Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR NON/MALUNION HUMERUS W/O GRAFT

Professional

Both

$2,834.00

Service Code	HCPCS 24430
Min. Negotiated Rate	$335.47
Max. Negotiated Rate	$1,983.80
Rate for Payer: Aetna Commercial	$1,409.77
Rate for Payer: BCBS Complete	$713.66
Rate for Payer: BCBS Trust/PPO	$335.47
Rate for Payer: Cash Price	$2,267.20
Rate for Payer: Cash Price	$2,267.20
Rate for Payer: Meridian Medicaid	$713.66
Rate for Payer: Priority Health Choice Medicaid	$679.68
Rate for Payer: Priority Health Cigna Priority Health	$1,983.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,617.74
Rate for Payer: Priority Health Narrow Network	$1,617.74
Rate for Payer: Priority Health SBD	$1,617.74
Rate for Payer: UMR Bronson Commercial	$1,303.64

PR REPAIR NONUNION CARPAL BONE EACH BONE

Professional

Both

$1,374.00

Service Code	HCPCS 25431
Min. Negotiated Rate	$448.70
Max. Negotiated Rate	$1,212.79
Rate for Payer: Aetna Commercial	$1,052.49
Rate for Payer: BCBS Complete	$535.87
Rate for Payer: BCBS Trust/PPO	$448.70
Rate for Payer: Cash Price	$1,099.20
Rate for Payer: Cash Price	$1,099.20
Rate for Payer: Meridian Medicaid	$535.87
Rate for Payer: Priority Health Choice Medicaid	$510.35
Rate for Payer: Priority Health Cigna Priority Health	$961.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,212.79
Rate for Payer: Priority Health Narrow Network	$1,212.79
Rate for Payer: Priority Health SBD	$1,212.79
Rate for Payer: UMR Bronson Commercial	$632.04

PR REPAIR NONUNION/MALUNION TARSAL BONES

Professional

Both

$1,292.00

Service Code	HCPCS 28320
Min. Negotiated Rate	$397.88
Max. Negotiated Rate	$2,281.73
Rate for Payer: Aetna Commercial	$821.23
Rate for Payer: BCBS Complete	$417.77
Rate for Payer: BCBS Trust/PPO	$2,281.73
Rate for Payer: Cash Price	$1,033.60
Rate for Payer: Cash Price	$1,033.60
Rate for Payer: Meridian Medicaid	$417.77
Rate for Payer: Priority Health Choice Medicaid	$397.88
Rate for Payer: Priority Health Cigna Priority Health	$904.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$935.51
Rate for Payer: Priority Health Narrow Network	$935.51
Rate for Payer: Priority Health SBD	$935.51
Rate for Payer: UMR Bronson Commercial	$594.32

PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT

Professional

Both

$3,826.00

Service Code	HCPCS 27720
Min. Negotiated Rate	$562.75
Max. Negotiated Rate	$2,678.20
Rate for Payer: Aetna Commercial	$1,167.83
Rate for Payer: BCBS Complete	$590.89
Rate for Payer: BCBS Trust/PPO	$677.28
Rate for Payer: Cash Price	$3,060.80
Rate for Payer: Cash Price	$3,060.80
Rate for Payer: Meridian Medicaid	$590.89
Rate for Payer: Priority Health Choice Medicaid	$562.75
Rate for Payer: Priority Health Cigna Priority Health	$2,678.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,339.43
Rate for Payer: Priority Health Narrow Network	$1,339.43
Rate for Payer: Priority Health SBD	$1,339.43
Rate for Payer: UMR Bronson Commercial	$1,759.96

PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT

Professional

Both

$3,752.00

Service Code	HCPCS 27722
Min. Negotiated Rate	$578.08
Max. Negotiated Rate	$2,626.40
Rate for Payer: Aetna Commercial	$1,193.91
Rate for Payer: BCBS Complete	$606.98
Rate for Payer: BCBS Trust/PPO	$635.54
Rate for Payer: Cash Price	$3,001.60
Rate for Payer: Cash Price	$3,001.60
Rate for Payer: Meridian Medicaid	$606.98
Rate for Payer: Priority Health Choice Medicaid	$578.08
Rate for Payer: Priority Health Cigna Priority Health	$2,626.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,373.14
Rate for Payer: Priority Health Narrow Network	$1,373.14
Rate for Payer: Priority Health SBD	$1,373.14
Rate for Payer: UMR Bronson Commercial	$1,725.92

PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)

Professional

Both

$1,361.00

Service Code	HCPCS 54437
Min. Negotiated Rate	$433.67
Max. Negotiated Rate	$1,755.01
Rate for Payer: Aetna Commercial	$867.12
Rate for Payer: BCBS Complete	$455.35
Rate for Payer: BCBS Trust/PPO	$1,755.01
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Meridian Medicaid	$455.35
Rate for Payer: Priority Health Choice Medicaid	$433.67
Rate for Payer: Priority Health Cigna Priority Health	$952.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,083.42
Rate for Payer: Priority Health Narrow Network	$1,083.42
Rate for Payer: Priority Health SBD	$1,083.42
Rate for Payer: UMR Bronson Commercial	$626.06

PR REPAIR PATENT DUCTUS ARTERIOSUS LIGATION

Professional

Both

$4,316.00

Service Code	HCPCS 33820
Min. Negotiated Rate	$610.46
Max. Negotiated Rate	$3,021.20
Rate for Payer: Aetna Commercial	$1,297.11
Rate for Payer: BCBS Complete	$640.98
Rate for Payer: BCBS Trust/PPO	$1,613.43
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Meridian Medicaid	$640.98
Rate for Payer: Priority Health Choice Medicaid	$610.46
Rate for Payer: Priority Health Cigna Priority Health	$3,021.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,516.09
Rate for Payer: Priority Health Narrow Network	$1,516.09
Rate for Payer: Priority Health SBD	$1,516.09
Rate for Payer: UMR Bronson Commercial	$1,985.36

PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC

Professional

Both

$4,060.00

Service Code	HCPCS 21743
Min. Negotiated Rate	$430.05
Max. Negotiated Rate	$3,437.80
Rate for Payer: Aetna Commercial	$2,118.84
Rate for Payer: BCBS Complete	$451.55
Rate for Payer: BCBS Trust/PPO	$3,437.80
Rate for Payer: Cash Price	$3,248.00
Rate for Payer: Cash Price	$3,248.00
Rate for Payer: Meridian Medicaid	$451.55
Rate for Payer: Priority Health Choice Medicaid	$430.05
Rate for Payer: Priority Health Cigna Priority Health	$2,842.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,424.56
Rate for Payer: Priority Health Narrow Network	$2,424.56
Rate for Payer: Priority Health SBD	$2,424.56
Rate for Payer: UMR Bronson Commercial	$1,867.60

PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN

Professional

Both

$4,060.00

Service Code	HCPCS 21740
Min. Negotiated Rate	$651.57
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$1,381.26
Rate for Payer: BCBS Complete	$684.15
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$3,248.00
Rate for Payer: Cash Price	$3,248.00
Rate for Payer: Meridian Medicaid	$684.15
Rate for Payer: Priority Health Choice Medicaid	$651.57
Rate for Payer: Priority Health Cigna Priority Health	$2,842.00
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
Rate for Payer: UMR Bronson Commercial	$1,867.60

PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

Professional

Both

$2,551.00

Service Code	HCPCS 27650
Min. Negotiated Rate	$424.72
Max. Negotiated Rate	$1,785.70
Rate for Payer: Aetna Commercial	$877.03
Rate for Payer: BCBS Complete	$445.96
Rate for Payer: BCBS Trust/PPO	$1,513.05
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Meridian Medicaid	$445.96
Rate for Payer: Priority Health Choice Medicaid	$424.72
Rate for Payer: Priority Health Cigna Priority Health	$1,785.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.56
Rate for Payer: Priority Health Narrow Network	$1,009.56
Rate for Payer: Priority Health SBD	$1,009.56
Rate for Payer: UMR Bronson Commercial	$1,173.46

PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

Facility

$2,551.00

Service Code	CPT 27650
Hospital Charge Code	27650
Min. Negotiated Rate	$652.92
Max. Negotiated Rate	$20,018.71
Rate for Payer: Aetna American Axle	$1,658.15
Rate for Payer: Aetna Commercial	$2,168.35
Rate for Payer: Aetna Medicare	$6,613.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,658.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,948.86
Rate for Payer: Amish Plain Church Group Commercial	$7,948.86
Rate for Payer: BCBS Complete	$3,652.66
Rate for Payer: BCBS MAPPO	$6,359.09
Rate for Payer: BCBS Trust/PPO	$4,373.86
Rate for Payer: BCN Medicare Advantage	$6,359.09
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cofinity Commercial	$1,785.70
Rate for Payer: Cofinity Commercial	$2,193.86
Rate for Payer: Encore Health Key Benefits Commercial	$2,040.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,359.09
Rate for Payer: Healthscope Commercial	$2,295.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,785.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,913.25
Rate for Payer: Mclaren Medicaid	$3,478.42
Rate for Payer: Mclaren Medicare	$6,359.09
Rate for Payer: Meridian Medicaid	$3,652.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,677.04
Rate for Payer: MI Amish Medical Board Commercial	$7,312.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,168.35
Rate for Payer: PACE Medicare	$6,041.14
Rate for Payer: PACE SWMI	$6,359.09
Rate for Payer: PHP Commercial	$2,168.35
Rate for Payer: PHP Medicare Advantage	$6,359.09
Rate for Payer: Priority Health Choice Medicaid	$3,478.42
Rate for Payer: Priority Health Cigna Priority Health	$1,785.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,018.71
Rate for Payer: Priority Health Medicare	$6,359.09
Rate for Payer: Priority Health Narrow Network	$16,014.97
Rate for Payer: Priority Health SBD	$1,607.13
Rate for Payer: Railroad Medicare Medicare	$6,359.09
Rate for Payer: UHC All Payor (Choice/PPO)	$718.21
Rate for Payer: UHC Dual Complete DSNP	$6,359.09
Rate for Payer: UHC Exchange	$652.92
Rate for Payer: UHC Medicare Advantage	$6,549.86
Rate for Payer: UMR Bronson Commercial	$943.87
Rate for Payer: VA VA	$6,359.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,913.25

PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

Professional

Both

$2,551.00

Service Code	HCPCS 27650
Hospital Charge Code	27650
Min. Negotiated Rate	$424.72
Max. Negotiated Rate	$1,785.70
Rate for Payer: Aetna Commercial	$877.03
Rate for Payer: BCBS Complete	$445.96
Rate for Payer: BCBS Trust/PPO	$1,513.05
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Meridian Medicaid	$445.96
Rate for Payer: Priority Health Choice Medicaid	$424.72
Rate for Payer: Priority Health Cigna Priority Health	$1,785.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.56
Rate for Payer: Priority Health Narrow Network	$1,009.56
Rate for Payer: Priority Health SBD	$1,009.56
Rate for Payer: UMR Bronson Commercial	$1,173.46

PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

Facility

$2,551.00

Service Code	CPT 27650
Hospital Charge Code	27650
Min. Negotiated Rate	$1,122.44
Max. Negotiated Rate	$2,295.90
Rate for Payer: Aetna American Axle	$1,658.15
Rate for Payer: Aetna Commercial	$2,168.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,658.15
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cofinity Commercial	$1,785.70
Rate for Payer: Cofinity Commercial	$2,193.86
Rate for Payer: Encore Health Key Benefits Commercial	$2,040.80
Rate for Payer: Healthscope Commercial	$2,295.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,785.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,913.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,168.35
Rate for Payer: PHP Commercial	$2,168.35
Rate for Payer: Priority Health Cigna Priority Health	$1,785.70
Rate for Payer: Priority Health SBD	$1,607.13
Rate for Payer: UMR Bronson Commercial	$1,122.44
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,913.25

PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT

Professional

Both

$1,778.00

Service Code	HCPCS 27407
Min. Negotiated Rate	$95.09
Max. Negotiated Rate	$1,244.60
Rate for Payer: Aetna Commercial	$1,063.01
Rate for Payer: BCBS Complete	$541.90
Rate for Payer: BCBS Trust/PPO	$95.09
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Meridian Medicaid	$541.90
Rate for Payer: Priority Health Choice Medicaid	$516.10
Rate for Payer: Priority Health Cigna Priority Health	$1,244.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,226.07
Rate for Payer: Priority Health Narrow Network	$1,226.07
Rate for Payer: Priority Health SBD	$1,226.07
Rate for Payer: UMR Bronson Commercial	$817.88

