Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH

Professional

Both

$1,067.00

Service Code	HCPCS 33210
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$800.25
Rate for Payer: Aetna Commercial	$218.64
Rate for Payer: Aetna Medicare	$533.50
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCN Commercial	$236.04
Rate for Payer: Cash Price	$853.60
Rate for Payer: Cash Price	$853.60
Rate for Payer: Mclaren Medicaid	$89.67
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$800.25
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$253.83
Rate for Payer: Priority Health Narrow/Tiered Network	$253.83
Rate for Payer: UHC Medicaid	$89.67
Rate for Payer: UHCCP Medicaid	$89.67

PR INSJ SUBQ RSVR PUMP/CONT INFUSION SYS VENTR CATH

Professional

Both

$2,807.00

Service Code	HCPCS 61215
Min. Negotiated Rate	$355.50
Max. Negotiated Rate	$2,105.25
Rate for Payer: Aetna Commercial	$652.56
Rate for Payer: Aetna Medicare	$1,403.50
Rate for Payer: BCBS Complete	$373.27
Rate for Payer: BCN Commercial	$1,102.82
Rate for Payer: Cash Price	$2,245.60
Rate for Payer: Cash Price	$2,245.60
Rate for Payer: Mclaren Medicaid	$355.50
Rate for Payer: Meridian Medicaid	$373.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,105.25
Rate for Payer: Priority Health Choice Medicaid	$355.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$927.16
Rate for Payer: Priority Health Narrow/Tiered Network	$927.16
Rate for Payer: UHC Medicaid	$355.50
Rate for Payer: UHCCP Medicaid	$355.50

PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED

Professional

Both

$308.00

Service Code	HCPCS 51703
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$98.20
Rate for Payer: Aetna Medicare	$154.00
Rate for Payer: BCBS Complete	$45.18
Rate for Payer: BCN Commercial	$113.04
Rate for Payer: Cash Price	$246.40
Rate for Payer: Cash Price	$246.40
Rate for Payer: Mclaren Medicaid	$43.03
Rate for Payer: Meridian Medicaid	$45.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$231.00
Rate for Payer: Priority Health Choice Medicaid	$43.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.14
Rate for Payer: Priority Health Narrow/Tiered Network	$123.14
Rate for Payer: UHC Medicaid	$43.03
Rate for Payer: UHCCP Medicaid	$43.03

PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

Professional

Both

$180.00

Service Code	HCPCS 51702
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$32.34
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCN Commercial	$36.85
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Mclaren Medicaid	$14.48
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: Priority Health Choice Medicaid	$14.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.15
Rate for Payer: Priority Health Narrow/Tiered Network	$40.15
Rate for Payer: UHC Medicaid	$14.48
Rate for Payer: UHCCP Medicaid	$14.48

PR INSJ TESTICULAR PROSTH SEPARATE PROCEDURE

Professional

Both

$751.00

Service Code	HCPCS 54660
Min. Negotiated Rate	$213.21
Max. Negotiated Rate	$591.83
Rate for Payer: Aetna Commercial	$457.01
Rate for Payer: Aetna Medicare	$375.50
Rate for Payer: BCBS Complete	$223.87
Rate for Payer: BCN Commercial	$543.30
Rate for Payer: Cash Price	$600.80
Rate for Payer: Cash Price	$600.80
Rate for Payer: Mclaren Medicaid	$213.21
Rate for Payer: Meridian Medicaid	$223.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$563.25
Rate for Payer: Priority Health Choice Medicaid	$213.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$591.83
Rate for Payer: Priority Health Narrow/Tiered Network	$591.83
Rate for Payer: UHC Medicaid	$213.21
Rate for Payer: UHCCP Medicaid	$213.21

