Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC

Facility

$40,617.97

Service Code	MSDRG 350
Min. Negotiated Rate	$18,845.12
Max. Negotiated Rate	$40,617.97
Rate for Payer: Aetna Medicare	$20,630.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,796.21
Rate for Payer: Amish Plain Church Group Commercial	$24,796.21
Rate for Payer: BCBS MAPPO	$19,836.97
Rate for Payer: BCBS Trust/PPO	$32,434.12
Rate for Payer: BCN Commercial	$32,434.12
Rate for Payer: BCN Medicare Advantage	$19,836.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,836.97
Rate for Payer: Mclaren Medicare	$19,836.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20,828.82
Rate for Payer: MI Amish Medical Board Commercial	$22,812.52
Rate for Payer: Molina Medicare/Medicaid	$21,820.67
Rate for Payer: Nomi Health Commercial	$32,145.51
Rate for Payer: PACE Medicare	$18,845.12
Rate for Payer: PACE SWMI	$19,836.97
Rate for Payer: PHP Medicare Advantage	$19,836.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$40,174.76
Rate for Payer: Priority Health Medicare	$19,836.97
Rate for Payer: Priority Health Tiered Network	$32,139.80
Rate for Payer: Railroad Medicare Medicare	$19,836.97
Rate for Payer: UHC All Payor (Choice/PPO)	$40,617.97
Rate for Payer: UHC Core	$33,982.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$19,836.97
Rate for Payer: UHC Exchange	$27,752.29
Rate for Payer: VA VA	$19,836.97

INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC

Facility

$27,539.51

Service Code	MSDRG 352
Min. Negotiated Rate	$9,123.82
Max. Negotiated Rate	$27,539.51
Rate for Payer: Aetna Medicare	$9,988.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,005.02
Rate for Payer: Amish Plain Church Group Commercial	$12,005.02
Rate for Payer: BCBS MAPPO	$9,604.02
Rate for Payer: BCBS Trust/PPO	$27,539.51
Rate for Payer: BCN Commercial	$27,539.51
Rate for Payer: BCN Medicare Advantage	$9,604.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,604.02
Rate for Payer: Mclaren Medicare	$9,604.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,084.22
Rate for Payer: MI Amish Medical Board Commercial	$11,044.62
Rate for Payer: Molina Medicare/Medicaid	$10,564.42
Rate for Payer: Nomi Health Commercial	$15,064.62
Rate for Payer: PACE Medicare	$9,123.82
Rate for Payer: PACE SWMI	$9,604.02
Rate for Payer: PHP Medicare Advantage	$9,604.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18,827.44
Rate for Payer: Priority Health Medicare	$9,604.02
Rate for Payer: Priority Health Tiered Network	$15,061.95
Rate for Payer: Railroad Medicare Medicare	$9,604.02
Rate for Payer: UHC All Payor (Choice/PPO)	$19,035.14
Rate for Payer: UHC Core	$15,925.29
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,604.02
Rate for Payer: UHC Exchange	$13,005.79
Rate for Payer: VA VA	$9,604.02

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$9,567.80

Service Code	APR-DRG 2282
Min. Negotiated Rate	$9,112.19
Max. Negotiated Rate	$9,567.80
Rate for Payer: BCBS Complete	$9,567.80
Rate for Payer: Mclaren Medicaid	$9,112.19
Rate for Payer: Meridian Medicaid	$9,567.80
Rate for Payer: Priority Health Choice Medicaid	$9,112.19
Rate for Payer: UHC Medicaid	$9,112.19
Rate for Payer: UHCCP Medicaid	$9,112.19

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$19,712.92

Service Code	APR-DRG 2284
Min. Negotiated Rate	$18,774.21
Max. Negotiated Rate	$19,712.92
Rate for Payer: BCBS Complete	$19,712.92
Rate for Payer: Mclaren Medicaid	$18,774.21
Rate for Payer: Meridian Medicaid	$19,712.92
Rate for Payer: Priority Health Choice Medicaid	$18,774.21
Rate for Payer: UHC Medicaid	$18,774.21
Rate for Payer: UHCCP Medicaid	$18,774.21

