Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RMVL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$429.00

Service Code	HCPCS 36589
Min. Negotiated Rate	$129.08
Max. Negotiated Rate	$278.85
Rate for Payer: Aetna Commercial	$172.97
Rate for Payer: Aetna Medicare	$134.24
Rate for Payer: BCBS Complete	$171.60
Rate for Payer: BCBS MAPPO	$129.08
Rate for Payer: BCN Medicare Advantage	$129.08
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cofinity Commercial	$185.88
Rate for Payer: Cofinity Commercial	$172.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$129.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$135.53
Rate for Payer: Nomi Health Commercial	$154.90
Rate for Payer: PACE SWMI	$129.08
Rate for Payer: PHP Medicare Advantage	$129.08
Rate for Payer: Priority Health Cigna Priority Health	$278.85
Rate for Payer: Priority Health Medicare	$130.37
Rate for Payer: UHC All Payor (Choice/PPO)	$129.08
Rate for Payer: UHC Dual Complete DSNP	$129.08
Rate for Payer: UHC Exchange	$129.08
Rate for Payer: UHC Medicare Advantage	$129.08

PR RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT

Professional

Both

$402.00

Service Code	HCPCS 11983
Min. Negotiated Rate	$99.73
Max. Negotiated Rate	$261.30
Rate for Payer: Aetna Commercial	$133.64
Rate for Payer: Aetna Medicare	$103.72
Rate for Payer: BCBS Complete	$160.80
Rate for Payer: BCBS MAPPO	$99.73
Rate for Payer: BCN Medicare Advantage	$99.73
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cofinity Commercial	$143.61
Rate for Payer: Cofinity Commercial	$133.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$99.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$104.72
Rate for Payer: Nomi Health Commercial	$119.68
Rate for Payer: PACE SWMI	$99.73
Rate for Payer: PHP Medicare Advantage	$99.73
Rate for Payer: Priority Health Cigna Priority Health	$261.30
Rate for Payer: Priority Health Medicare	$100.73
Rate for Payer: UHC All Payor (Choice/PPO)	$99.73
Rate for Payer: UHC Dual Complete DSNP	$99.73
Rate for Payer: UHC Exchange	$99.73
Rate for Payer: UHC Medicare Advantage	$99.73

PR RNL NDSC NFROT/PLOT W/ENDOPYELOTOMY

Professional

Both

$1,386.00

Service Code	HCPCS 50575
Min. Negotiated Rate	$554.40
Max. Negotiated Rate	$974.39
Rate for Payer: Aetna Commercial	$906.72
Rate for Payer: Aetna Medicare	$703.73
Rate for Payer: BCBS Complete	$554.40
Rate for Payer: BCBS MAPPO	$676.66
Rate for Payer: BCN Medicare Advantage	$676.66
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cofinity Commercial	$974.39
Rate for Payer: Cofinity Commercial	$906.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$676.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$710.49
Rate for Payer: Nomi Health Commercial	$811.99
Rate for Payer: PACE SWMI	$676.66
Rate for Payer: PHP Medicare Advantage	$676.66
Rate for Payer: Priority Health Cigna Priority Health	$900.90
Rate for Payer: Priority Health Medicare	$683.43
Rate for Payer: UHC All Payor (Choice/PPO)	$676.66
Rate for Payer: UHC Dual Complete DSNP	$676.66
Rate for Payer: UHC Exchange	$676.66
Rate for Payer: UHC Medicare Advantage	$676.66

PR ROBOTIC SURGICAL SYSTEM

Professional

Both

$61.00

Service Code	HCPCS S2900
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$39.65
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$39.65

PR ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID

Professional

Both

$80.00

Service Code	HCPCS 95852
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: Aetna Medicare	$5.63
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS MAPPO	$5.41
Rate for Payer: BCN Medicare Advantage	$5.41
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$7.79
Rate for Payer: Cofinity Commercial	$7.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.68
Rate for Payer: Nomi Health Commercial	$6.49
Rate for Payer: PACE SWMI	$5.41
Rate for Payer: PHP Medicare Advantage	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$52.00
Rate for Payer: Priority Health Medicare	$5.46
Rate for Payer: UHC All Payor (Choice/PPO)	$5.41
Rate for Payer: UHC Dual Complete DSNP	$5.41
Rate for Payer: UHC Exchange	$5.41
Rate for Payer: UHC Medicare Advantage	$5.41