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

Facility

$3,549.00

Service Code	CPT 36561
Hospital Charge Code	36561
Hospital Revenue Code	960
Min. Negotiated Rate	$625.69
Max. Negotiated Rate	$3,194.10
Rate for Payer: Aetna Commercial	$3,016.65
Rate for Payer: Aetna Medicare	$922.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,109.06
Rate for Payer: Amish Plain Church Group Commercial	$1,109.06
Rate for Payer: BCBS Complete	$656.92
Rate for Payer: BCBS MAPPO	$887.25
Rate for Payer: BCBS Trust/PPO	$2,917.63
Rate for Payer: BCN Commercial	$2,917.63
Rate for Payer: BCN Medicare Advantage	$887.25
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Cofinity Commercial	$3,052.14
Rate for Payer: Encore Health Key Benefits Commercial	$2,839.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$887.25
Rate for Payer: Healthscope Commercial	$3,194.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,661.75
Rate for Payer: Mclaren Medicaid	$625.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$931.61
Rate for Payer: Meridian Medicaid	$656.92
Rate for Payer: MI Amish Medical Board Commercial	$1,020.34
Rate for Payer: Molina Medicare/Medicaid	$975.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,016.65
Rate for Payer: Nomi Health Commercial	$2,910.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,661.75
Rate for Payer: PACE Senior Care Partners	$842.89
Rate for Payer: PACE SWMI	$887.25
Rate for Payer: PHP Commercial	$3,016.65
Rate for Payer: PHP Medicare Advantage	$887.25
Rate for Payer: Priority Health Choice Medicaid	$625.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,087.63
Rate for Payer: Priority Health Medicare	$896.12
Rate for Payer: Priority Health Narrow/Tiered Network	$2,470.10
Rate for Payer: Railroad Medicare Medicare	$887.25
Rate for Payer: UHC Core	$2,963.41
Rate for Payer: UHC Exchange	$887.25
Rate for Payer: UHC Medicaid	$625.69
Rate for Payer: UHC Medicare Advantage	$887.25
Rate for Payer: UHCCP Medicaid	$625.69
Rate for Payer: VA VA	$887.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,661.75

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

Facility

$3,549.00

Service Code	CPT 36561
Hospital Charge Code	36561
Hospital Revenue Code	960
Min. Negotiated Rate	$2,470.10
Max. Negotiated Rate	$3,194.10
Rate for Payer: Aetna Commercial	$3,016.65
Rate for Payer: BCBS Trust/PPO	$2,931.12
Rate for Payer: BCN Commercial	$2,931.12
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Cofinity Commercial	$3,052.14
Rate for Payer: Encore Health Key Benefits Commercial	$2,839.20
Rate for Payer: Healthscope Commercial	$3,194.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,661.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,016.65
Rate for Payer: Nomi Health Commercial	$2,910.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,661.75
Rate for Payer: PHP Commercial	$3,016.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,087.63
Rate for Payer: Priority Health Narrow/Tiered Network	$2,470.10
Rate for Payer: UHC Core	$2,963.41
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,661.75

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

Professional

Both

$3,549.00

Service Code	HCPCS 36561
Hospital Charge Code	36561
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$2,661.75
Rate for Payer: Aetna Commercial	$446.52
Rate for Payer: Aetna Medicare	$1,774.50
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCN Commercial	$490.01
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,661.75
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$526.95
Rate for Payer: Priority Health Narrow/Tiered Network	$526.95
Rate for Payer: UHC Medicaid	$191.27
Rate for Payer: UHCCP Medicaid	$191.27

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

Professional

Both

$3,549.00

Service Code	HCPCS 36561
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$2,661.75
Rate for Payer: Aetna Commercial	$446.52
Rate for Payer: Aetna Medicare	$1,774.50
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCN Commercial	$490.01
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,661.75
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$526.95
Rate for Payer: Priority Health Narrow/Tiered Network	$526.95
Rate for Payer: UHC Medicaid	$191.27
Rate for Payer: UHCCP Medicaid	$191.27

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

Professional

Both

$3,686.00

Service Code	HCPCS 36560
Min. Negotiated Rate	$232.38
Max. Negotiated Rate	$2,764.50
Rate for Payer: Aetna Commercial	$514.09
Rate for Payer: Aetna Medicare	$1,843.00
Rate for Payer: BCBS Complete	$244.00
Rate for Payer: BCN Commercial	$575.17
Rate for Payer: Cash Price	$2,948.80
Rate for Payer: Cash Price	$2,948.80
Rate for Payer: Mclaren Medicaid	$232.38
Rate for Payer: Meridian Medicaid	$244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,764.50
Rate for Payer: Priority Health Choice Medicaid	$232.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$618.52
Rate for Payer: Priority Health Narrow/Tiered Network	$618.52
Rate for Payer: UHC Medicaid	$232.38
Rate for Payer: UHCCP Medicaid	$232.38