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$7,004.01

Service Code	APR-DRG 2281
Min. Negotiated Rate	$6,670.48
Max. Negotiated Rate	$7,004.01
Rate for Payer: BCBS Complete	$7,004.01
Rate for Payer: Mclaren Medicaid	$6,670.48
Rate for Payer: Meridian Medicaid	$7,004.01
Rate for Payer: Priority Health Choice Medicaid	$6,670.48
Rate for Payer: UHC Medicaid	$6,670.48
Rate for Payer: UHCCP Medicaid	$6,670.48

INGUINAL, FEMORAL AND UMBILICAL HERNIA PROCEDURES

Facility

$11,242.41

Service Code	APR-DRG 2283
Min. Negotiated Rate	$10,707.06
Max. Negotiated Rate	$11,242.41
Rate for Payer: BCBS Complete	$11,242.41
Rate for Payer: Mclaren Medicaid	$10,707.06
Rate for Payer: Meridian Medicaid	$11,242.41
Rate for Payer: Priority Health Choice Medicaid	$10,707.06
Rate for Payer: UHC Medicaid	$10,707.06
Rate for Payer: UHCCP Medicaid	$10,707.06

INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDING URETHROCYSTOGRAPHY

Facility

$402.95

Service Code	CPT 51600
Hospital Revenue Code	360
Min. Negotiated Rate	$402.95
Max. Negotiated Rate	$402.95
Rate for Payer: BCBS Trust/PPO	$402.95
Rate for Payer: BCN Commercial	$402.95

INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE

Facility

$1,288.18

Service Code	CPT 38792
Hospital Revenue Code	360
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$1,288.18
Rate for Payer: Aetna Medicare	$414.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$497.91
Rate for Payer: Amish Plain Church Group Commercial	$497.91
Rate for Payer: BCBS Complete	$218.76
Rate for Payer: BCBS MAPPO	$398.33
Rate for Payer: BCBS Trust/PPO	$107.78
Rate for Payer: BCN Commercial	$107.78
Rate for Payer: BCN Medicare Advantage	$398.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$398.33
Rate for Payer: Mclaren Medicaid	$208.33
Rate for Payer: Mclaren Medicare	$398.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$418.25
Rate for Payer: Meridian Medicaid	$418.25
Rate for Payer: MI Amish Medical Board Commercial	$458.08
Rate for Payer: Molina Medicare/Medicaid	$438.16
Rate for Payer: Nomi Health Commercial	$1,194.99
Rate for Payer: PACE Medicare	$378.41
Rate for Payer: PACE SWMI	$398.33
Rate for Payer: PHP Medicare Advantage	$398.33
Rate for Payer: Priority Health Choice Medicaid	$208.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,288.18
Rate for Payer: Priority Health Medicare	$398.33
Rate for Payer: Priority Health Tiered Network	$1,030.54
Rate for Payer: Railroad Medicare Medicare	$398.33
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$398.33
Rate for Payer: UHC Medicaid	$208.33
Rate for Payer: UHCCP Medicaid	$208.33
Rate for Payer: VA VA	$398.33

INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT), INCLUDING IMAGING GUIDANCE, WHEN PERFORMED

Facility

$2,850.01

Service Code	CPT 64448
Hospital Revenue Code	360
Min. Negotiated Rate	$460.91
Max. Negotiated Rate	$2,850.01
Rate for Payer: Aetna Medicare	$916.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,101.61
Rate for Payer: Amish Plain Church Group Commercial	$1,101.61
Rate for Payer: BCBS Complete	$484.00
Rate for Payer: BCBS MAPPO	$881.29
Rate for Payer: BCBS Trust/PPO	$650.99
Rate for Payer: BCN Commercial	$650.99
Rate for Payer: BCN Medicare Advantage	$881.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$881.29
Rate for Payer: Mclaren Medicaid	$460.91
Rate for Payer: Mclaren Medicare	$881.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$925.35
Rate for Payer: Meridian Medicaid	$925.35
Rate for Payer: MI Amish Medical Board Commercial	$1,013.48
Rate for Payer: Molina Medicare/Medicaid	$969.42
Rate for Payer: Nomi Health Commercial	$2,643.87
Rate for Payer: PACE Medicare	$837.23
Rate for Payer: PACE SWMI	$881.29
Rate for Payer: PHP Medicare Advantage	$881.29
Rate for Payer: Priority Health Choice Medicaid	$460.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,850.01
Rate for Payer: Priority Health Medicare	$881.29
Rate for Payer: Priority Health Tiered Network	$2,280.01
Rate for Payer: Railroad Medicare Medicare	$881.29
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$881.29
Rate for Payer: UHC Medicaid	$460.91
Rate for Payer: UHCCP Medicaid	$460.91
Rate for Payer: VA VA	$881.29

INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

Facility

$989.08

Service Code	CPT 20550
Hospital Revenue Code	360
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$989.08
Rate for Payer: Aetna Medicare	$318.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$382.31
Rate for Payer: Amish Plain Church Group Commercial	$382.31
Rate for Payer: BCBS Complete	$167.97
Rate for Payer: BCBS MAPPO	$305.85
Rate for Payer: BCBS Trust/PPO	$224.17
Rate for Payer: BCN Commercial	$224.17
Rate for Payer: BCN Medicare Advantage	$305.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.85
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Mclaren Medicare	$305.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$321.14
Rate for Payer: Meridian Medicaid	$321.14
Rate for Payer: MI Amish Medical Board Commercial	$351.73
Rate for Payer: Molina Medicare/Medicaid	$336.44
Rate for Payer: Nomi Health Commercial	$917.55
Rate for Payer: PACE Medicare	$290.56
Rate for Payer: PACE SWMI	$305.85
Rate for Payer: PHP Medicare Advantage	$305.85
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$989.08
Rate for Payer: Priority Health Medicare	$305.85
Rate for Payer: Priority Health Tiered Network	$791.26
Rate for Payer: Railroad Medicare Medicare	$305.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$305.85
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96
Rate for Payer: VA VA	$305.85

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

$709.60

Service Code	CPT 22853
Hospital Revenue Code	360
Min. Negotiated Rate	$709.60
Max. Negotiated Rate	$709.60
Rate for Payer: BCBS Trust/PPO	$709.60
Rate for Payer: BCN Commercial	$709.60

INSERTION OF INTRAUTERINE DEVICE (IUD)

Facility

$557.28

Service Code	CPT 58300
Hospital Revenue Code	360
Min. Negotiated Rate	$117.08
Max. Negotiated Rate	$557.28
Rate for Payer: BCBS Trust/PPO	$557.28
Rate for Payer: BCN Commercial	$557.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$146.35
Rate for Payer: Priority Health Tiered Network	$117.08