PR ROPRTJ > 1 MO AFTER ORIGINAL OPRATION

Professional

Both

$578.00

Service Code	HCPCS 35700
Min. Negotiated Rate	$145.85
Max. Negotiated Rate	$375.70
Rate for Payer: Aetna Commercial	$195.44
Rate for Payer: Aetna Medicare	$151.68
Rate for Payer: BCBS Complete	$231.20
Rate for Payer: BCBS MAPPO	$145.85
Rate for Payer: BCN Medicare Advantage	$145.85
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cofinity Commercial	$195.44
Rate for Payer: Cofinity Commercial	$210.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$145.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$153.14
Rate for Payer: Nomi Health Commercial	$175.02
Rate for Payer: PACE SWMI	$145.85
Rate for Payer: PHP Medicare Advantage	$145.85
Rate for Payer: Priority Health Cigna Priority Health	$375.70
Rate for Payer: Priority Health Medicare	$147.31
Rate for Payer: UHC All Payor (Choice/PPO)	$145.85
Rate for Payer: UHC Dual Complete DSNP	$145.85
Rate for Payer: UHC Exchange	$145.85
Rate for Payer: UHC Medicare Advantage	$145.85

PR ROPRTJ CAB/VALVE PX > 1 MO AFTER ORIGINAL OPERJ

Professional

Both

$1,703.00

Service Code	HCPCS 33530
Min. Negotiated Rate	$502.04
Max. Negotiated Rate	$1,106.95
Rate for Payer: Aetna Commercial	$672.73
Rate for Payer: Aetna Medicare	$522.12
Rate for Payer: BCBS Complete	$681.20
Rate for Payer: BCBS MAPPO	$502.04
Rate for Payer: BCN Medicare Advantage	$502.04
Rate for Payer: Cash Price	$1,362.40
Rate for Payer: Cash Price	$1,362.40
Rate for Payer: Cofinity Commercial	$722.94
Rate for Payer: Cofinity Commercial	$672.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$502.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$527.14
Rate for Payer: Nomi Health Commercial	$602.45
Rate for Payer: PACE SWMI	$502.04
Rate for Payer: PHP Medicare Advantage	$502.04
Rate for Payer: Priority Health Cigna Priority Health	$1,106.95
Rate for Payer: Priority Health Medicare	$507.06
Rate for Payer: UHC All Payor (Choice/PPO)	$502.04
Rate for Payer: UHC Dual Complete DSNP	$502.04
Rate for Payer: UHC Exchange	$502.04
Rate for Payer: UHC Medicare Advantage	$502.04

PR ROPRTJ CRTD TEAEC > 1 MO AFTER ORIGINAL OPRATIO

Professional

Both

$316.00

Service Code	HCPCS 35390
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$220.61
Rate for Payer: Aetna Commercial	$205.29
Rate for Payer: Aetna Medicare	$159.33
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: BCBS MAPPO	$153.20
Rate for Payer: BCN Medicare Advantage	$153.20
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cofinity Commercial	$220.61
Rate for Payer: Cofinity Commercial	$205.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$153.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$160.86
Rate for Payer: Nomi Health Commercial	$183.84
Rate for Payer: PACE SWMI	$153.20
Rate for Payer: PHP Medicare Advantage	$153.20
Rate for Payer: Priority Health Cigna Priority Health	$205.40
Rate for Payer: Priority Health Medicare	$154.73
Rate for Payer: UHC All Payor (Choice/PPO)	$153.20
Rate for Payer: UHC Dual Complete DSNP	$153.20
Rate for Payer: UHC Exchange	$153.20
Rate for Payer: UHC Medicare Advantage	$153.20

PR ROUT FOOT CARE PER VISIT

Professional

Both

$27.00

Service Code	HCPCS S0390
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$17.55
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Priority Health Cigna Priority Health	$17.55