PR INSJ TUNNELED CTR VAD W/SUBQ PUMP

Professional

Both

$3,697.00

Service Code	HCPCS 36563
Min. Negotiated Rate	$218.33
Max. Negotiated Rate	$2,772.75
Rate for Payer: Aetna Commercial	$489.50
Rate for Payer: Aetna Medicare	$1,848.50
Rate for Payer: BCBS Complete	$229.25
Rate for Payer: BCN Commercial	$538.32
Rate for Payer: Cash Price	$2,957.60
Rate for Payer: Cash Price	$2,957.60
Rate for Payer: Mclaren Medicaid	$218.33
Rate for Payer: Meridian Medicaid	$229.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,772.75
Rate for Payer: Priority Health Choice Medicaid	$218.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$578.90
Rate for Payer: Priority Health Narrow/Tiered Network	$578.90
Rate for Payer: UHC Medicaid	$218.33
Rate for Payer: UHCCP Medicaid	$218.33

PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>

Professional

Both

$2,041.00

Service Code	HCPCS 36558
Min. Negotiated Rate	$148.25
Max. Negotiated Rate	$1,530.75
Rate for Payer: Aetna Commercial	$346.05
Rate for Payer: Aetna Medicare	$1,020.50
Rate for Payer: BCBS Complete	$155.66
Rate for Payer: BCN Commercial	$382.45
Rate for Payer: Cash Price	$1,632.80
Rate for Payer: Cash Price	$1,632.80
Rate for Payer: Mclaren Medicaid	$148.25
Rate for Payer: Meridian Medicaid	$155.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,530.75
Rate for Payer: Priority Health Choice Medicaid	$148.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$411.27
Rate for Payer: Priority Health Narrow/Tiered Network	$411.27
Rate for Payer: UHC Medicaid	$148.25
Rate for Payer: UHCCP Medicaid	$148.25

PR INSJ TUN VAD REQ 2 CATH 2 SITS W/O SUBQ PORT/PMP

Professional

Both

$1,790.00

Service Code	HCPCS 36565
Min. Negotiated Rate	$199.58
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$450.12
Rate for Payer: Aetna Medicare	$895.00
Rate for Payer: BCBS Complete	$209.56
Rate for Payer: BCN Commercial	$499.48
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Mclaren Medicaid	$199.58
Rate for Payer: Meridian Medicaid	$209.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,342.50
Rate for Payer: Priority Health Choice Medicaid	$199.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$537.13
Rate for Payer: Priority Health Narrow/Tiered Network	$537.13
Rate for Payer: UHC Medicaid	$199.58
Rate for Payer: UHCCP Medicaid	$199.58

PR INSJ TUN VAD REQ 2 CATH 2 SITS W/SUBQ PORT

Professional

Both

$2,994.00

Service Code	HCPCS 36566
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$2,245.50
Rate for Payer: Aetna Commercial	$481.26
Rate for Payer: Aetna Medicare	$1,497.00
Rate for Payer: BCBS Complete	$223.65
Rate for Payer: BCN Commercial	$527.36
Rate for Payer: Cash Price	$2,395.20
Rate for Payer: Cash Price	$2,395.20
Rate for Payer: Mclaren Medicaid	$213.00
Rate for Payer: Meridian Medicaid	$223.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,245.50
Rate for Payer: Priority Health Choice Medicaid	$213.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$567.11
Rate for Payer: Priority Health Narrow/Tiered Network	$567.11
Rate for Payer: UHC Medicaid	$213.00
Rate for Payer: UHCCP Medicaid	$213.00

PR INSJ VENTRIC ASSIST DEV XTRCORP SINGLE VENTRICLE

Professional

Both

$2,579.00

Service Code	HCPCS 33975
Min. Negotiated Rate	$751.25
Max. Negotiated Rate	$2,052.63
Rate for Payer: Aetna Commercial	$1,751.37
Rate for Payer: Aetna Medicare	$1,289.50
Rate for Payer: BCBS Complete	$788.81
Rate for Payer: BCN Commercial	$1,908.77
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Mclaren Medicaid	$751.25
Rate for Payer: Meridian Medicaid	$788.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,934.25
Rate for Payer: Priority Health Choice Medicaid	$751.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,052.63
Rate for Payer: Priority Health Narrow/Tiered Network	$2,052.63
Rate for Payer: UHC Medicaid	$751.25
Rate for Payer: UHCCP Medicaid	$751.25

