Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INPATIENT APRDRG 9504: EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$30,257.06

Service Code	APR-DRG 9504
Hospital Charge Code	APRDRG 9504
Min. Negotiated Rate	$28,816.25
Max. Negotiated Rate	$30,257.06
Rate for Payer: BCBS Complete	$30,257.06
Rate for Payer: Mclaren Medicaid	$28,816.25
Rate for Payer: Meridian Medicaid	$30,257.06
Rate for Payer: Priority Health Choice Medicaid	$28,816.25

INPATIENT APRDRG 9511: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,489.86

Service Code	APR-DRG 9511
Hospital Charge Code	APRDRG 9511
Min. Negotiated Rate	$7,133.20
Max. Negotiated Rate	$7,489.86
Rate for Payer: BCBS Complete	$7,489.86
Rate for Payer: Mclaren Medicaid	$7,133.20
Rate for Payer: Meridian Medicaid	$7,489.86
Rate for Payer: Priority Health Choice Medicaid	$7,133.20

INPATIENT APRDRG 9512: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,061.99

Service Code	APR-DRG 9512
Hospital Charge Code	APRDRG 9512
Min. Negotiated Rate	$8,630.47
Max. Negotiated Rate	$9,061.99
Rate for Payer: BCBS Complete	$9,061.99
Rate for Payer: Mclaren Medicaid	$8,630.47
Rate for Payer: Meridian Medicaid	$9,061.99
Rate for Payer: Priority Health Choice Medicaid	$8,630.47

INPATIENT APRDRG 9513: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,710.43

Service Code	APR-DRG 9513
Hospital Charge Code	APRDRG 9513
Min. Negotiated Rate	$12,105.17
Max. Negotiated Rate	$12,710.43
Rate for Payer: BCBS Complete	$12,710.43
Rate for Payer: Mclaren Medicaid	$12,105.17
Rate for Payer: Meridian Medicaid	$12,710.43
Rate for Payer: Priority Health Choice Medicaid	$12,105.17

INPATIENT APRDRG 9514: MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$22,294.48

Service Code	APR-DRG 9514
Hospital Charge Code	APRDRG 9514
Min. Negotiated Rate	$21,232.84
Max. Negotiated Rate	$22,294.48
Rate for Payer: BCBS Complete	$22,294.48
Rate for Payer: Mclaren Medicaid	$21,232.84
Rate for Payer: Meridian Medicaid	$22,294.48
Rate for Payer: Priority Health Choice Medicaid	$21,232.84

INPATIENT APRDRG 9521: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,177.40

Service Code	APR-DRG 9521
Hospital Charge Code	APRDRG 9521
Min. Negotiated Rate	$5,883.24
Max. Negotiated Rate	$6,177.40
Rate for Payer: BCBS Complete	$6,177.40
Rate for Payer: Mclaren Medicaid	$5,883.24
Rate for Payer: Meridian Medicaid	$6,177.40
Rate for Payer: Priority Health Choice Medicaid	$5,883.24

INPATIENT APRDRG 9522: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,952.28

Service Code	APR-DRG 9522
Hospital Charge Code	APRDRG 9522
Min. Negotiated Rate	$7,573.60
Max. Negotiated Rate	$7,952.28
Rate for Payer: BCBS Complete	$7,952.28
Rate for Payer: Mclaren Medicaid	$7,573.60
Rate for Payer: Meridian Medicaid	$7,952.28
Rate for Payer: Priority Health Choice Medicaid	$7,573.60

INPATIENT APRDRG 9523: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$10,708.94

Service Code	APR-DRG 9523
Hospital Charge Code	APRDRG 9523
Min. Negotiated Rate	$10,198.99
Max. Negotiated Rate	$10,708.94
Rate for Payer: BCBS Complete	$10,708.94
Rate for Payer: Mclaren Medicaid	$10,198.99
Rate for Payer: Meridian Medicaid	$10,708.94
Rate for Payer: Priority Health Choice Medicaid	$10,198.99

INPATIENT APRDRG 9524: NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$21,471.01

