Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING URETERAL STENT)

Facility

$1,832.42

Service Code	CPT 50389
Hospital Revenue Code	360
Min. Negotiated Rate	$348.92
Max. Negotiated Rate	$1,832.42
Rate for Payer: Aetna Medicare	$677.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$813.71
Rate for Payer: Amish Plain Church Group Commercial	$813.71
Rate for Payer: BCBS Complete	$366.37
Rate for Payer: BCBS MAPPO	$650.97
Rate for Payer: BCN Medicare Advantage	$650.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$650.97
Rate for Payer: Mclaren Medicaid	$348.92
Rate for Payer: Mclaren Medicare	$650.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$683.52
Rate for Payer: Meridian Medicaid	$366.37
Rate for Payer: MI Amish Medical Board Commercial	$748.62
Rate for Payer: PACE Medicare	$618.42
Rate for Payer: PACE SWMI	$650.97
Rate for Payer: PHP Medicare Advantage	$650.97
Rate for Payer: Priority Health Choice Medicaid	$348.92
Rate for Payer: Priority Health Medicare	$650.97
Rate for Payer: Railroad Medicare Medicare	$650.97
Rate for Payer: UHC All Payor (Choice/PPO)	$1,832.42
Rate for Payer: UHC Dual Complete DSNP	$650.97
Rate for Payer: UHC Medicare Advantage	$650.97
Rate for Payer: UHCCP Medicaid	$366.50
Rate for Payer: VA VA	$650.97

REMOVAL OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS, WITHOUT REPLACEMENT OF PROSTHESIS

Facility

$9,468.51

Service Code	CPT 54415
Hospital Revenue Code	360
Min. Negotiated Rate	$1,802.95
Max. Negotiated Rate	$9,468.51
Rate for Payer: Aetna Medicare	$3,498.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,204.64
Rate for Payer: Amish Plain Church Group Commercial	$4,204.64
Rate for Payer: BCBS Complete	$1,893.10
Rate for Payer: BCBS MAPPO	$3,363.71
Rate for Payer: BCN Medicare Advantage	$3,363.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,363.71
Rate for Payer: Mclaren Medicaid	$1,802.95
Rate for Payer: Mclaren Medicare	$3,363.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,531.90
Rate for Payer: Meridian Medicaid	$1,893.10
Rate for Payer: MI Amish Medical Board Commercial	$3,868.27
Rate for Payer: PACE Medicare	$3,195.52
Rate for Payer: PACE SWMI	$3,363.71
Rate for Payer: PHP Medicare Advantage	$3,363.71
Rate for Payer: Priority Health Choice Medicaid	$1,802.95
Rate for Payer: Priority Health Medicare	$3,363.71
Rate for Payer: Railroad Medicare Medicare	$3,363.71
Rate for Payer: UHC All Payor (Choice/PPO)	$9,468.51
Rate for Payer: UHC Dual Complete DSNP	$3,363.71
Rate for Payer: UHC Medicare Advantage	$3,363.71
Rate for Payer: UHCCP Medicaid	$1,893.77
Rate for Payer: VA VA	$3,363.71

REMOVAL OF RUPTURED BREAST IMPLANT, INCLUDING IMPLANT CONTENTS (EG, SALINE, SILICONE GEL)

Facility

$10,512.58

Service Code	CPT 19330
Hospital Revenue Code	360
Min. Negotiated Rate	$2,001.76
Max. Negotiated Rate	$10,512.58
Rate for Payer: Aetna Medicare	$3,884.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,668.27
Rate for Payer: Amish Plain Church Group Commercial	$4,668.27
Rate for Payer: BCBS Complete	$2,101.84
Rate for Payer: BCBS MAPPO	$3,734.62
Rate for Payer: BCN Medicare Advantage	$3,734.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,734.62
Rate for Payer: Mclaren Medicaid	$2,001.76
Rate for Payer: Mclaren Medicare	$3,734.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,921.35
Rate for Payer: Meridian Medicaid	$2,101.84
Rate for Payer: MI Amish Medical Board Commercial	$4,294.81
Rate for Payer: PACE Medicare	$3,547.89
Rate for Payer: PACE SWMI	$3,734.62
Rate for Payer: PHP Medicare Advantage	$3,734.62
Rate for Payer: Priority Health Choice Medicaid	$2,001.76
Rate for Payer: Priority Health Medicare	$3,734.62
Rate for Payer: Railroad Medicare Medicare	$3,734.62
Rate for Payer: UHC All Payor (Choice/PPO)	$10,512.58
Rate for Payer: UHC Dual Complete DSNP	$3,734.62
Rate for Payer: UHC Medicare Advantage	$3,734.62
Rate for Payer: UHCCP Medicaid	$2,102.59
Rate for Payer: VA VA	$3,734.62

REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS

Facility

$545.50

Service Code	CPT 11200
Hospital Revenue Code	360
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED

Facility

$9,441.17

Service Code	CPT 63662
Hospital Revenue Code	360
Min. Negotiated Rate	$1,797.74
Max. Negotiated Rate	$9,441.17
Rate for Payer: Aetna Medicare	$3,488.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,192.50
Rate for Payer: Amish Plain Church Group Commercial	$4,192.50
Rate for Payer: BCBS Complete	$1,887.63
Rate for Payer: BCBS MAPPO	$3,354.00
Rate for Payer: BCN Medicare Advantage	$3,354.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,354.00
Rate for Payer: Mclaren Medicaid	$1,797.74
Rate for Payer: Mclaren Medicare	$3,354.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,521.70
Rate for Payer: Meridian Medicaid	$1,887.63
Rate for Payer: MI Amish Medical Board Commercial	$3,857.10
Rate for Payer: PACE Medicare	$3,186.30
Rate for Payer: PACE SWMI	$3,354.00
Rate for Payer: PHP Medicare Advantage	$3,354.00
Rate for Payer: Priority Health Choice Medicaid	$1,797.74
Rate for Payer: Priority Health Medicare	$3,354.00
Rate for Payer: Railroad Medicare Medicare	$3,354.00
Rate for Payer: UHC All Payor (Choice/PPO)	$9,441.17
Rate for Payer: UHC Dual Complete DSNP	$3,354.00
Rate for Payer: UHC Medicare Advantage	$3,354.00
Rate for Payer: UHCCP Medicaid	$1,888.30
Rate for Payer: VA VA	$3,354.00

REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)

Facility

$5,021.81

Service Code	CPT 15851
Hospital Revenue Code	360
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$5,021.81
Rate for Payer: Aetna Medicare	$1,855.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC All Payor (Choice/PPO)	$5,021.81
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP Medicaid	$1,004.40
Rate for Payer: VA VA	$1,784.01

REMOVAL OF TISSUE EXPANDER WITHOUT INSERTION OF IMPLANT

Facility

$7,857.23

Service Code	CPT 11971
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION

Facility

$4,264.69

Service Code	CPT 36590
Hospital Revenue Code	360
Min. Negotiated Rate	$812.06
Max. Negotiated Rate	$4,264.69
Rate for Payer: Aetna Medicare	$1,575.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,893.80
Rate for Payer: Amish Plain Church Group Commercial	$1,893.80
Rate for Payer: BCBS Complete	$852.66
Rate for Payer: BCBS MAPPO	$1,515.04
Rate for Payer: BCN Medicare Advantage	$1,515.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,515.04
Rate for Payer: Mclaren Medicaid	$812.06
Rate for Payer: Mclaren Medicare	$1,515.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,590.79
Rate for Payer: Meridian Medicaid	$852.66
Rate for Payer: MI Amish Medical Board Commercial	$1,742.30
Rate for Payer: PACE Medicare	$1,439.29
Rate for Payer: PACE SWMI	$1,515.04
Rate for Payer: PHP Medicare Advantage	$1,515.04
Rate for Payer: Priority Health Choice Medicaid	$812.06
Rate for Payer: Priority Health Medicare	$1,515.04
Rate for Payer: Railroad Medicare Medicare	$1,515.04
Rate for Payer: UHC All Payor (Choice/PPO)	$4,264.69
Rate for Payer: UHC Dual Complete DSNP	$1,515.04
Rate for Payer: UHC Medicare Advantage	$1,515.04
Rate for Payer: UHCCP Medicaid	$852.97
Rate for Payer: VA VA	$1,515.04

REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP

Facility

$1,697.33

Service Code	CPT 36589
Hospital Revenue Code	360
Min. Negotiated Rate	$323.20
Max. Negotiated Rate	$1,697.33
Rate for Payer: Aetna Medicare	$627.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$753.73
Rate for Payer: Amish Plain Church Group Commercial	$753.73
Rate for Payer: BCBS Complete	$339.36
Rate for Payer: BCBS MAPPO	$602.98
Rate for Payer: BCN Medicare Advantage	$602.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$602.98
Rate for Payer: Mclaren Medicaid	$323.20
Rate for Payer: Mclaren Medicare	$602.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$633.13
Rate for Payer: Meridian Medicaid	$339.36
Rate for Payer: MI Amish Medical Board Commercial	$693.43
Rate for Payer: PACE Medicare	$572.83
Rate for Payer: PACE SWMI	$602.98
Rate for Payer: PHP Medicare Advantage	$602.98
Rate for Payer: Priority Health Choice Medicaid	$323.20
Rate for Payer: Priority Health Medicare	$602.98
Rate for Payer: Railroad Medicare Medicare	$602.98
Rate for Payer: UHC All Payor (Choice/PPO)	$1,697.33
Rate for Payer: UHC Dual Complete DSNP	$602.98
Rate for Payer: UHC Medicare Advantage	$602.98
Rate for Payer: UHCCP Medicaid	$339.48
Rate for Payer: VA VA	$602.98

REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$8,640.87

Service Code	CPT 49422
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)

Facility

$13,956.13

Service Code	CPT 53442
Hospital Revenue Code	360
Min. Negotiated Rate	$2,657.46
Max. Negotiated Rate	$13,956.13
Rate for Payer: Aetna Medicare	$5,156.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,197.44
Rate for Payer: Amish Plain Church Group Commercial	$6,197.44
Rate for Payer: BCBS Complete	$2,790.33
Rate for Payer: BCBS MAPPO	$4,957.95
Rate for Payer: BCN Medicare Advantage	$4,957.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,957.95
Rate for Payer: Mclaren Medicaid	$2,657.46
Rate for Payer: Mclaren Medicare	$4,957.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,205.85
Rate for Payer: Meridian Medicaid	$2,790.33
Rate for Payer: MI Amish Medical Board Commercial	$5,701.64
Rate for Payer: PACE Medicare	$4,710.05
Rate for Payer: PACE SWMI	$4,957.95
Rate for Payer: PHP Medicare Advantage	$4,957.95
Rate for Payer: Priority Health Choice Medicaid	$2,657.46
Rate for Payer: Priority Health Medicare	$4,957.95
Rate for Payer: Railroad Medicare Medicare	$4,957.95
Rate for Payer: UHC All Payor (Choice/PPO)	$13,956.13
Rate for Payer: UHC Dual Complete DSNP	$4,957.95
Rate for Payer: UHC Medicare Advantage	$4,957.95
Rate for Payer: UHCCP Medicaid	$2,791.33
Rate for Payer: VA VA	$4,957.95

REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

Facility

$8,728.81

Service Code	CPT 57287
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,745.82
Rate for Payer: VA VA	$3,100.93

REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM

Facility

$4,393.64

Service Code	CPT 20694
Hospital Revenue Code	360
Min. Negotiated Rate	$836.62
Max. Negotiated Rate	$4,393.64
Rate for Payer: Aetna Medicare	$1,623.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,951.06
Rate for Payer: Amish Plain Church Group Commercial	$1,951.06
Rate for Payer: BCBS Complete	$878.45
Rate for Payer: BCBS MAPPO	$1,560.85
Rate for Payer: BCN Medicare Advantage	$1,560.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,560.85
Rate for Payer: Mclaren Medicaid	$836.62
Rate for Payer: Mclaren Medicare	$1,560.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,638.89
Rate for Payer: Meridian Medicaid	$878.45
Rate for Payer: MI Amish Medical Board Commercial	$1,794.98
Rate for Payer: PACE Medicare	$1,482.81
Rate for Payer: PACE SWMI	$1,560.85
Rate for Payer: PHP Medicare Advantage	$1,560.85
Rate for Payer: Priority Health Choice Medicaid	$836.62
Rate for Payer: Priority Health Medicare	$1,560.85
Rate for Payer: Railroad Medicare Medicare	$1,560.85
Rate for Payer: UHC All Payor (Choice/PPO)	$4,393.64
Rate for Payer: UHC Dual Complete DSNP	$1,560.85
Rate for Payer: UHC Medicare Advantage	$1,560.85
Rate for Payer: UHCCP Medicaid	$878.76
Rate for Payer: VA VA	$1,560.85

REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

Facility

$1,095.50

Service Code	CPT 11983
Hospital Revenue Code	360
Min. Negotiated Rate	$208.60
Max. Negotiated Rate	$1,095.50
Rate for Payer: Aetna Medicare	$404.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$486.48
Rate for Payer: Amish Plain Church Group Commercial	$486.48
Rate for Payer: BCBS Complete	$219.03
Rate for Payer: BCBS MAPPO	$389.18
Rate for Payer: BCN Medicare Advantage	$389.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.18
Rate for Payer: Mclaren Medicaid	$208.60
Rate for Payer: Mclaren Medicare	$389.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$408.64
Rate for Payer: Meridian Medicaid	$219.03
Rate for Payer: MI Amish Medical Board Commercial	$447.56
Rate for Payer: PACE Medicare	$369.72
Rate for Payer: PACE SWMI	$389.18
Rate for Payer: PHP Medicare Advantage	$389.18
Rate for Payer: Priority Health Choice Medicaid	$208.60
Rate for Payer: Priority Health Medicare	$389.18
Rate for Payer: Railroad Medicare Medicare	$389.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,095.50
Rate for Payer: UHC Dual Complete DSNP	$389.18
Rate for Payer: UHC Medicare Advantage	$389.18
Rate for Payer: UHCCP Medicaid	$219.11
Rate for Payer: VA VA	$389.18

REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY

Facility

$8,640.87

Service Code	CPT 35206
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY

Facility

$14,840.35

Service Code	CPT 35236
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM

Facility

$1,096.83

Service Code	CPT 13131
Hospital Revenue Code	360
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM

Facility

$1,680.50

Service Code	CPT 13132
Hospital Revenue Code	360
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$1,680.50
Rate for Payer: Aetna Medicare	$620.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$746.25
Rate for Payer: Amish Plain Church Group Commercial	$746.25
Rate for Payer: BCBS Complete	$335.99
Rate for Payer: BCBS MAPPO	$597.00
Rate for Payer: BCN Medicare Advantage	$597.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$597.00
Rate for Payer: Mclaren Medicaid	$319.99
Rate for Payer: Mclaren Medicare	$597.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$626.85
Rate for Payer: Meridian Medicaid	$335.99
Rate for Payer: MI Amish Medical Board Commercial	$686.55
Rate for Payer: PACE Medicare	$567.15
Rate for Payer: PACE SWMI	$597.00
Rate for Payer: PHP Medicare Advantage	$597.00
Rate for Payer: Priority Health Choice Medicaid	$319.99
Rate for Payer: Priority Health Medicare	$597.00
Rate for Payer: Railroad Medicare Medicare	$597.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,680.50
Rate for Payer: UHC Dual Complete DSNP	$597.00
Rate for Payer: UHC Medicare Advantage	$597.00
Rate for Payer: UHCCP Medicaid	$336.11
Rate for Payer: VA VA	$597.00

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM

Facility

$1,680.50

Service Code	CPT 13121
Hospital Revenue Code	360
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$1,680.50
Rate for Payer: Aetna Medicare	$620.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$746.25
Rate for Payer: Amish Plain Church Group Commercial	$746.25
Rate for Payer: BCBS Complete	$335.99
Rate for Payer: BCBS MAPPO	$597.00
Rate for Payer: BCN Medicare Advantage	$597.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$597.00
Rate for Payer: Mclaren Medicaid	$319.99
Rate for Payer: Mclaren Medicare	$597.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$626.85
Rate for Payer: Meridian Medicaid	$335.99
Rate for Payer: MI Amish Medical Board Commercial	$686.55
Rate for Payer: PACE Medicare	$567.15
Rate for Payer: PACE SWMI	$597.00
Rate for Payer: PHP Medicare Advantage	$597.00
Rate for Payer: Priority Health Choice Medicaid	$319.99
Rate for Payer: Priority Health Medicare	$597.00
Rate for Payer: Railroad Medicare Medicare	$597.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,680.50
Rate for Payer: UHC Dual Complete DSNP	$597.00
Rate for Payer: UHC Medicare Advantage	$597.00
Rate for Payer: UHCCP Medicaid	$336.11
Rate for Payer: VA VA	$597.00

REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM

Facility

$1,680.50

Service Code	CPT 13101
Hospital Revenue Code	360
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$1,680.50
Rate for Payer: Aetna Medicare	$620.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$746.25
Rate for Payer: Amish Plain Church Group Commercial	$746.25
Rate for Payer: BCBS Complete	$335.99
Rate for Payer: BCBS MAPPO	$597.00
Rate for Payer: BCN Medicare Advantage	$597.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$597.00
Rate for Payer: Mclaren Medicaid	$319.99
Rate for Payer: Mclaren Medicare	$597.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$626.85
Rate for Payer: Meridian Medicaid	$335.99
Rate for Payer: MI Amish Medical Board Commercial	$686.55
Rate for Payer: PACE Medicare	$567.15
Rate for Payer: PACE SWMI	$597.00
Rate for Payer: PHP Medicare Advantage	$597.00
Rate for Payer: Priority Health Choice Medicaid	$319.99
Rate for Payer: Priority Health Medicare	$597.00
Rate for Payer: Railroad Medicare Medicare	$597.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,680.50
Rate for Payer: UHC Dual Complete DSNP	$597.00
Rate for Payer: UHC Medicare Advantage	$597.00
Rate for Payer: UHCCP Medicaid	$336.11
Rate for Payer: VA VA	$597.00

REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON

Facility

$4,393.64

Service Code	CPT 26410
Hospital Revenue Code	360
Min. Negotiated Rate	$836.62
Max. Negotiated Rate	$4,393.64
Rate for Payer: Aetna Medicare	$1,623.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,951.06
Rate for Payer: Amish Plain Church Group Commercial	$1,951.06
Rate for Payer: BCBS Complete	$878.45
Rate for Payer: BCBS MAPPO	$1,560.85
Rate for Payer: BCN Medicare Advantage	$1,560.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,560.85
Rate for Payer: Mclaren Medicaid	$836.62
Rate for Payer: Mclaren Medicare	$1,560.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,638.89
Rate for Payer: Meridian Medicaid	$878.45
Rate for Payer: MI Amish Medical Board Commercial	$1,794.98
Rate for Payer: PACE Medicare	$1,482.81
Rate for Payer: PACE SWMI	$1,560.85
Rate for Payer: PHP Medicare Advantage	$1,560.85
Rate for Payer: Priority Health Choice Medicaid	$836.62
Rate for Payer: Priority Health Medicare	$1,560.85
Rate for Payer: Railroad Medicare Medicare	$1,560.85
Rate for Payer: UHC All Payor (Choice/PPO)	$4,393.64
Rate for Payer: UHC Dual Complete DSNP	$1,560.85
Rate for Payer: UHC Medicare Advantage	$1,560.85
Rate for Payer: UHCCP Medicaid	$878.76
Rate for Payer: VA VA	$1,560.85

REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON

Facility

$19,611.80

Service Code	CPT 27665
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON

Facility

$8,907.47

Service Code	CPT 27658
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON

Facility

$19,611.80

Service Code	CPT 27659
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED

Facility

$9,688.38

Service Code	CPT 49553
Hospital Revenue Code	360
Min. Negotiated Rate	$1,844.82
Max. Negotiated Rate	$9,688.38
Rate for Payer: Aetna Medicare	$3,579.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,302.27
Rate for Payer: Amish Plain Church Group Commercial	$4,302.27
Rate for Payer: BCBS Complete	$1,937.06
Rate for Payer: BCBS MAPPO	$3,441.82
Rate for Payer: BCN Medicare Advantage	$3,441.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,441.82
Rate for Payer: Mclaren Medicaid	$1,844.82
Rate for Payer: Mclaren Medicare	$3,441.82
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,613.91
Rate for Payer: Meridian Medicaid	$1,937.06
Rate for Payer: MI Amish Medical Board Commercial	$3,958.09
Rate for Payer: PACE Medicare	$3,269.73
Rate for Payer: PACE SWMI	$3,441.82
Rate for Payer: PHP Medicare Advantage	$3,441.82
Rate for Payer: Priority Health Choice Medicaid	$1,844.82
Rate for Payer: Priority Health Medicare	$3,441.82
Rate for Payer: Railroad Medicare Medicare	$3,441.82
Rate for Payer: UHC All Payor (Choice/PPO)	$9,688.38
Rate for Payer: UHC Dual Complete DSNP	$3,441.82
Rate for Payer: UHC Medicare Advantage	$3,441.82
Rate for Payer: UHCCP Medicaid	$1,937.74
Rate for Payer: VA VA	$3,441.82

Know your out-of-pocket cost for care.

All Charges