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

Facility

$66,785.41

Service Code	CPT 54405
Hospital Revenue Code	360
Min. Negotiated Rate	$10,800.78
Max. Negotiated Rate	$66,785.41
Rate for Payer: Aetna Medicare	$21,477.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$25,814.49
Rate for Payer: Amish Plain Church Group Commercial	$25,814.49
Rate for Payer: BCBS Complete	$11,341.85
Rate for Payer: BCBS MAPPO	$20,651.59
Rate for Payer: BCBS Trust/PPO	$13,544.80
Rate for Payer: BCN Commercial	$13,544.80
Rate for Payer: BCN Medicare Advantage	$20,651.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,651.59
Rate for Payer: Mclaren Medicaid	$10,800.78
Rate for Payer: Mclaren Medicare	$20,651.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21,684.17
Rate for Payer: Meridian Medicaid	$21,684.17
Rate for Payer: MI Amish Medical Board Commercial	$23,749.33
Rate for Payer: Molina Medicare/Medicaid	$22,716.75
Rate for Payer: Nomi Health Commercial	$61,954.77
Rate for Payer: PACE Medicare	$19,619.01
Rate for Payer: PACE SWMI	$20,651.59
Rate for Payer: PHP Medicare Advantage	$20,651.59
Rate for Payer: Priority Health Choice Medicaid	$10,800.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$66,785.41
Rate for Payer: Priority Health Medicare	$20,651.59
Rate for Payer: Priority Health Tiered Network	$53,428.33
Rate for Payer: Railroad Medicare Medicare	$20,651.59
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$20,651.59
Rate for Payer: UHC Medicaid	$10,800.78
Rate for Payer: UHCCP Medicaid	$10,800.78
Rate for Payer: VA VA	$20,651.59

INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)

Facility

$42,513.04

Service Code	CPT 54400
Hospital Revenue Code	360
Min. Negotiated Rate	$6,875.36
Max. Negotiated Rate	$42,513.04
Rate for Payer: Aetna Medicare	$13,671.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,432.51
Rate for Payer: Amish Plain Church Group Commercial	$16,432.51
Rate for Payer: BCBS Complete	$7,219.79
Rate for Payer: BCBS MAPPO	$13,146.01
Rate for Payer: BCBS Trust/PPO	$7,736.65
Rate for Payer: BCN Commercial	$7,736.65
Rate for Payer: BCN Medicare Advantage	$13,146.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,146.01
Rate for Payer: Mclaren Medicaid	$6,875.36
Rate for Payer: Mclaren Medicare	$13,146.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,803.31
Rate for Payer: Meridian Medicaid	$13,803.31
Rate for Payer: MI Amish Medical Board Commercial	$15,117.91
Rate for Payer: Molina Medicare/Medicaid	$14,460.61
Rate for Payer: Nomi Health Commercial	$39,438.03
Rate for Payer: PACE Medicare	$12,488.71
Rate for Payer: PACE SWMI	$13,146.01
Rate for Payer: PHP Medicare Advantage	$13,146.01
Rate for Payer: Priority Health Choice Medicaid	$6,875.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$42,513.04
Rate for Payer: Priority Health Medicare	$13,146.01
Rate for Payer: Priority Health Tiered Network	$34,010.43
Rate for Payer: Railroad Medicare Medicare	$13,146.01
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,146.01
Rate for Payer: UHC Medicaid	$6,875.36
Rate for Payer: UHCCP Medicaid	$6,875.36
Rate for Payer: VA VA	$13,146.01

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

Facility

$10,174.29

Service Code	CPT 36561
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.43
Max. Negotiated Rate	$10,174.29
Rate for Payer: Aetna Medicare	$3,271.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,932.66
Rate for Payer: Amish Plain Church Group Commercial	$3,932.66
Rate for Payer: BCBS Complete	$1,727.85
Rate for Payer: BCBS MAPPO	$3,146.13
Rate for Payer: BCBS Trust/PPO	$1,882.50
Rate for Payer: BCN Commercial	$1,882.50
Rate for Payer: BCN Medicare Advantage	$3,146.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,146.13
Rate for Payer: Mclaren Medicaid	$1,645.43
Rate for Payer: Mclaren Medicare	$3,146.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,303.44
Rate for Payer: Meridian Medicaid	$3,303.44
Rate for Payer: MI Amish Medical Board Commercial	$3,618.05
Rate for Payer: Molina Medicare/Medicaid	$3,460.74
Rate for Payer: Nomi Health Commercial	$9,438.39
Rate for Payer: PACE Medicare	$2,988.82
Rate for Payer: PACE SWMI	$3,146.13
Rate for Payer: PHP Medicare Advantage	$3,146.13
Rate for Payer: Priority Health Choice Medicaid	$1,645.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,174.29
Rate for Payer: Priority Health Medicare	$3,146.13
Rate for Payer: Priority Health Tiered Network	$8,139.43
Rate for Payer: Railroad Medicare Medicare	$3,146.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,146.13
Rate for Payer: UHC Medicaid	$1,645.43
Rate for Payer: UHCCP Medicaid	$1,645.43
Rate for Payer: VA VA	$3,146.13

