Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$879.00

Service Code	HCPCS 33990
Min. Negotiated Rate	$224.72
Max. Negotiated Rate	$1,090.41
Rate for Payer: Aetna Commercial	$486.27
Rate for Payer: BCBS Complete	$235.96
Rate for Payer: BCBS Trust/PPO	$1,090.41
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Meridian Medicaid	$235.96
Rate for Payer: Priority Health Choice Medicaid	$224.72
Rate for Payer: Priority Health Cigna Priority Health	$615.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$560.68
Rate for Payer: Priority Health Narrow Network	$560.68
Rate for Payer: Priority Health SBD	$560.68
Rate for Payer: UMR Bronson Commercial	$404.34

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

Professional

Both

$3,314.00

Service Code	HCPCS 33991
Min. Negotiated Rate	$282.01
Max. Negotiated Rate	$2,319.80
Rate for Payer: Aetna Commercial	$635.02
Rate for Payer: BCBS Complete	$296.11
Rate for Payer: BCBS Trust/PPO	$1,109.43
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Cash Price	$2,651.20
Rate for Payer: Meridian Medicaid	$296.11
Rate for Payer: Priority Health Choice Medicaid	$282.01
Rate for Payer: Priority Health Cigna Priority Health	$2,319.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$705.90
Rate for Payer: Priority Health Narrow Network	$705.90
Rate for Payer: Priority Health SBD	$705.90
Rate for Payer: UMR Bronson Commercial	$1,524.44

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

Facility

$1,699.00

Service Code	CPT 36571
Hospital Charge Code	36571
Hospital Revenue Code	960
Min. Negotiated Rate	$304.19
Max. Negotiated Rate	$8,919.33
Rate for Payer: Aetna American Axle	$1,104.35
Rate for Payer: Aetna Commercial	$1,444.15
Rate for Payer: Aetna Medicare	$2,946.62
Rate for Payer: Aetna New Business (MI Preferred)	$1,104.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,541.61
Rate for Payer: Amish Plain Church Group Commercial	$3,541.61
Rate for Payer: BCBS Complete	$1,627.44
Rate for Payer: BCBS MAPPO	$2,833.29
Rate for Payer: BCBS Trust/PPO	$2,814.56
Rate for Payer: BCN Medicare Advantage	$2,833.29
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cofinity Commercial	$1,189.30
Rate for Payer: Cofinity Commercial	$1,461.14
Rate for Payer: Encore Health Key Benefits Commercial	$1,359.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,833.29
Rate for Payer: Healthscope Commercial	$1,529.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,189.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,274.25
Rate for Payer: Mclaren Medicaid	$1,549.81
Rate for Payer: Mclaren Medicare	$2,833.29
Rate for Payer: Meridian Medicaid	$1,627.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,974.95
Rate for Payer: MI Amish Medical Board Commercial	$3,258.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,444.15
Rate for Payer: PACE Medicare	$2,691.63
Rate for Payer: PACE SWMI	$2,833.29
Rate for Payer: PHP Commercial	$1,444.15
Rate for Payer: PHP Medicare Advantage	$2,833.29
Rate for Payer: Priority Health Choice Medicaid	$1,549.81
Rate for Payer: Priority Health Cigna Priority Health	$1,189.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,919.33
Rate for Payer: Priority Health Medicare	$2,833.29
Rate for Payer: Priority Health Narrow Network	$7,135.46
Rate for Payer: Priority Health SBD	$1,070.37
Rate for Payer: Railroad Medicare Medicare	$2,833.29
Rate for Payer: UHC All Payor (Choice/PPO)	$334.61
Rate for Payer: UHC Dual Complete DSNP	$2,833.29
Rate for Payer: UHC Exchange	$304.19
Rate for Payer: UHC Medicare Advantage	$2,918.29
Rate for Payer: UMR Bronson Commercial	$628.63
Rate for Payer: VA VA	$2,833.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,274.25

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

Professional

Both

$1,699.00

Service Code	HCPCS 36571
Hospital Charge Code	36571
Min. Negotiated Rate	$197.88
Max. Negotiated Rate	$1,189.30
Rate for Payer: Aetna Commercial	$418.88
Rate for Payer: BCBS Complete	$207.77
Rate for Payer: BCBS Trust/PPO	$651.39
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Meridian Medicaid	$207.77
Rate for Payer: Priority Health Choice Medicaid	$197.88
Rate for Payer: Priority Health Cigna Priority Health	$1,189.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$491.53
Rate for Payer: Priority Health Narrow Network	$491.53
Rate for Payer: Priority Health SBD	$491.53
Rate for Payer: UMR Bronson Commercial	$781.54