Service Code	APR-DRG 9524
Hospital Charge Code	APRDRG 9524
Min. Negotiated Rate	$20,448.58
Max. Negotiated Rate	$21,471.01
Rate for Payer: BCBS Complete	$21,471.01
Rate for Payer: Mclaren Medicaid	$20,448.58
Rate for Payer: Meridian Medicaid	$21,471.01
Rate for Payer: Priority Health Choice Medicaid	$20,448.58

INPT/ED TELECONSULT30

Professional

Both

$197.00

Service Code	HCPCS G0425
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$491.32
Rate for Payer: Aetna Commercial	$99.61
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCBS Trust/PPO	$491.32
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$117.79
Rate for Payer: Priority Health Narrow Network	$117.79
Rate for Payer: Priority Health SBD	$117.79

INPT/ED TELECONSULT50

Professional

Both

$267.00

Service Code	HCPCS G0426
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$562.64
Rate for Payer: Aetna Commercial	$133.90
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCBS Trust/PPO	$562.64
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Mclaren Medicaid	$82.86
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$165.33
Rate for Payer: Priority Health Narrow Network	$165.33
Rate for Payer: Priority Health SBD	$165.33

INPT/ED TELECONSULT70

Professional

Both

$396.00

Service Code	HCPCS G0427
Min. Negotiated Rate	$117.15
Max. Negotiated Rate	$348.68
Rate for Payer: Aetna Commercial	$197.06
Rate for Payer: BCBS Complete	$123.01
Rate for Payer: BCBS Trust/PPO	$348.68
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Mclaren Medicaid	$117.15
Rate for Payer: Meridian Medicaid	$123.01
Rate for Payer: Priority Health Choice Medicaid	$117.15
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.15
Rate for Payer: Priority Health Narrow Network	$235.15
Rate for Payer: Priority Health SBD	$235.15

INPT/TELE FOLLOW UP 35

Professional

Both

$180.00

Service Code	HCPCS G0408
Min. Negotiated Rate	$66.46
Max. Negotiated Rate	$1,554.26
Rate for Payer: Aetna Commercial	$101.64
Rate for Payer: BCBS Complete	$69.78
Rate for Payer: BCBS Trust/PPO	$1,554.26
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Mclaren Medicaid	$66.46
Rate for Payer: Meridian Medicaid	$69.78
Rate for Payer: Priority Health Choice Medicaid	$66.46
Rate for Payer: Priority Health Cigna Priority Health	$126.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.14
Rate for Payer: Priority Health Narrow Network	$140.14
Rate for Payer: Priority Health SBD	$140.14

INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)

Facility

$878.00

Service Code	CPT 11981
Hospital Revenue Code	360
Min. Negotiated Rate	$61.23
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Medicare	$118.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$142.08
Rate for Payer: Amish Plain Church Group Commercial	$142.08
Rate for Payer: BCBS Complete	$65.29
Rate for Payer: BCBS MAPPO	$113.66
Rate for Payer: BCBS Trust/PPO	$72.58
Rate for Payer: BCN Medicare Advantage	$113.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.66
Rate for Payer: Mclaren Medicaid	$62.17
Rate for Payer: Mclaren Medicare	$113.66
Rate for Payer: Meridian Medicaid	$65.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$119.34
Rate for Payer: MI Amish Medical Board Commercial	$130.71
Rate for Payer: PACE Medicare	$107.98
Rate for Payer: PACE SWMI	$113.66
Rate for Payer: PHP Medicare Advantage	$113.66
Rate for Payer: Priority Health Choice Medicaid	$62.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$351.10
Rate for Payer: Priority Health Medicare	$113.66
Rate for Payer: Priority Health Narrow Network	$280.88
Rate for Payer: Railroad Medicare Medicare	$113.66
Rate for Payer: UHC All Payor (Choice/PPO)	$67.35
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$113.66
Rate for Payer: UHC Exchange	$61.23
Rate for Payer: UHC Medicare Advantage	$117.07
Rate for Payer: VA VA	$113.66

INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)

