Choice Medicaid	$508.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,441.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,441.61
Rate for Payer: UHC Medicaid	$508.86
Rate for Payer: UHCCP Medicaid	$508.86

PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ

Professional

Both

$2,356.00

Service Code	HCPCS 63685
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$1,767.00
Rate for Payer: Aetna Commercial	$465.59
Rate for Payer: Aetna Medicare	$1,178.00
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$511.92
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,767.00
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$594.59
Rate for Payer: Priority Health Narrow/Tiered Network	$594.59
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

Know your out-of-pocket cost for care.

All Charges