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

Facility

$1,699.00

Service Code	CPT 36571
Hospital Charge Code	36571
Hospital Revenue Code	960
Min. Negotiated Rate	$747.56
Max. Negotiated Rate	$1,529.10
Rate for Payer: Aetna American Axle	$1,104.35
Rate for Payer: Aetna Commercial	$1,444.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,104.35
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cofinity Commercial	$1,461.14
Rate for Payer: Cofinity Commercial	$1,189.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,359.20
Rate for Payer: Healthscope Commercial	$1,529.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,189.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,274.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,444.15
Rate for Payer: PHP Commercial	$1,444.15
Rate for Payer: Priority Health Cigna Priority Health	$1,189.30
Rate for Payer: Priority Health SBD	$1,070.37
Rate for Payer: UMR Bronson Commercial	$747.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,274.25

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

Professional

Both

$1,699.00

Service Code	HCPCS 36571
Min. Negotiated Rate	$197.88
Max. Negotiated Rate	$1,189.30
Rate for Payer: Aetna Commercial	$418.88
Rate for Payer: BCBS Complete	$207.77
Rate for Payer: BCBS Trust/PPO	$651.39
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Cash Price	$1,359.20
Rate for Payer: Meridian Medicaid	$207.77
Rate for Payer: Priority Health Choice Medicaid	$197.88
Rate for Payer: Priority Health Cigna Priority Health	$1,189.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$491.53
Rate for Payer: Priority Health Narrow Network	$491.53
Rate for Payer: Priority Health SBD	$491.53
Rate for Payer: UMR Bronson Commercial	$781.54

PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY

Professional

Both

$1,644.00

Service Code	HCPCS 19342
Min. Negotiated Rate	$488.41
Max. Negotiated Rate	$1,594.65
Rate for Payer: Aetna Commercial	$822.56
Rate for Payer: BCBS Complete	$512.83
Rate for Payer: BCBS Trust/PPO	$1,594.65
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Meridian Medicaid	$512.83
Rate for Payer: Priority Health Choice Medicaid	$488.41
Rate for Payer: Priority Health Cigna Priority Health	$1,150.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$937.58
Rate for Payer: Priority Health Narrow Network	$937.58
Rate for Payer: Priority Health SBD	$937.58
Rate for Payer: UMR Bronson Commercial	$756.24

PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS

Professional

Both

$1,853.00

Service Code	HCPCS 61886
Min. Negotiated Rate	$575.74
Max. Negotiated Rate	$1,507.29
Rate for Payer: Aetna Commercial	$1,112.99
Rate for Payer: BCBS Complete	$604.53
Rate for Payer: BCBS Trust/PPO	$1,034.41
Rate for Payer: Cash Price	$1,482.40
Rate for Payer: Cash Price	$1,482.40
Rate for Payer: Meridian Medicaid	$604.53
Rate for Payer: Priority Health Choice Medicaid	$575.74
Rate for Payer: Priority Health Cigna Priority Health	$1,297.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,507.29
Rate for Payer: Priority Health Narrow Network	$1,507.29
Rate for Payer: Priority Health SBD	$1,507.29
Rate for Payer: UMR Bronson Commercial	$852.38

PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR

Professional

Both

$1,622.00

Service Code	HCPCS 61885
Min. Negotiated Rate	$345.06
Max. Negotiated Rate	$1,135.40
Rate for Payer: Aetna Commercial	$671.13
Rate for Payer: BCBS Complete	$362.31
Rate for Payer: BCBS Trust/PPO	$810.94
Rate for Payer: Cash Price	$1,297.60
Rate for Payer: Cash Price	$1,297.60
Rate for Payer: Meridian Medicaid	$362.31
Rate for Payer: Priority Health Choice Medicaid	$345.06
Rate for Payer: Priority Health Cigna Priority Health	$1,135.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$905.40
Rate for Payer: Priority Health Narrow Network	$905.40
Rate for Payer: Priority Health SBD	$905.40
Rate for Payer: UMR Bronson Commercial	$746.12

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

Professional

Both

$1,860.00

Service Code	HCPCS 33249
Min. Negotiated Rate	$571.91
Max. Negotiated Rate	$1,436.28
Rate for Payer: Aetna Commercial	$1,231.48
Rate for Payer: BCBS Complete	$600.51
Rate for Payer: BCBS Trust/PPO	$1,179.17
Rate for Payer: Cash Price	$1,488.00
Rate for Payer: Cash Price	$1,488.00
Rate for Payer: Meridian Medicaid	$600.51
Rate for Payer: Priority Health Choice Medicaid	$571.91
Rate for Payer: Priority Health Cigna Priority Health	$1,302.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,436.28
Rate for Payer: Priority Health Narrow Network	$1,436.28
Rate for Payer: Priority Health SBD	$1,436.28
Rate for Payer: UMR Bronson Commercial	$855.60