Facility

$17,231.52

Service Code	CPT 19340
Hospital Revenue Code	360
Min. Negotiated Rate	$748.86
Max. Negotiated Rate	$17,231.52
Rate for Payer: Aetna Medicare	$6,034.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,253.02
Rate for Payer: Amish Plain Church Group Commercial	$7,253.02
Rate for Payer: BCBS Complete	$3,332.91
Rate for Payer: BCBS MAPPO	$5,802.42
Rate for Payer: BCBS Trust/PPO	$5,244.85
Rate for Payer: BCN Medicare Advantage	$5,802.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,802.42
Rate for Payer: Mclaren Medicaid	$3,173.92
Rate for Payer: Mclaren Medicare	$5,802.42
Rate for Payer: Meridian Medicaid	$3,332.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,092.54
Rate for Payer: MI Amish Medical Board Commercial	$6,672.78
Rate for Payer: PACE Medicare	$5,512.30
Rate for Payer: PACE SWMI	$5,802.42
Rate for Payer: PHP Medicare Advantage	$5,802.42
Rate for Payer: Priority Health Choice Medicaid	$3,173.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,231.52
Rate for Payer: Priority Health Medicare	$5,802.42
Rate for Payer: Priority Health Narrow Network	$13,785.22
Rate for Payer: Railroad Medicare Medicare	$5,802.42
Rate for Payer: UHC All Payor (Choice/PPO)	$823.75
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$5,802.42
Rate for Payer: UHC Exchange	$748.86
Rate for Payer: UHC Medicare Advantage	$5,976.49
Rate for Payer: VA VA	$5,802.42

INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP, RESERVOIR, AND CUFF

Facility

$57,816.97

Service Code	CPT 53445
Hospital Revenue Code	360
Min. Negotiated Rate	$741.98
Max. Negotiated Rate	$57,816.97
Rate for Payer: Aetna Medicare	$18,666.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,435.89
Rate for Payer: Amish Plain Church Group Commercial	$22,435.89
Rate for Payer: BCBS Complete	$10,309.74
Rate for Payer: BCBS MAPPO	$17,948.71
Rate for Payer: BCBS Trust/PPO	$9,413.32
Rate for Payer: BCN Medicare Advantage	$17,948.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,948.71
Rate for Payer: Mclaren Medicaid	$9,817.94
Rate for Payer: Mclaren Medicare	$17,948.71
Rate for Payer: Meridian Medicaid	$10,309.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$18,846.15
Rate for Payer: MI Amish Medical Board Commercial	$20,641.02
Rate for Payer: PACE Medicare	$17,051.27
Rate for Payer: PACE SWMI	$17,948.71
Rate for Payer: PHP Medicare Advantage	$17,948.71
Rate for Payer: Priority Health Choice Medicaid	$9,817.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57,816.97
Rate for Payer: Priority Health Medicare	$17,948.71
Rate for Payer: Priority Health Narrow Network	$46,253.58
Rate for Payer: Railroad Medicare Medicare	$17,948.71
Rate for Payer: UHC All Payor (Choice/PPO)	$816.18
Rate for Payer: UHC Core	$10,600.00
Rate for Payer: UHC Dual Complete DSNP	$17,948.71
Rate for Payer: UHC Exchange	$741.98
Rate for Payer: UHC Medicare Advantage	$18,487.17
Rate for Payer: VA VA	$17,948.71

INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$878.00

Service Code	CPT 22853
Hospital Revenue Code	360
Min. Negotiated Rate	$252.13
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$537.99
Rate for Payer: UHC All Payor (Choice/PPO)	$277.34
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$252.13

INSERTION OF INTRAUTERINE DEVICE (IUD)

Facility

$878.00

Service Code	CPT 58300
Hospital Revenue Code	360
Min. Negotiated Rate	$49.12
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$422.51
Rate for Payer: UHC All Payor (Choice/PPO)	$54.03
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$49.12