PR REPAIR RECTOCELE SEPARATE PROCEDURE

Professional

Both

$1,263.00

Service Code	HCPCS 45560
Min. Negotiated Rate	$442.40
Max. Negotiated Rate	$2,240.52
Rate for Payer: Aetna Commercial	$927.04
Rate for Payer: BCBS Complete	$464.52
Rate for Payer: BCBS Trust/PPO	$2,240.52
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Cash Price	$1,010.40
Rate for Payer: Meridian Medicaid	$464.52
Rate for Payer: Priority Health Choice Medicaid	$442.40
Rate for Payer: Priority Health Cigna Priority Health	$884.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,214.16
Rate for Payer: Priority Health Narrow Network	$1,214.16
Rate for Payer: Priority Health SBD	$1,214.16
Rate for Payer: UMR Bronson Commercial	$580.98

PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT

Professional

Both

$2,721.00

Service Code	HCPCS 27654
Min. Negotiated Rate	$462.00
Max. Negotiated Rate	$1,904.70
Rate for Payer: Aetna Commercial	$947.16
Rate for Payer: BCBS Complete	$485.10
Rate for Payer: BCBS Trust/PPO	$1,383.09
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Meridian Medicaid	$485.10
Rate for Payer: Priority Health Choice Medicaid	$462.00
Rate for Payer: Priority Health Cigna Priority Health	$1,904.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,094.83
Rate for Payer: Priority Health Narrow Network	$1,094.83
Rate for Payer: Priority Health SBD	$1,094.83
Rate for Payer: UMR Bronson Commercial	$1,251.66

PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL

Professional

Both

$2,934.00

Service Code	HCPCS 27698
Min. Negotiated Rate	$411.30
Max. Negotiated Rate	$2,053.80
Rate for Payer: Aetna Commercial	$851.31
Rate for Payer: BCBS Complete	$431.86
Rate for Payer: BCBS Trust/PPO	$474.94
Rate for Payer: Cash Price	$2,347.20
Rate for Payer: Cash Price	$2,347.20
Rate for Payer: Meridian Medicaid	$431.86
Rate for Payer: Priority Health Choice Medicaid	$411.30
Rate for Payer: Priority Health Cigna Priority Health	$2,053.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$980.95
Rate for Payer: Priority Health Narrow Network	$980.95
Rate for Payer: Priority Health SBD	$980.95
Rate for Payer: UMR Bronson Commercial	$1,349.64

PR REPAIR SYNDACTYLY EACH SPACE COMPLEX

Professional

Both

$2,217.00

Service Code	HCPCS 26562
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$2,122.77
Rate for Payer: Aetna Commercial	$1,830.63
Rate for Payer: BCBS Complete	$932.40
Rate for Payer: BCBS Trust/PPO	$616.00
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Meridian Medicaid	$932.40
Rate for Payer: Priority Health Choice Medicaid	$888.00
Rate for Payer: Priority Health Cigna Priority Health	$1,551.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,122.77
Rate for Payer: Priority Health Narrow Network	$2,122.77
Rate for Payer: Priority Health SBD	$2,122.77
Rate for Payer: UMR Bronson Commercial	$1,019.82

PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS

Professional

Both

$1,944.00

Service Code	HCPCS 26560
Min. Negotiated Rate	$218.72
Max. Negotiated Rate	$1,360.80
Rate for Payer: Aetna Commercial	$838.58
Rate for Payer: BCBS Complete	$433.43
Rate for Payer: BCBS Trust/PPO	$218.72
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Meridian Medicaid	$433.43
Rate for Payer: Priority Health Choice Medicaid	$412.79
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$991.17
Rate for Payer: Priority Health Narrow Network	$991.17
Rate for Payer: Priority Health SBD	$991.17
Rate for Payer: UMR Bronson Commercial	$894.24

PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT

Professional

Both

$2,357.00

Service Code	HCPCS 26561
Min. Negotiated Rate	$540.45
Max. Negotiated Rate	$1,649.90
Rate for Payer: Aetna Commercial	$1,308.00
Rate for Payer: BCBS Complete	$666.70
Rate for Payer: BCBS Trust/PPO	$540.45
Rate for Payer: Cash Price	$1,885.60
Rate for Payer: Cash Price	$1,885.60
Rate for Payer: Meridian Medicaid	$666.70
Rate for Payer: Priority Health Choice Medicaid	$634.95
Rate for Payer: Priority Health Cigna Priority Health	$1,649.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,522.76
Rate for Payer: Priority Health Narrow Network	$1,522.76
Rate for Payer: Priority Health SBD	$1,522.76
Rate for Payer: UMR Bronson Commercial	$1,084.22

