Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROXYZINE HCL 10 MG TABLET

Facility

$387.75

Service Code	NDC 60687066401
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$155.10
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna Medicare	$193.88
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: BCBS Complete	$155.10
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$271.43
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Cofinity Medicare Advantage	$271.43
Rate for Payer: Encore Health Key Benefits Commercial	$310.20
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$252.04
Rate for Payer: Priority Health SBD	$244.28

HYDROXYZINE HCL 10 MG TABLET

Facility

$352.50

Service Code	NDC 63739048310
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$222.07
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Commercial	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Cofinity Medicare Advantage	$246.75
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health Cigna Priority Health	$229.12
Rate for Payer: Priority Health SBD	$222.07

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084025311
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084025301
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 25 MG TABLET

Facility

$281.20

Service Code	NDC 68084025401
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$177.16
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Commercial	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Cofinity Medicare Advantage	$196.84
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health Cigna Priority Health	$182.78
Rate for Payer: Priority Health SBD	$177.16

HYDROXYZINE HCL 25 MG TABLET

Facility

$281.20

Service Code	NDC 68084025401
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna Medicare	$140.60
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: BCBS Complete	$112.48
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Commercial	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Cofinity Medicare Advantage	$196.84
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health Cigna Priority Health	$182.78
Rate for Payer: Priority Health SBD	$177.16

HYDROXYZINE HCL 25 MG TABLET

Facility

$122.20

Service Code	NDC 23155050101
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$76.99
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Cofinity Commercial	$85.54
Rate for Payer: Cofinity Medicare Advantage	$85.54
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$79.43
Rate for Payer: Priority Health SBD	$76.99

HYDROXYZINE HCL 25 MG TABLET

Facility

$441.80

Service Code	NDC 63739048610
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$176.72
Max. Negotiated Rate	$397.62
Rate for Payer: Aetna Commercial	$375.53
Rate for Payer: Aetna Medicare	$220.90
Rate for Payer: Aetna New Business (MI Preferred)	$287.17
Rate for Payer: BCBS Complete	$176.72
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$309.26
Rate for Payer: Cofinity Commercial	$379.95
Rate for Payer: Cofinity Medicare Advantage	$309.26
Rate for Payer: Encore Health Key Benefits Commercial	$353.44
Rate for Payer: Healthscope Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.53
Rate for Payer: PHP Commercial	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$287.17
Rate for Payer: Priority Health SBD	$278.33

HYDROXYZINE HCL 25 MG TABLET

Facility

$216.20

Service Code	NDC 10702001101
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$86.48
Max. Negotiated Rate	$194.58
Rate for Payer: Aetna Commercial	$183.77
Rate for Payer: Aetna Medicare	$108.10
Rate for Payer: Aetna New Business (MI Preferred)	$140.53
Rate for Payer: BCBS Complete	$86.48
Rate for Payer: Cash Price	$172.96
Rate for Payer: Cofinity Commercial	$151.34
Rate for Payer: Cofinity Commercial	$185.93
Rate for Payer: Cofinity Medicare Advantage	$151.34
Rate for Payer: Encore Health Key Benefits Commercial	$172.96
Rate for Payer: Healthscope Commercial	$194.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.77
Rate for Payer: PHP Commercial	$183.77
Rate for Payer: Priority Health Cigna Priority Health	$140.53
Rate for Payer: Priority Health SBD	$136.21

HYDROXYZINE HCL 25 MG TABLET

Facility

$2.82

Service Code	NDC 68084025411
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.78

HYDROXYZINE HCL 25 MG TABLET

Facility

$2.82

Service Code	NDC 68084025411
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.54
Rate for Payer: Aetna Commercial	$2.40
Rate for Payer: Aetna Medicare	$1.41
Rate for Payer: Aetna New Business (MI Preferred)	$1.83
Rate for Payer: BCBS Complete	$1.13
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Commercial	$1.97
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Cofinity Medicare Advantage	$1.97
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.40
Rate for Payer: PHP Commercial	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.83
Rate for Payer: Priority Health SBD	$1.78

HYDROXYZINE HCL 25 MG TABLET

Facility

$352.50

Service Code	NDC 00904661761
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$222.07
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Commercial	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Cofinity Medicare Advantage	$246.75
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health Cigna Priority Health	$229.12
Rate for Payer: Priority Health SBD	$222.07

HYDROXYZINE HCL 25 MG TABLET

Facility

$352.50

Service Code	NDC 00904661761
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$317.25
Rate for Payer: Aetna Commercial	$299.62
Rate for Payer: Aetna Medicare	$176.25
Rate for Payer: Aetna New Business (MI Preferred)	$229.12
Rate for Payer: BCBS Complete	$141.00
Rate for Payer: Cash Price	$282.00
Rate for Payer: Cofinity Commercial	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Cofinity Medicare Advantage	$246.75
Rate for Payer: Encore Health Key Benefits Commercial	$282.00
Rate for Payer: Healthscope Commercial	$317.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.62
Rate for Payer: PHP Commercial	$299.62
Rate for Payer: Priority Health Cigna Priority Health	$229.12
Rate for Payer: Priority Health SBD	$222.07