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

Facility

$10,174.29

Service Code	CPT 36558
Hospital Revenue Code	360
Min. Negotiated Rate	$1,623.57
Max. Negotiated Rate	$10,174.29
Rate for Payer: Aetna Medicare	$3,271.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,932.66
Rate for Payer: Amish Plain Church Group Commercial	$3,932.66
Rate for Payer: BCBS Complete	$1,727.85
Rate for Payer: BCBS MAPPO	$3,146.13
Rate for Payer: BCBS Trust/PPO	$1,623.57
Rate for Payer: BCN Commercial	$1,623.57
Rate for Payer: BCN Medicare Advantage	$3,146.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,146.13
Rate for Payer: Mclaren Medicaid	$1,645.43
Rate for Payer: Mclaren Medicare	$3,146.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,303.44
Rate for Payer: Meridian Medicaid	$3,303.44
Rate for Payer: MI Amish Medical Board Commercial	$3,618.05
Rate for Payer: Molina Medicare/Medicaid	$3,460.74
Rate for Payer: Nomi Health Commercial	$9,438.39
Rate for Payer: PACE Medicare	$2,988.82
Rate for Payer: PACE SWMI	$3,146.13
Rate for Payer: PHP Medicare Advantage	$3,146.13
Rate for Payer: Priority Health Choice Medicaid	$1,645.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,174.29
Rate for Payer: Priority Health Medicare	$3,146.13
Rate for Payer: Priority Health Tiered Network	$8,139.43
Rate for Payer: Railroad Medicare Medicare	$3,146.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,146.13
Rate for Payer: UHC Medicaid	$1,645.43
Rate for Payer: UHCCP Medicaid	$1,645.43
Rate for Payer: VA VA	$3,146.13

INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN

Facility

$11,537.07

Service Code	CPT 49421
Hospital Revenue Code	360
Min. Negotiated Rate	$1,865.82
Max. Negotiated Rate	$11,537.07
Rate for Payer: Aetna Medicare	$3,710.23
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,459.41
Rate for Payer: Amish Plain Church Group Commercial	$4,459.41
Rate for Payer: BCBS Complete	$1,959.29
Rate for Payer: BCBS MAPPO	$3,567.53
Rate for Payer: BCBS Trust/PPO	$1,942.23
Rate for Payer: BCN Commercial	$1,942.23
Rate for Payer: BCN Medicare Advantage	$3,567.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,567.53
Rate for Payer: Mclaren Medicaid	$1,865.82
Rate for Payer: Mclaren Medicare	$3,567.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,745.91
Rate for Payer: Meridian Medicaid	$3,745.91
Rate for Payer: MI Amish Medical Board Commercial	$4,102.66
Rate for Payer: Molina Medicare/Medicaid	$3,924.28
Rate for Payer: Nomi Health Commercial	$10,702.59
Rate for Payer: PACE Medicare	$3,389.15
Rate for Payer: PACE SWMI	$3,567.53
Rate for Payer: PHP Medicare Advantage	$3,567.53
Rate for Payer: Priority Health Choice Medicaid	$1,865.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,537.07
Rate for Payer: Priority Health Medicare	$3,567.53
Rate for Payer: Priority Health Tiered Network	$9,229.66
Rate for Payer: Railroad Medicare Medicare	$3,567.53
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,567.53
Rate for Payer: UHC Medicaid	$1,865.82
Rate for Payer: UHCCP Medicaid	$1,865.82
Rate for Payer: VA VA	$3,567.53

INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER

Facility

$62,512.62

Service Code	CPT 64590
Hospital Revenue Code	360
Min. Negotiated Rate	$10,109.77
Max. Negotiated Rate	$62,512.62
Rate for Payer: Mclaren Medicaid	$10,109.77
Rate for Payer: Aetna Medicare	$20,103.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,162.94
Rate for Payer: Amish Plain Church Group Commercial	$24,162.94
Rate for Payer: BCBS Complete	$10,616.23
Rate for Payer: BCBS MAPPO	$19,330.35
Rate for Payer: BCBS Trust/PPO	$18,779.62
Rate for Payer: BCN Commercial	$18,779.62
Rate for Payer: BCN Medicare Advantage	$19,330.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,330.35
Rate for Payer: Mclaren Medicare	$19,330.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20,296.87
Rate for Payer: Meridian Medicaid	$20,296.87
Rate for Payer: MI Amish Medical Board Commercial	$22,229.90
Rate for Payer: Molina Medicare/Medicaid	$21,263.38
Rate for Payer: Nomi Health Commercial	$57,991.05
Rate for Payer: PACE Medicare	$18,363.83
Rate for Payer: PACE SWMI	$19,330.35
Rate for Payer: PHP Medicare Advantage	$19,330.35
Rate for Payer: Priority Health Choice Medicaid	$10,109.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$62,512.62
Rate for Payer: Priority Health Medicare	$19,330.35
Rate for Payer: Priority Health Tiered Network	$50,010.10
Rate for Payer: Railroad Medicare Medicare	$19,330.35
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$19,330.35
Rate for Payer: UHC Medicaid	$10,109.77
Rate for Payer: UHCCP Medicaid	$10,109.77
Rate for Payer: VA VA	$19,330.35

INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER

Facility

$99,432.20

Service Code	CPT 63685
Hospital Revenue Code	360
Min. Negotiated Rate	$16,080.55
Max. Negotiated Rate	$99,432.20
Rate for Payer: Aetna Medicare	$31,976.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$38,433.43
Rate for Payer: Amish Plain Church Group Commercial	$38,433.43
Rate for Payer: BCBS Complete	$16,886.11
Rate for Payer: BCBS MAPPO	$30,746.74
Rate for Payer: BCBS Trust/PPO	$24,660.17
Rate for Payer: BCN Commercial	$24,660.17
Rate for Payer: BCN Medicare Advantage	$30,746.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$30,746.74
Rate for Payer: Mclaren Medicaid	$16,080.55
Rate for Payer: Mclaren Medicare	$30,746.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$32,284.08
Rate for Payer: Meridian Medicaid	$32,284.08
Rate for Payer: MI Amish Medical Board Commercial	$35,358.75
Rate for Payer: Molina Medicare/Medicaid	$33,821.41
Rate for Payer: Nomi Health Commercial	$92,240.22
Rate for Payer: PACE Medicare	$29,209.40
Rate for Payer: PACE SWMI	$30,746.74
Rate for Payer: PHP Medicare Advantage	$30,746.74
Rate for Payer: Priority Health Choice Medicaid	$16,080.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$99,432.20
Rate for Payer: Priority Health Medicare	$30,746.74
Rate for Payer: Priority Health Tiered Network	$79,545.76
Rate for Payer: Railroad Medicare Medicare	$30,746.74
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$30,746.74
Rate for Payer: UHC Medicaid	$16,080.55
Rate for Payer: UHCCP Medicaid	$16,080.55
Rate for Payer: VA VA	$30,746.74

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$21,831.26

Service Code	APR-DRG 1762
Min. Negotiated Rate	$20,791.68
Max. Negotiated Rate	$21,831.26
Rate for Payer: BCBS Complete	$21,831.26
Rate for Payer: Mclaren Medicaid	$20,791.68
Rate for Payer: Meridian Medicaid	$21,831.26
Rate for Payer: Priority Health Choice Medicaid	$20,791.68
Rate for Payer: UHC Medicaid	$20,791.68
Rate for Payer: UHCCP Medicaid	$20,791.68