INSERTION OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED

Facility

$14,847.89

Service Code	CPT 37191
Hospital Revenue Code	360
Min. Negotiated Rate	$210.22
Max. Negotiated Rate	$14,847.89
Rate for Payer: Aetna Medicare	$5,085.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,112.15
Rate for Payer: Amish Plain Church Group Commercial	$6,112.15
Rate for Payer: BCBS Complete	$2,808.66
Rate for Payer: BCBS MAPPO	$4,889.72
Rate for Payer: BCBS Trust/PPO	$2,294.87
Rate for Payer: BCN Medicare Advantage	$4,889.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,889.72
Rate for Payer: Mclaren Medicaid	$2,674.68
Rate for Payer: Mclaren Medicare	$4,889.72
Rate for Payer: Meridian Medicaid	$2,808.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,134.21
Rate for Payer: MI Amish Medical Board Commercial	$5,623.18
Rate for Payer: PACE Medicare	$4,645.23
Rate for Payer: PACE SWMI	$4,889.72
Rate for Payer: PHP Medicare Advantage	$4,889.72
Rate for Payer: Priority Health Choice Medicaid	$2,674.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14,847.89
Rate for Payer: Priority Health Medicare	$4,889.72
Rate for Payer: Priority Health Narrow Network	$11,878.31
Rate for Payer: Railroad Medicare Medicare	$4,889.72
Rate for Payer: UHC All Payor (Choice/PPO)	$231.24
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$4,889.72
Rate for Payer: UHC Exchange	$210.22
Rate for Payer: UHC Medicare Advantage	$5,036.41
Rate for Payer: VA VA	$4,889.72

INSERTION OF MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDERS, AND RESERVOIR

Facility

$57,816.97

Service Code	CPT 54405
Hospital Revenue Code	360
Min. Negotiated Rate	$789.79
Max. Negotiated Rate	$57,816.97
Rate for Payer: Aetna Medicare	$18,666.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,435.89
Rate for Payer: Amish Plain Church Group Commercial	$22,435.89
Rate for Payer: BCBS Complete	$10,309.74
Rate for Payer: BCBS MAPPO	$17,948.71
Rate for Payer: BCBS Trust/PPO	$10,269.07
Rate for Payer: BCN Medicare Advantage	$17,948.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,948.71
Rate for Payer: Mclaren Medicaid	$9,817.94
Rate for Payer: Mclaren Medicare	$17,948.71
Rate for Payer: Meridian Medicaid	$10,309.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$18,846.15
Rate for Payer: MI Amish Medical Board Commercial	$20,641.02
Rate for Payer: PACE Medicare	$17,051.27
Rate for Payer: PACE SWMI	$17,948.71
Rate for Payer: PHP Medicare Advantage	$17,948.71
Rate for Payer: Priority Health Choice Medicaid	$9,817.94
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$57,816.97
Rate for Payer: Priority Health Medicare	$17,948.71
Rate for Payer: Priority Health Narrow Network	$46,253.58
Rate for Payer: Railroad Medicare Medicare	$17,948.71
Rate for Payer: UHC All Payor (Choice/PPO)	$868.77
Rate for Payer: UHC Core	$10,600.00
Rate for Payer: UHC Dual Complete DSNP	$17,948.71
Rate for Payer: UHC Exchange	$789.79
Rate for Payer: UHC Medicare Advantage	$18,487.17
Rate for Payer: VA VA	$17,948.71

INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)

Facility

$13,737.10

Service Code	CPT 54660
Hospital Revenue Code	360
Min. Negotiated Rate	$353.96
Max. Negotiated Rate	$13,737.10
Rate for Payer: Aetna Medicare	$4,788.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,755.12
Rate for Payer: Amish Plain Church Group Commercial	$5,755.12
Rate for Payer: BCBS Complete	$2,644.60
Rate for Payer: BCBS MAPPO	$4,604.10
Rate for Payer: BCBS Trust/PPO	$1,510.65
Rate for Payer: BCN Medicare Advantage	$4,604.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,604.10
Rate for Payer: Mclaren Medicaid	$2,518.44
Rate for Payer: Mclaren Medicare	$4,604.10
Rate for Payer: Meridian Medicaid	$2,644.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,834.30
Rate for Payer: MI Amish Medical Board Commercial	$5,294.72
Rate for Payer: PACE Medicare	$4,373.90
Rate for Payer: PACE SWMI	$4,604.10
Rate for Payer: PHP Medicare Advantage	$4,604.10
Rate for Payer: Priority Health Choice Medicaid	$2,518.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,737.10
Rate for Payer: Priority Health Medicare	$4,604.10
Rate for Payer: Priority Health Narrow Network	$10,989.68
Rate for Payer: Railroad Medicare Medicare	$4,604.10
Rate for Payer: UHC All Payor (Choice/PPO)	$389.36
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$4,604.10
Rate for Payer: UHC Exchange	$353.96
Rate for Payer: UHC Medicare Advantage	$4,742.22
Rate for Payer: VA VA	$4,604.10