PR INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING

Professional

Both

$2,242.00

Service Code	HCPCS 63685
Min. Negotiated Rate	$218.96
Max. Negotiated Rate	$1,569.40
Rate for Payer: Aetna Commercial	$465.59
Rate for Payer: BCBS Complete	$229.91
Rate for Payer: BCBS Trust/PPO	$1,113.66
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Meridian Medicaid	$229.91
Rate for Payer: Priority Health Choice Medicaid	$218.96
Rate for Payer: Priority Health Cigna Priority Health	$1,569.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$613.79
Rate for Payer: Priority Health Narrow Network	$613.79
Rate for Payer: Priority Health SBD	$613.79
Rate for Payer: UMR Bronson Commercial	$1,031.32

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

Professional

Both

$1,016.00

Service Code	HCPCS 33210
Min. Negotiated Rate	$100.54
Max. Negotiated Rate	$1,347.69
Rate for Payer: Aetna Commercial	$218.64
Rate for Payer: BCBS Complete	$105.57
Rate for Payer: BCBS Trust/PPO	$1,347.69
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Meridian Medicaid	$105.57
Rate for Payer: Priority Health Choice Medicaid	$100.54
Rate for Payer: Priority Health Cigna Priority Health	$711.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$252.16
Rate for Payer: Priority Health Narrow Network	$252.16
Rate for Payer: Priority Health SBD	$252.16
Rate for Payer: UMR Bronson Commercial	$467.36

PR INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH

Professional

Both

$2,672.00

Service Code	HCPCS 61215
Min. Negotiated Rate	$338.67
Max. Negotiated Rate	$1,870.40
Rate for Payer: Aetna Commercial	$652.56
Rate for Payer: BCBS Complete	$355.60
Rate for Payer: BCBS Trust/PPO	$682.56
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Cash Price	$2,137.60
Rate for Payer: Meridian Medicaid	$355.60
Rate for Payer: Priority Health Choice Medicaid	$338.67
Rate for Payer: Priority Health Cigna Priority Health	$1,870.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$888.40
Rate for Payer: Priority Health Narrow Network	$888.40
Rate for Payer: Priority Health SBD	$888.40
Rate for Payer: UMR Bronson Commercial	$1,229.12

PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED

Professional

Both

$293.00

Service Code	HCPCS 51703
Min. Negotiated Rate	$48.14
Max. Negotiated Rate	$2,051.39
Rate for Payer: Aetna Commercial	$98.20
Rate for Payer: BCBS Complete	$50.55
Rate for Payer: BCBS Trust/PPO	$2,051.39
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Meridian Medicaid	$50.55
Rate for Payer: Priority Health Choice Medicaid	$48.14
Rate for Payer: Priority Health Cigna Priority Health	$205.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121.59
Rate for Payer: Priority Health Narrow Network	$121.59
Rate for Payer: Priority Health SBD	$121.59
Rate for Payer: UMR Bronson Commercial	$134.78

PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE

Professional

Both

$172.00

Service Code	HCPCS 51702
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$1,962.63
Rate for Payer: Aetna Commercial	$32.34
Rate for Payer: BCBS Complete	$16.78
Rate for Payer: BCBS Trust/PPO	$1,962.63
Rate for Payer: Cash Price	$137.60
Rate for Payer: Cash Price	$137.60
Rate for Payer: Meridian Medicaid	$16.78
Rate for Payer: Priority Health Choice Medicaid	$15.98
Rate for Payer: Priority Health Cigna Priority Health	$120.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39.99
Rate for Payer: Priority Health Narrow Network	$39.99
Rate for Payer: Priority Health SBD	$39.99
Rate for Payer: UMR Bronson Commercial	$79.12

PR INSJ TESTICULAR PROSTH SEPARATE PROCEDURE

Professional

Both

$715.00

Service Code	HCPCS 54660
Min. Negotiated Rate	$230.25
Max. Negotiated Rate	$2,434.41
Rate for Payer: Aetna Commercial	$457.01
Rate for Payer: BCBS Complete	$241.76
Rate for Payer: BCBS Trust/PPO	$2,434.41
Rate for Payer: Cash Price	$572.00
Rate for Payer: Cash Price	$572.00
Rate for Payer: Meridian Medicaid	$241.76
Rate for Payer: Priority Health Choice Medicaid	$230.25
Rate for Payer: Priority Health Cigna Priority Health	$500.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$574.40
Rate for Payer: Priority Health Narrow Network	$574.40
Rate for Payer: Priority Health SBD	$574.40
Rate for Payer: UMR Bronson Commercial	$328.90