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$27,279.91

Service Code	APR-DRG 1763
Min. Negotiated Rate	$25,980.86
Max. Negotiated Rate	$27,279.91
Rate for Payer: BCBS Complete	$27,279.91
Rate for Payer: Mclaren Medicaid	$25,980.86
Rate for Payer: Meridian Medicaid	$27,279.91
Rate for Payer: Priority Health Choice Medicaid	$25,980.86
Rate for Payer: UHC Medicaid	$25,980.86
Rate for Payer: UHCCP Medicaid	$25,980.86

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$10,650.77

Service Code	APR-DRG 1761
Min. Negotiated Rate	$10,143.59
Max. Negotiated Rate	$10,650.77
Rate for Payer: BCBS Complete	$10,650.77
Rate for Payer: Mclaren Medicaid	$10,143.59
Rate for Payer: Meridian Medicaid	$10,650.77
Rate for Payer: Priority Health Choice Medicaid	$10,143.59
Rate for Payer: UHC Medicaid	$10,143.59
Rate for Payer: UHCCP Medicaid	$10,143.59

INSERTION, REVISION AND REPLACEMENTS OF PACEMAKER AND OTHER CARDIAC DEVICES

Facility

$40,232.47

Service Code	APR-DRG 1764
Min. Negotiated Rate	$38,316.64
Max. Negotiated Rate	$40,232.47
Rate for Payer: BCBS Complete	$40,232.47
Rate for Payer: Mclaren Medicaid	$38,316.64
Rate for Payer: Meridian Medicaid	$40,232.47
Rate for Payer: Priority Health Choice Medicaid	$38,316.64
Rate for Payer: UHC Medicaid	$38,316.64
Rate for Payer: UHCCP Medicaid	$38,316.64

INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)

Facility

$77.40

Service Code	NDC 09900001834
Hospital Charge Code	300906
Hospital Revenue Code	250
Min. Negotiated Rate	$48.76
Max. Negotiated Rate	$69.66
Rate for Payer: Aetna Commercial	$65.79
Rate for Payer: Aetna New Business (MI Preferred)	$50.31
Rate for Payer: Cash Price	$61.92
Rate for Payer: Cofinity Advantage	$54.18
Rate for Payer: Cofinity Commercial	$66.56
Rate for Payer: Encore Health Key Benefits Commercial	$61.92
Rate for Payer: Healthscope Commercial	$69.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.05
Rate for Payer: PHP Commercial	$65.79
Rate for Payer: Priority Health SBD	$48.76

INSULIN 1 UNIT/ ML INFUSION 100 ML (IV PREMIX)

Facility

$77.40

Service Code	NDC 09900001834
Hospital Charge Code	300906
Hospital Revenue Code	250
Min. Negotiated Rate	$30.42
Max. Negotiated Rate	$69.66
Rate for Payer: Aetna Commercial	$65.79
Rate for Payer: Aetna Medicare	$38.70
Rate for Payer: Aetna New Business (MI Preferred)	$50.31
Rate for Payer: BCBS Complete	$30.96
Rate for Payer: Cash Price	$61.92
Rate for Payer: Cofinity Advantage	$54.18
Rate for Payer: Cofinity Commercial	$66.56
Rate for Payer: Encore Health Key Benefits Commercial	$61.92
Rate for Payer: Healthscope Commercial	$69.66
Rate for Payer: MI Amish Medical Board Commercial	$61.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.05
Rate for Payer: PHP Commercial	$65.79
Rate for Payer: Priority Health SBD	$48.76
Rate for Payer: UHC All Payor (Choice/PPO)	$50.31
Rate for Payer: UHC Core	$40.33
Rate for Payer: UHC Exchange	$30.42

Know your out-of-pocket cost for care.

All Charges