PR INS NEW/RPLCMT PRM PACEMAKR W/TRANS ELTRD ATRIAL

Professional

Both

$1,559.00

Service Code	HCPCS 33206
Min. Negotiated Rate	$256.45
Max. Negotiated Rate	$1,169.25
Rate for Payer: Aetna Commercial	$610.49
Rate for Payer: Aetna Medicare	$779.50
Rate for Payer: BCBS Complete	$269.27
Rate for Payer: BCN Commercial	$670.78
Rate for Payer: Cash Price	$1,247.20
Rate for Payer: Cash Price	$1,247.20
Rate for Payer: Mclaren Medicaid	$256.45
Rate for Payer: Meridian Medicaid	$269.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,169.25
Rate for Payer: Priority Health Choice Medicaid	$256.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$721.34
Rate for Payer: Priority Health Narrow/Tiered Network	$721.34
Rate for Payer: UHC Medicaid	$256.45
Rate for Payer: UHCCP Medicaid	$256.45

PR INS NEW/RPLCMT PRM PM W/TRANSV ELTRD ATRIAL&VENT

Professional

Both

$1,715.00

Service Code	HCPCS 33208
Min. Negotiated Rate	$290.75
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$698.84
Rate for Payer: Aetna Medicare	$857.50
Rate for Payer: BCBS Complete	$305.29
Rate for Payer: BCN Commercial	$761.91
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Mclaren Medicaid	$290.75
Rate for Payer: Meridian Medicaid	$305.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,286.25
Rate for Payer: Priority Health Choice Medicaid	$290.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$819.34
Rate for Payer: Priority Health Narrow/Tiered Network	$819.34
Rate for Payer: UHC Medicaid	$290.75
Rate for Payer: UHCCP Medicaid	$290.75

PR INS NEW/RPLC PRM PACEMAKER W/TRANSV ELTRD VENTR

Professional

Both

$1,870.00

Service Code	HCPCS 33207
Min. Negotiated Rate	$269.23
Max. Negotiated Rate	$1,402.50
Rate for Payer: Aetna Commercial	$643.35
Rate for Payer: Aetna Medicare	$935.00
Rate for Payer: BCBS Complete	$282.69
Rate for Payer: BCN Commercial	$705.64
Rate for Payer: Cash Price	$1,496.00
Rate for Payer: Cash Price	$1,496.00
Rate for Payer: Mclaren Medicaid	$269.23
Rate for Payer: Meridian Medicaid	$282.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,402.50
Rate for Payer: Priority Health Choice Medicaid	$269.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$758.83
Rate for Payer: Priority Health Narrow/Tiered Network	$758.83
Rate for Payer: UHC Medicaid	$269.23
Rate for Payer: UHCCP Medicaid	$269.23

PR INS PACEMAKER PULSE GEN ONLY W/EXIST DUAL LEADS

Professional

Both

$1,309.00

Service Code	HCPCS 33213
Min. Negotiated Rate	$193.62
Max. Negotiated Rate	$981.75
Rate for Payer: Aetna Commercial	$450.33
Rate for Payer: Aetna Medicare	$654.50
Rate for Payer: BCBS Complete	$203.30
Rate for Payer: BCN Commercial	$498.48
Rate for Payer: Cash Price	$1,047.20
Rate for Payer: Cash Price	$1,047.20
Rate for Payer: Mclaren Medicaid	$193.62
Rate for Payer: Meridian Medicaid	$203.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$981.75
Rate for Payer: Priority Health Choice Medicaid	$193.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$536.05
Rate for Payer: Priority Health Narrow/Tiered Network	$536.05
Rate for Payer: UHC Medicaid	$193.62
Rate for Payer: UHCCP Medicaid	$193.62