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

Professional

Both

$3,378.00

Service Code	HCPCS 36561
Min. Negotiated Rate	$208.95
Max. Negotiated Rate	$2,364.60
Rate for Payer: Aetna Commercial	$446.52
Rate for Payer: BCBS Complete	$219.40
Rate for Payer: BCBS Trust/PPO	$486.56
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Meridian Medicaid	$219.40
Rate for Payer: Priority Health Choice Medicaid	$208.95
Rate for Payer: Priority Health Cigna Priority Health	$2,364.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$521.85
Rate for Payer: Priority Health Narrow Network	$521.85
Rate for Payer: Priority Health SBD	$521.85
Rate for Payer: UMR Bronson Commercial	$1,553.88

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

Professional

Both

$3,378.00

Service Code	HCPCS 36561
Hospital Charge Code	36561
Min. Negotiated Rate	$208.95
Max. Negotiated Rate	$2,364.60
Rate for Payer: Aetna Commercial	$446.52
Rate for Payer: BCBS Complete	$219.40
Rate for Payer: BCBS Trust/PPO	$486.56
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Meridian Medicaid	$219.40
Rate for Payer: Priority Health Choice Medicaid	$208.95
Rate for Payer: Priority Health Cigna Priority Health	$2,364.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$521.85
Rate for Payer: Priority Health Narrow Network	$521.85
Rate for Payer: Priority Health SBD	$521.85
Rate for Payer: UMR Bronson Commercial	$1,553.88

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

Facility

$3,378.00

Service Code	CPT 36561
Hospital Charge Code	36561
Hospital Revenue Code	960
Min. Negotiated Rate	$321.22
Max. Negotiated Rate	$8,919.33
Rate for Payer: Aetna American Axle	$2,195.70
Rate for Payer: Aetna Commercial	$2,871.30
Rate for Payer: Aetna Medicare	$2,946.62
Rate for Payer: Aetna New Business (MI Preferred)	$2,195.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,541.61
Rate for Payer: Amish Plain Church Group Commercial	$3,541.61
Rate for Payer: BCBS Complete	$1,627.44
Rate for Payer: BCBS MAPPO	$2,833.29
Rate for Payer: BCBS Trust/PPO	$2,441.65
Rate for Payer: BCN Medicare Advantage	$2,833.29
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cofinity Commercial	$2,364.60
Rate for Payer: Cofinity Commercial	$2,905.08
Rate for Payer: Encore Health Key Benefits Commercial	$2,702.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,833.29
Rate for Payer: Healthscope Commercial	$3,040.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,364.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,533.50
Rate for Payer: Mclaren Medicaid	$1,549.81
Rate for Payer: Mclaren Medicare	$2,833.29
Rate for Payer: Meridian Medicaid	$1,627.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,974.95
Rate for Payer: MI Amish Medical Board Commercial	$3,258.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,871.30
Rate for Payer: PACE Medicare	$2,691.63
Rate for Payer: PACE SWMI	$2,833.29
Rate for Payer: PHP Commercial	$2,871.30
Rate for Payer: PHP Medicare Advantage	$2,833.29
Rate for Payer: Priority Health Choice Medicaid	$1,549.81
Rate for Payer: Priority Health Cigna Priority Health	$2,364.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,919.33
Rate for Payer: Priority Health Medicare	$2,833.29
Rate for Payer: Priority Health Narrow Network	$7,135.46
Rate for Payer: Priority Health SBD	$2,128.14
Rate for Payer: Railroad Medicare Medicare	$2,833.29
Rate for Payer: UHC All Payor (Choice/PPO)	$353.34
Rate for Payer: UHC Dual Complete DSNP	$2,833.29
Rate for Payer: UHC Exchange	$321.22
Rate for Payer: UHC Medicare Advantage	$2,918.29
Rate for Payer: UMR Bronson Commercial	$1,249.86
Rate for Payer: VA VA	$2,833.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,533.50