PR REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON

Professional

Both

$746.00

Service Code	HCPCS 28208
Min. Negotiated Rate	$207.68
Max. Negotiated Rate	$902.86
Rate for Payer: Aetna Commercial	$419.67
Rate for Payer: BCBS Complete	$218.06
Rate for Payer: BCBS Trust/PPO	$902.86
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cash Price	$596.80
Rate for Payer: Meridian Medicaid	$218.06
Rate for Payer: Priority Health Choice Medicaid	$207.68
Rate for Payer: Priority Health Cigna Priority Health	$522.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$492.26
Rate for Payer: Priority Health Narrow Network	$492.26
Rate for Payer: Priority Health SBD	$492.26
Rate for Payer: UMR Bronson Commercial	$343.16

PR REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA TDN/MUSC

Professional

Both

$2,289.00

Service Code	HCPCS 24341
Min. Negotiated Rate	$91.92
Max. Negotiated Rate	$1,602.30
Rate for Payer: Aetna Commercial	$990.50
Rate for Payer: BCBS Complete	$511.71
Rate for Payer: BCBS Trust/PPO	$91.92
Rate for Payer: Cash Price	$1,831.20
Rate for Payer: Cash Price	$1,831.20
Rate for Payer: Meridian Medicaid	$511.71
Rate for Payer: Priority Health Choice Medicaid	$487.34
Rate for Payer: Priority Health Cigna Priority Health	$1,602.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,152.53
Rate for Payer: Priority Health Narrow Network	$1,152.53
Rate for Payer: Priority Health SBD	$1,152.53
Rate for Payer: UMR Bronson Commercial	$1,052.94

PR REPLACE AORTIC VALVE OPEN AXILLRY ARTRY APPROACH

Professional

Both

$2,524.00

Service Code	HCPCS 33363
Min. Negotiated Rate	$639.24
Max. Negotiated Rate	$2,121.44
Rate for Payer: Aetna Commercial	$1,838.76
Rate for Payer: BCBS Complete	$895.94
Rate for Payer: BCBS Trust/PPO	$639.24
Rate for Payer: Cash Price	$2,019.20
Rate for Payer: Cash Price	$2,019.20
Rate for Payer: Meridian Medicaid	$895.94
Rate for Payer: Priority Health Choice Medicaid	$853.28
Rate for Payer: Priority Health Cigna Priority Health	$1,766.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,121.44
Rate for Payer: Priority Health Narrow Network	$2,121.44
Rate for Payer: Priority Health SBD	$2,121.44
Rate for Payer: UMR Bronson Commercial	$1,161.04

PR REPLACE AORTIC VALVE OPENFEMORAL ARTERY APPROACH

Professional

Both

$4,231.00

Service Code	HCPCS 33362
Min. Negotiated Rate	$618.64
Max. Negotiated Rate	$2,961.70
Rate for Payer: Aetna Commercial	$1,772.76
Rate for Payer: BCBS Complete	$863.29
Rate for Payer: BCBS Trust/PPO	$618.64
Rate for Payer: Cash Price	$3,384.80
Rate for Payer: Cash Price	$3,384.80
Rate for Payer: Meridian Medicaid	$863.29
Rate for Payer: Priority Health Choice Medicaid	$822.18
Rate for Payer: Priority Health Cigna Priority Health	$2,961.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,049.09
Rate for Payer: Priority Health Narrow Network	$2,049.09
Rate for Payer: Priority Health SBD	$2,049.09
Rate for Payer: UMR Bronson Commercial	$1,946.26

PR REPLACE AORTIC VALVE OPEN TRANSAORTIC APPROACH

Professional

Both

$5,113.00

Service Code	HCPCS 33365
Min. Negotiated Rate	$775.54
Max. Negotiated Rate	$3,579.10
Rate for Payer: Aetna Commercial	$1,916.59
Rate for Payer: BCBS Complete	$933.29
Rate for Payer: BCBS Trust/PPO	$775.54
Rate for Payer: Cash Price	$4,090.40
Rate for Payer: Cash Price	$4,090.40
Rate for Payer: Meridian Medicaid	$933.29
Rate for Payer: Priority Health Choice Medicaid	$888.85
Rate for Payer: Priority Health Cigna Priority Health	$3,579.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,215.07
Rate for Payer: Priority Health Narrow Network	$2,215.07
Rate for Payer: Priority Health SBD	$2,215.07
Rate for Payer: UMR Bronson Commercial	$2,351.98

Know your out-of-pocket cost for care.

All Charges