PR ROUTINE OB CARE VAG DLVRY & POSTPARTUM CARE VB

Professional

Both

$4,028.00

Service Code	HCPCS 59610
Min. Negotiated Rate	$1,611.20
Max. Negotiated Rate	$3,540.57
Rate for Payer: Aetna Commercial	$3,294.70
Rate for Payer: Aetna Medicare	$2,557.08
Rate for Payer: BCBS Complete	$1,611.20
Rate for Payer: BCBS MAPPO	$2,458.73
Rate for Payer: BCN Medicare Advantage	$2,458.73
Rate for Payer: Cash Price	$3,222.40
Rate for Payer: Cash Price	$3,222.40
Rate for Payer: Cofinity Commercial	$3,540.57
Rate for Payer: Cofinity Commercial	$3,294.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,458.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,581.67
Rate for Payer: Nomi Health Commercial	$2,950.48
Rate for Payer: PACE SWMI	$2,458.73
Rate for Payer: PHP Medicare Advantage	$2,458.73
Rate for Payer: Priority Health Cigna Priority Health	$2,618.20
Rate for Payer: Priority Health Medicare	$2,483.32
Rate for Payer: UHC All Payor (Choice/PPO)	$2,458.73
Rate for Payer: UHC Dual Complete DSNP	$2,458.73
Rate for Payer: UHC Exchange	$2,458.73
Rate for Payer: UHC Medicare Advantage	$2,458.73

PR ROUTINE OBSTETRICAL CARE ATTEMPTED VBAC

Professional

Both

$4,323.00

Service Code	HCPCS 59618
Min. Negotiated Rate	$1,729.20
Max. Negotiated Rate	$3,794.90
Rate for Payer: Aetna Commercial	$3,531.37
Rate for Payer: Aetna Medicare	$2,740.76
Rate for Payer: BCBS Complete	$1,729.20
Rate for Payer: BCBS MAPPO	$2,635.35
Rate for Payer: BCN Medicare Advantage	$2,635.35
Rate for Payer: Cash Price	$3,458.40
Rate for Payer: Cash Price	$3,458.40
Rate for Payer: Cofinity Commercial	$3,531.37
Rate for Payer: Cofinity Commercial	$3,794.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,635.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,767.12
Rate for Payer: Nomi Health Commercial	$3,162.42
Rate for Payer: PACE SWMI	$2,635.35
Rate for Payer: PHP Medicare Advantage	$2,635.35
Rate for Payer: Priority Health Cigna Priority Health	$2,809.95
Rate for Payer: Priority Health Medicare	$2,661.70
Rate for Payer: UHC All Payor (Choice/PPO)	$2,635.35
Rate for Payer: UHC Dual Complete DSNP	$2,635.35
Rate for Payer: UHC Exchange	$2,635.35
Rate for Payer: UHC Medicare Advantage	$2,635.35

PR RPLCMT ALL/PART URETER INTESTINE SGM W/ANAST

Professional

Both

$2,539.00

Service Code	HCPCS 50840
Min. Negotiated Rate	$1,015.60
Max. Negotiated Rate	$1,691.38
Rate for Payer: Aetna Commercial	$1,573.92
Rate for Payer: Aetna Medicare	$1,221.55
Rate for Payer: BCBS Complete	$1,015.60
Rate for Payer: BCBS MAPPO	$1,174.57
Rate for Payer: BCN Medicare Advantage	$1,174.57
Rate for Payer: Cash Price	$2,031.20
Rate for Payer: Cash Price	$2,031.20
Rate for Payer: Cofinity Commercial	$1,691.38
Rate for Payer: Cofinity Commercial	$1,573.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,174.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,233.30
Rate for Payer: Nomi Health Commercial	$1,409.48
Rate for Payer: PACE SWMI	$1,174.57
Rate for Payer: PHP Medicare Advantage	$1,174.57
Rate for Payer: Priority Health Cigna Priority Health	$1,650.35
Rate for Payer: Priority Health Medicare	$1,186.32
Rate for Payer: UHC All Payor (Choice/PPO)	$1,174.57
Rate for Payer: UHC Dual Complete DSNP	$1,174.57
Rate for Payer: UHC Exchange	$1,174.57
Rate for Payer: UHC Medicare Advantage	$1,174.57

PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS

Professional

Both

$9,690.00

Service Code	HCPCS 33411
Min. Negotiated Rate	$3,212.15
Max. Negotiated Rate	$6,298.50
Rate for Payer: Aetna Commercial	$4,304.28
Rate for Payer: Aetna Medicare	$3,340.64
Rate for Payer: BCBS Complete	$3,876.00
Rate for Payer: BCBS MAPPO	$3,212.15
Rate for Payer: BCN Medicare Advantage	$3,212.15
Rate for Payer: Cash Price	$7,752.00
Rate for Payer: Cash Price	$7,752.00
Rate for Payer: Cofinity Commercial	$4,625.50
Rate for Payer: Cofinity Commercial	$4,304.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,212.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,372.76
Rate for Payer: Nomi Health Commercial	$3,854.58
Rate for Payer: PACE SWMI	$3,212.15
Rate for Payer: PHP Medicare Advantage	$3,212.15
Rate for Payer: Priority Health Cigna Priority Health	$6,298.50
Rate for Payer: Priority Health Medicare	$3,244.27
Rate for Payer: UHC All Payor (Choice/PPO)	$3,212.15
Rate for Payer: UHC Dual Complete DSNP	$3,212.15
Rate for Payer: UHC Exchange	$3,212.15
Rate for Payer: UHC Medicare Advantage	$3,212.15

PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND

Professional

Both

$6,847.00

Service Code	HCPCS 33406
Min. Negotiated Rate	$2,738.80
Max. Negotiated Rate	$4,450.55
Rate for Payer: Aetna Commercial	$3,707.27
Rate for Payer: Aetna Medicare	$2,877.28
Rate for Payer: BCBS Complete	$2,738.80
Rate for Payer: BCBS MAPPO	$2,766.62
Rate for Payer: BCN Medicare Advantage	$2,766.62
Rate for Payer: Cash Price	$5,477.60
Rate for Payer: Cash Price	$5,477.60
Rate for Payer: Cofinity Commercial	$3,983.93
Rate for Payer: Cofinity Commercial	$3,707.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,766.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,904.95
Rate for Payer: Nomi Health Commercial	$3,319.94
Rate for Payer: PACE SWMI	$2,766.62
Rate for Payer: PHP Medicare Advantage	$2,766.62
Rate for Payer: Priority Health Cigna Priority Health	$4,450.55
Rate for Payer: Priority Health Medicare	$2,794.29
Rate for Payer: UHC All Payor (Choice/PPO)	$2,766.62
Rate for Payer: UHC Dual Complete DSNP	$2,766.62
Rate for Payer: UHC Exchange	$2,766.62
Rate for Payer: UHC Medicare Advantage	$2,766.62

PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE

Professional

Both

$8,127.00

Service Code	HCPCS 33410
Min. Negotiated Rate	$2,440.87
Max. Negotiated Rate	$5,282.55
Rate for Payer: Aetna Commercial	$3,270.77
Rate for Payer: Aetna Medicare	$2,538.50
Rate for Payer: BCBS Complete	$3,250.80
Rate for Payer: BCBS MAPPO	$2,440.87
Rate for Payer: BCN Medicare Advantage	$2,440.87
Rate for Payer: Cash Price	$6,501.60
Rate for Payer: Cash Price	$6,501.60
Rate for Payer: Cofinity Commercial	$3,514.85
Rate for Payer: Cofinity Commercial	$3,270.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,440.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,562.91
Rate for Payer: Nomi Health Commercial	$2,929.04
Rate for Payer: PACE SWMI	$2,440.87
Rate for Payer: PHP Medicare Advantage	$2,440.87
Rate for Payer: Priority Health Cigna Priority Health	$5,282.55
Rate for Payer: Priority Health Medicare	$2,465.28
Rate for Payer: UHC All Payor (Choice/PPO)	$2,440.87
Rate for Payer: UHC Dual Complete DSNP	$2,440.87
Rate for Payer: UHC Exchange	$2,440.87
Rate for Payer: UHC Medicare Advantage	$2,440.87

PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL

Professional

Both

$5,033.00

Service Code	HCPCS 62143
Min. Negotiated Rate	$1,036.68
Max. Negotiated Rate	$3,271.45
Rate for Payer: Aetna Commercial	$1,389.15
Rate for Payer: Aetna Medicare	$1,078.15
Rate for Payer: BCBS Complete	$2,013.20
Rate for Payer: BCBS MAPPO	$1,036.68
Rate for Payer: BCN Medicare Advantage	$1,036.68
Rate for Payer: Cash Price	$4,026.40
Rate for Payer: Cash Price	$4,026.40
Rate for Payer: Cofinity Commercial	$1,492.82
Rate for Payer: Cofinity Commercial	$1,389.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,036.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,088.51
Rate for Payer: Nomi Health Commercial	$1,244.02
Rate for Payer: PACE SWMI	$1,036.68
Rate for Payer: PHP Medicare Advantage	$1,036.68
Rate for Payer: Priority Health Cigna Priority Health	$3,271.45
Rate for Payer: Priority Health Medicare	$1,047.05
Rate for Payer: UHC All Payor (Choice/PPO)	$1,036.68
Rate for Payer: UHC Dual Complete DSNP	$1,036.68
Rate for Payer: UHC Exchange	$1,036.68
Rate for Payer: UHC Medicare Advantage	$1,036.68

PR RPLCMT CATH CTR VAD SUBQ PORT/PMP

Professional

Both

$1,024.00

Service Code	HCPCS 36578
Min. Negotiated Rate	$191.32
Max. Negotiated Rate	$665.60
Rate for Payer: Aetna Commercial	$256.37
Rate for Payer: Aetna Medicare	$198.97
Rate for Payer: BCBS Complete	$409.60
Rate for Payer: BCBS MAPPO	$191.32
Rate for Payer: BCN Medicare Advantage	$191.32
Rate for Payer: Cash Price	$819.20
Rate for Payer: Cash Price	$819.20
Rate for Payer: Cofinity Commercial	$275.50
Rate for Payer: Cofinity Commercial	$256.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$191.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$200.89
Rate for Payer: Nomi Health Commercial	$229.58
Rate for Payer: PACE SWMI	$191.32
Rate for Payer: PHP Medicare Advantage	$191.32
Rate for Payer: Priority Health Cigna Priority Health	$665.60
Rate for Payer: Priority Health Medicare	$193.23
Rate for Payer: UHC All Payor (Choice/PPO)	$191.32
Rate for Payer: UHC Dual Complete DSNP	$191.32
Rate for Payer: UHC Exchange	$191.32
Rate for Payer: UHC Medicare Advantage	$191.32

PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$771.00

Service Code	HCPCS 36580
Min. Negotiated Rate	$61.41
Max. Negotiated Rate	$501.15
Rate for Payer: Aetna Commercial	$82.29
Rate for Payer: Aetna Medicare	$63.87
Rate for Payer: BCBS Complete	$308.40
Rate for Payer: BCBS MAPPO	$61.41
Rate for Payer: BCN Medicare Advantage	$61.41
Rate for Payer: Cash Price	$616.80
Rate for Payer: Cash Price	$616.80
Rate for Payer: Cofinity Commercial	$88.43
Rate for Payer: Cofinity Commercial	$82.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$61.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$64.48
Rate for Payer: Nomi Health Commercial	$73.69
Rate for Payer: PACE SWMI	$61.41
Rate for Payer: PHP Medicare Advantage	$61.41
Rate for Payer: Priority Health Cigna Priority Health	$501.15
Rate for Payer: Priority Health Medicare	$62.02
Rate for Payer: UHC All Payor (Choice/PPO)	$61.41
Rate for Payer: UHC Dual Complete DSNP	$61.41
Rate for Payer: UHC Exchange	$61.41
Rate for Payer: UHC Medicare Advantage	$61.41

PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT

Professional

Both

$2,142.00

Service Code	HCPCS 36585
Min. Negotiated Rate	$293.26
Max. Negotiated Rate	$1,392.30
Rate for Payer: Aetna Commercial	$392.97
Rate for Payer: Aetna Medicare	$304.99
Rate for Payer: BCBS Complete	$856.80
Rate for Payer: BCBS MAPPO	$293.26
Rate for Payer: BCN Medicare Advantage	$293.26
Rate for Payer: Cash Price	$1,713.60
Rate for Payer: Cash Price	$1,713.60
Rate for Payer: Cofinity Commercial	$422.29
Rate for Payer: Cofinity Commercial	$392.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$293.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$307.92
Rate for Payer: Nomi Health Commercial	$351.91
Rate for Payer: PACE SWMI	$293.26
Rate for Payer: PHP Medicare Advantage	$293.26
Rate for Payer: Priority Health Cigna Priority Health	$1,392.30
Rate for Payer: Priority Health Medicare	$296.19
Rate for Payer: UHC All Payor (Choice/PPO)	$293.26
Rate for Payer: UHC Dual Complete DSNP	$293.26
Rate for Payer: UHC Exchange	$293.26
Rate for Payer: UHC Medicare Advantage	$293.26

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP

Professional

Both

$1,945.00

Service Code	HCPCS 36583
Min. Negotiated Rate	$317.76
Max. Negotiated Rate	$1,264.25
Rate for Payer: Aetna Commercial	$425.80
Rate for Payer: Aetna Medicare	$330.47
Rate for Payer: BCBS Complete	$778.00
Rate for Payer: BCBS MAPPO	$317.76
Rate for Payer: BCN Medicare Advantage	$317.76
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cofinity Commercial	$457.57
Rate for Payer: Cofinity Commercial	$425.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$317.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$333.65
Rate for Payer: Nomi Health Commercial	$381.31
Rate for Payer: PACE SWMI	$317.76
Rate for Payer: PHP Medicare Advantage	$317.76
Rate for Payer: Priority Health Cigna Priority Health	$1,264.25
Rate for Payer: Priority Health Medicare	$320.94
Rate for Payer: UHC All Payor (Choice/PPO)	$317.76
Rate for Payer: UHC Dual Complete DSNP	$317.76
Rate for Payer: UHC Exchange	$317.76
Rate for Payer: UHC Medicare Advantage	$317.76

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT

Professional

Both

$564.00

Service Code	HCPCS 36582
Min. Negotiated Rate	$225.60
Max. Negotiated Rate	$392.23
Rate for Payer: Aetna Commercial	$364.99
Rate for Payer: Aetna Medicare	$283.28
Rate for Payer: BCBS Complete	$225.60
Rate for Payer: BCBS MAPPO	$272.38
Rate for Payer: BCN Medicare Advantage	$272.38
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cash Price	$451.20
Rate for Payer: Cofinity Commercial	$392.23
Rate for Payer: Cofinity Commercial	$364.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$272.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$286.00
Rate for Payer: Nomi Health Commercial	$326.86
Rate for Payer: PACE SWMI	$272.38
Rate for Payer: PHP Medicare Advantage	$272.38
Rate for Payer: Priority Health Cigna Priority Health	$366.60
Rate for Payer: Priority Health Medicare	$275.10
Rate for Payer: UHC All Payor (Choice/PPO)	$272.38
Rate for Payer: UHC Dual Complete DSNP	$272.38
Rate for Payer: UHC Exchange	$272.38
Rate for Payer: UHC Medicare Advantage	$272.38

PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$1,570.00

Service Code	HCPCS 36581
Min. Negotiated Rate	$172.66
Max. Negotiated Rate	$1,020.50
Rate for Payer: Aetna Commercial	$231.36
Rate for Payer: Aetna Medicare	$179.57
Rate for Payer: BCBS Complete	$628.00
Rate for Payer: BCBS MAPPO	$172.66
Rate for Payer: BCN Medicare Advantage	$172.66
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Cofinity Commercial	$248.63
Rate for Payer: Cofinity Commercial	$231.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$172.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$181.29
Rate for Payer: Nomi Health Commercial	$207.19
Rate for Payer: PACE SWMI	$172.66
Rate for Payer: PHP Medicare Advantage	$172.66
Rate for Payer: Priority Health Cigna Priority Health	$1,020.50
Rate for Payer: Priority Health Medicare	$174.39
Rate for Payer: UHC All Payor (Choice/PPO)	$172.66
Rate for Payer: UHC Dual Complete DSNP	$172.66
Rate for Payer: UHC Exchange	$172.66
Rate for Payer: UHC Medicare Advantage	$172.66

PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER

Professional

Both

$1,874.00

Service Code	HCPCS 62194
Min. Negotiated Rate	$488.25
Max. Negotiated Rate	$1,218.10
Rate for Payer: Aetna Commercial	$654.25
Rate for Payer: Aetna Medicare	$507.78
Rate for Payer: BCBS Complete	$749.60
Rate for Payer: BCBS MAPPO	$488.25
Rate for Payer: BCN Medicare Advantage	$488.25
Rate for Payer: Cash Price	$1,499.20
Rate for Payer: Cash Price	$1,499.20
Rate for Payer: Cofinity Commercial	$703.08
Rate for Payer: Cofinity Commercial	$654.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$488.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$512.66
Rate for Payer: Nomi Health Commercial	$585.90
Rate for Payer: PACE SWMI	$488.25
Rate for Payer: PHP Medicare Advantage	$488.25
Rate for Payer: Priority Health Cigna Priority Health	$1,218.10
Rate for Payer: Priority Health Medicare	$493.13
Rate for Payer: UHC All Payor (Choice/PPO)	$488.25
Rate for Payer: UHC Dual Complete DSNP	$488.25
Rate for Payer: UHC Exchange	$488.25
Rate for Payer: UHC Medicare Advantage	$488.25

PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT

Professional

Both

$2,266.00

Service Code	HCPCS 63744
Min. Negotiated Rate	$705.13
Max. Negotiated Rate	$1,472.90
Rate for Payer: Aetna Commercial	$944.87
Rate for Payer: Aetna Medicare	$733.34
Rate for Payer: BCBS Complete	$906.40
Rate for Payer: BCBS MAPPO	$705.13
Rate for Payer: BCN Medicare Advantage	$705.13
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cofinity Commercial	$944.87
Rate for Payer: Cofinity Commercial	$1,015.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$705.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$740.39
Rate for Payer: Nomi Health Commercial	$846.16
Rate for Payer: PACE SWMI	$705.13
Rate for Payer: PHP Medicare Advantage	$705.13
Rate for Payer: Priority Health Cigna Priority Health	$1,472.90
Rate for Payer: Priority Health Medicare	$712.18
Rate for Payer: UHC All Payor (Choice/PPO)	$705.13
Rate for Payer: UHC Dual Complete DSNP	$705.13
Rate for Payer: UHC Exchange	$705.13
Rate for Payer: UHC Medicare Advantage	$705.13

PR RPLCMT/IRRIGATION VENTRICULAR CATHETER

Professional

Both

$2,725.00

Service Code	HCPCS 62225
Min. Negotiated Rate	$530.02
Max. Negotiated Rate	$1,771.25
Rate for Payer: Aetna Commercial	$710.23
Rate for Payer: Aetna Medicare	$551.22
Rate for Payer: BCBS Complete	$1,090.00
Rate for Payer: BCBS MAPPO	$530.02
Rate for Payer: BCN Medicare Advantage	$530.02
Rate for Payer: Cash Price	$2,180.00
Rate for Payer: Cash Price	$2,180.00
Rate for Payer: Cofinity Commercial	$763.23
Rate for Payer: Cofinity Commercial	$710.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$530.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$556.52
Rate for Payer: Nomi Health Commercial	$636.02
Rate for Payer: PACE SWMI	$530.02
Rate for Payer: PHP Medicare Advantage	$530.02
Rate for Payer: Priority Health Cigna Priority Health	$1,771.25
Rate for Payer: Priority Health Medicare	$535.32
Rate for Payer: UHC All Payor (Choice/PPO)	$530.02
Rate for Payer: UHC Dual Complete DSNP	$530.02
Rate for Payer: UHC Exchange	$530.02
Rate for Payer: UHC Medicare Advantage	$530.02

Know your out-of-pocket cost for care.

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