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

Facility

$3,378.00

Service Code	CPT 36561
Hospital Charge Code	36561
Hospital Revenue Code	960
Min. Negotiated Rate	$1,486.32
Max. Negotiated Rate	$3,040.20
Rate for Payer: Aetna American Axle	$2,195.70
Rate for Payer: Aetna Commercial	$2,871.30
Rate for Payer: Aetna New Business (MI Preferred)	$2,195.70
Rate for Payer: Cash Price	$2,702.40
Rate for Payer: Cofinity Commercial	$2,364.60
Rate for Payer: Cofinity Commercial	$2,905.08
Rate for Payer: Encore Health Key Benefits Commercial	$2,702.40
Rate for Payer: Healthscope Commercial	$3,040.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,364.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,533.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,871.30
Rate for Payer: PHP Commercial	$2,871.30
Rate for Payer: Priority Health Cigna Priority Health	$2,364.60
Rate for Payer: Priority Health SBD	$2,128.14
Rate for Payer: UMR Bronson Commercial	$1,486.32
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,533.50

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

Professional

Both

$3,509.00

Service Code	HCPCS 36560
Min. Negotiated Rate	$244.31
Max. Negotiated Rate	$2,456.30
Rate for Payer: Aetna Commercial	$514.09
Rate for Payer: BCBS Complete	$256.53
Rate for Payer: BCBS Trust/PPO	$2,003.31
Rate for Payer: Cash Price	$2,807.20
Rate for Payer: Cash Price	$2,807.20
Rate for Payer: Meridian Medicaid	$256.53
Rate for Payer: Priority Health Choice Medicaid	$244.31
Rate for Payer: Priority Health Cigna Priority Health	$2,456.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$607.49
Rate for Payer: Priority Health Narrow Network	$607.49
Rate for Payer: Priority Health SBD	$607.49
Rate for Payer: UMR Bronson Commercial	$1,614.14

PR INSJ TUNNELED CTR VAD W/SUBQ PUMP

Professional

Both

$3,519.00

Service Code	HCPCS 36563
Min. Negotiated Rate	$228.34
Max. Negotiated Rate	$2,463.30
Rate for Payer: Aetna Commercial	$489.50
Rate for Payer: BCBS Complete	$239.76
Rate for Payer: BCBS Trust/PPO	$742.79
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Cash Price	$2,815.20
Rate for Payer: Meridian Medicaid	$239.76
Rate for Payer: Priority Health Choice Medicaid	$228.34
Rate for Payer: Priority Health Cigna Priority Health	$2,463.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$573.98
Rate for Payer: Priority Health Narrow Network	$573.98
Rate for Payer: Priority Health SBD	$573.98
Rate for Payer: UMR Bronson Commercial	$1,618.74

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

Professional

Both

$1,943.00

Service Code	HCPCS 36558
Min. Negotiated Rate	$162.52
Max. Negotiated Rate	$1,620.82
Rate for Payer: Aetna Commercial	$346.05
Rate for Payer: BCBS Complete	$170.65
Rate for Payer: BCBS Trust/PPO	$1,620.82
Rate for Payer: Cash Price	$1,554.40
Rate for Payer: Cash Price	$1,554.40
Rate for Payer: Meridian Medicaid	$170.65
Rate for Payer: Priority Health Choice Medicaid	$162.52
Rate for Payer: Priority Health Cigna Priority Health	$1,360.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$406.95
Rate for Payer: Priority Health Narrow Network	$406.95
Rate for Payer: Priority Health SBD	$406.95
Rate for Payer: UMR Bronson Commercial	$893.78

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

Professional

Both

$1,704.00

Service Code	HCPCS 36565
Min. Negotiated Rate	$212.57
Max. Negotiated Rate	$1,192.80
Rate for Payer: Aetna Commercial	$450.12
Rate for Payer: BCBS Complete	$223.20
Rate for Payer: BCBS Trust/PPO	$705.81
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Meridian Medicaid	$223.20
Rate for Payer: Priority Health Choice Medicaid	$212.57
Rate for Payer: Priority Health Cigna Priority Health	$1,192.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$527.17
Rate for Payer: Priority Health Narrow Network	$527.17
Rate for Payer: Priority Health SBD	$527.17
Rate for Payer: UMR Bronson Commercial	$783.84

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

Professional

Both

$2,850.00

Service Code	HCPCS 36566
Min. Negotiated Rate	$224.72
Max. Negotiated Rate	$1,995.00
Rate for Payer: Aetna Commercial	$481.26
Rate for Payer: BCBS Complete	$235.96
Rate for Payer: BCBS Trust/PPO	$907.09
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Meridian Medicaid	$235.96
Rate for Payer: Priority Health Choice Medicaid	$224.72
Rate for Payer: Priority Health Cigna Priority Health	$1,995.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$560.68
Rate for Payer: Priority Health Narrow Network	$560.68
Rate for Payer: Priority Health SBD	$560.68
Rate for Payer: UMR Bronson Commercial	$1,311.00

Know your out-of-pocket cost for care.

All Charges