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER

Facility

$8,913.25

Service Code	CPT 36561
Hospital Revenue Code	360
Min. Negotiated Rate	$321.22
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,427.23
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$353.34
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$321.22
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER

Facility

$8,913.25

Service Code	CPT 36558
Hospital Revenue Code	360
Min. Negotiated Rate	$249.84
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,230.92
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$274.82
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$249.84
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN

Facility

$10,620.61

Service Code	CPT 49421
Hospital Revenue Code	360
Min. Negotiated Rate	$220.37
Max. Negotiated Rate	$10,620.61
Rate for Payer: Aetna Medicare	$3,201.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,847.99
Rate for Payer: Amish Plain Church Group Commercial	$3,847.99
Rate for Payer: BCBS Complete	$1,768.23
Rate for Payer: BCBS MAPPO	$3,078.39
Rate for Payer: BCBS Trust/PPO	$1,472.51
Rate for Payer: BCN Medicare Advantage	$3,078.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,078.39
Rate for Payer: Mclaren Medicaid	$1,683.88
Rate for Payer: Mclaren Medicare	$3,078.39
Rate for Payer: Meridian Medicaid	$1,768.23
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,232.31
Rate for Payer: MI Amish Medical Board Commercial	$3,540.15
Rate for Payer: PACE Medicare	$2,924.47
Rate for Payer: PACE SWMI	$3,078.39
Rate for Payer: PHP Medicare Advantage	$3,078.39
Rate for Payer: Priority Health Choice Medicaid	$1,683.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,620.61
Rate for Payer: Priority Health Medicare	$3,078.39
Rate for Payer: Priority Health Narrow Network	$8,496.49
Rate for Payer: Railroad Medicare Medicare	$3,078.39
Rate for Payer: UHC All Payor (Choice/PPO)	$242.41
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,078.39
Rate for Payer: UHC Exchange	$220.37
Rate for Payer: UHC Medicare Advantage	$3,170.74
Rate for Payer: VA VA	$3,078.39

INSERTION OR REPLACEMENT OF BREAST IMPLANT ON SEPARATE DAY FROM MASTECTOMY

Facility

$26,404.35

Service Code	CPT 19342
Hospital Revenue Code	360
Min. Negotiated Rate	$750.82
Max. Negotiated Rate	$26,404.35
Rate for Payer: Aetna Medicare	$8,723.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,484.70
Rate for Payer: Amish Plain Church Group Commercial	$10,484.70
Rate for Payer: BCBS Complete	$4,817.93
Rate for Payer: BCBS MAPPO	$8,387.76
Rate for Payer: BCBS Trust/PPO	$3,955.41
Rate for Payer: BCN Medicare Advantage	$8,387.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,387.76
Rate for Payer: Mclaren Medicaid	$4,588.10
Rate for Payer: Mclaren Medicare	$8,387.76
Rate for Payer: Meridian Medicaid	$4,817.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,807.15
Rate for Payer: MI Amish Medical Board Commercial	$9,645.92
Rate for Payer: PACE Medicare	$7,968.37
Rate for Payer: PACE SWMI	$8,387.76
Rate for Payer: PHP Medicare Advantage	$8,387.76
Rate for Payer: Priority Health Choice Medicaid	$4,588.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26,404.35
Rate for Payer: Priority Health Medicare	$8,387.76
Rate for Payer: Priority Health Narrow Network	$21,123.48
Rate for Payer: Railroad Medicare Medicare	$8,387.76
Rate for Payer: UHC All Payor (Choice/PPO)	$825.90
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$8,387.76
Rate for Payer: UHC Exchange	$750.82
Rate for Payer: UHC Medicare Advantage	$8,639.39
Rate for Payer: VA VA	$8,387.76

Know your out-of-pocket cost for care.

All Charges