PR INS PACEMAKER PULSE GEN ONLY W/EXIST MULT LEADS

Professional

Both

$766.00

Service Code	HCPCS 33221
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$574.50
Rate for Payer: Aetna Commercial	$484.70
Rate for Payer: Aetna Medicare	$383.00
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$526.86
Rate for Payer: Cash Price	$612.80
Rate for Payer: Cash Price	$612.80
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$574.50
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$566.58
Rate for Payer: Priority Health Narrow/Tiered Network	$566.58
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

PR INS PM PLS GEN W/EXIST SINGLE LEAD

Professional

Both

$1,154.00

Service Code	HCPCS 33212
Min. Negotiated Rate	$186.38
Max. Negotiated Rate	$865.50
Rate for Payer: Aetna Commercial	$432.27
Rate for Payer: Aetna Medicare	$577.00
Rate for Payer: BCBS Complete	$195.70
Rate for Payer: BCN Commercial	$479.06
Rate for Payer: Cash Price	$923.20
Rate for Payer: Cash Price	$923.20
Rate for Payer: Mclaren Medicaid	$186.38
Rate for Payer: Meridian Medicaid	$195.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$865.50
Rate for Payer: Priority Health Choice Medicaid	$186.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$515.16
Rate for Payer: Priority Health Narrow/Tiered Network	$515.16
Rate for Payer: UHC Medicaid	$186.38
Rate for Payer: UHCCP Medicaid	$186.38

PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD

Professional

Both

$1,211.00

Service Code	HCPCS 33270
Min. Negotiated Rate	$314.39
Max. Negotiated Rate	$908.25
Rate for Payer: Aetna Commercial	$756.49
Rate for Payer: Aetna Medicare	$605.50
Rate for Payer: BCBS Complete	$330.11
Rate for Payer: BCN Commercial	$824.66
Rate for Payer: Cash Price	$968.80
Rate for Payer: Cash Price	$968.80
Rate for Payer: Mclaren Medicaid	$314.39
Rate for Payer: Meridian Medicaid	$330.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$908.25
Rate for Payer: Priority Health Choice Medicaid	$314.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$886.82
Rate for Payer: Priority Health Narrow/Tiered Network	$886.82
Rate for Payer: UHC Medicaid	$314.39
Rate for Payer: UHCCP Medicaid	$314.39

PR INS/RPLC PERPH SAC/GSTRC NPG/RCVR PCKT CRTJ&CONN

Professional

Both

$1,025.00

Service Code	HCPCS 64590
Min. Negotiated Rate	$170.19
Max. Negotiated Rate	$768.75
Rate for Payer: Aetna Commercial	$205.58
Rate for Payer: Aetna Medicare	$512.50
Rate for Payer: BCBS Complete	$178.70
Rate for Payer: BCN Commercial	$441.71
Rate for Payer: Cash Price	$820.00
Rate for Payer: Cash Price	$820.00
Rate for Payer: Mclaren Medicaid	$170.19
Rate for Payer: Meridian Medicaid	$178.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$768.75
Rate for Payer: Priority Health Choice Medicaid	$170.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$513.03
Rate for Payer: Priority Health Narrow/Tiered Network	$513.03
Rate for Payer: UHC Medicaid	$170.19
Rate for Payer: UHCCP Medicaid	$170.19

PR INSRT CH WALL RESPIR ELTRD/RA & CONJ PULSE GEN

Professional

Both

$500.00

Service Code	HCPCS 0466T
Min. Negotiated Rate	$200.00
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Medicare	$250.00
Rate for Payer: BCBS Complete	$200.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$375.00

PR INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY

Professional

Both

$219.00

Service Code	HCPCS 32562
Min. Negotiated Rate	$34.29
Max. Negotiated Rate	$164.25
Rate for Payer: Aetna Commercial	$78.58
Rate for Payer: Aetna Medicare	$109.50
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCN Commercial	$88.14
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Mclaren Medicaid	$34.29
Rate for Payer: Meridian Medicaid	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$164.25
Rate for Payer: Priority Health Choice Medicaid	$34.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.00
Rate for Payer: Priority Health Narrow/Tiered Network	$83.00
Rate for Payer: UHC Medicaid	$34.29
Rate for Payer: UHCCP Medicaid	$34.29

Know your out-of-pocket cost for care.

All Charges