HYDROXYZINE HCL 25 MG TABLET

Facility

$216.20

Service Code	NDC 10702001101
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$136.21
Max. Negotiated Rate	$194.58
Rate for Payer: Aetna Commercial	$183.77
Rate for Payer: Aetna New Business (MI Preferred)	$140.53
Rate for Payer: Cash Price	$172.96
Rate for Payer: Cofinity Commercial	$151.34
Rate for Payer: Cofinity Commercial	$185.93
Rate for Payer: Cofinity Medicare Advantage	$151.34
Rate for Payer: Encore Health Key Benefits Commercial	$172.96
Rate for Payer: Healthscope Commercial	$194.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.77
Rate for Payer: PHP Commercial	$183.77
Rate for Payer: Priority Health Cigna Priority Health	$140.53
Rate for Payer: Priority Health SBD	$136.21

HYDROXYZINE HCL 25 MG TABLET

Facility

$441.80

Service Code	NDC 63739048610
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$278.33
Max. Negotiated Rate	$397.62
Rate for Payer: Aetna Commercial	$375.53
Rate for Payer: Aetna New Business (MI Preferred)	$287.17
Rate for Payer: Cash Price	$353.44
Rate for Payer: Cofinity Commercial	$309.26
Rate for Payer: Cofinity Commercial	$379.95
Rate for Payer: Cofinity Medicare Advantage	$309.26
Rate for Payer: Encore Health Key Benefits Commercial	$353.44
Rate for Payer: Healthscope Commercial	$397.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$375.53
Rate for Payer: PHP Commercial	$375.53
Rate for Payer: Priority Health Cigna Priority Health	$287.17
Rate for Payer: Priority Health SBD	$278.33

HYDROXYZINE HCL 25 MG TABLET

Facility

$122.20

Service Code	NDC 23155050101
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$48.88
Max. Negotiated Rate	$109.98
Rate for Payer: Aetna Commercial	$103.87
Rate for Payer: Aetna Medicare	$61.10
Rate for Payer: Aetna New Business (MI Preferred)	$79.43
Rate for Payer: BCBS Complete	$48.88
Rate for Payer: Cash Price	$97.76
Rate for Payer: Cofinity Commercial	$105.09
Rate for Payer: Cofinity Commercial	$85.54
Rate for Payer: Cofinity Medicare Advantage	$85.54
Rate for Payer: Encore Health Key Benefits Commercial	$97.76
Rate for Payer: Healthscope Commercial	$109.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.87
Rate for Payer: PHP Commercial	$103.87
Rate for Payer: Priority Health Cigna Priority Health	$79.43
Rate for Payer: Priority Health SBD	$76.99

HYMENOTOMY, SIMPLE INCISION

Facility

$8,728.81

Service Code	CPT 56442
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

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$406.60

Service Code	NDC 42192033901
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$256.16
Max. Negotiated Rate	$365.94
Rate for Payer: Aetna Commercial	$345.61
Rate for Payer: Aetna New Business (MI Preferred)	$264.29
Rate for Payer: Cash Price	$325.28
Rate for Payer: Cofinity Commercial	$284.62
Rate for Payer: Cofinity Commercial	$349.68
Rate for Payer: Cofinity Medicare Advantage	$284.62
Rate for Payer: Encore Health Key Benefits Commercial	$325.28
Rate for Payer: Healthscope Commercial	$365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.61
Rate for Payer: PHP Commercial	$345.61
Rate for Payer: Priority Health Cigna Priority Health	$264.29
Rate for Payer: Priority Health SBD	$256.16

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$373.65

Service Code	NDC 43199001101
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$149.46
Max. Negotiated Rate	$336.29
Rate for Payer: Aetna Commercial	$317.60
Rate for Payer: Aetna Medicare	$186.82
Rate for Payer: Aetna New Business (MI Preferred)	$242.87
Rate for Payer: BCBS Complete	$149.46
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Cofinity Medicare Advantage	$261.56
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$336.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: PHP Commercial	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health SBD	$235.40

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$203.30

Service Code	NDC 70156010501
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$81.32
Max. Negotiated Rate	$182.97
Rate for Payer: Aetna Commercial	$172.81
Rate for Payer: Aetna Medicare	$101.65
Rate for Payer: Aetna New Business (MI Preferred)	$132.15
Rate for Payer: BCBS Complete	$81.32
Rate for Payer: Cash Price	$162.64
Rate for Payer: Cofinity Commercial	$142.31
Rate for Payer: Cofinity Commercial	$174.84
Rate for Payer: Cofinity Medicare Advantage	$142.31
Rate for Payer: Encore Health Key Benefits Commercial	$162.64
Rate for Payer: Healthscope Commercial	$182.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.81
Rate for Payer: PHP Commercial	$172.81
Rate for Payer: Priority Health Cigna Priority Health	$132.15
Rate for Payer: Priority Health SBD	$128.08

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$373.65

Service Code	NDC 43199001101
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$235.40
Max. Negotiated Rate	$336.29
Rate for Payer: Aetna Commercial	$317.60
Rate for Payer: Aetna New Business (MI Preferred)	$242.87
Rate for Payer: Cash Price	$298.92
Rate for Payer: Cofinity Commercial	$261.56
Rate for Payer: Cofinity Commercial	$321.34
Rate for Payer: Cofinity Medicare Advantage	$261.56
Rate for Payer: Encore Health Key Benefits Commercial	$298.92
Rate for Payer: Healthscope Commercial	$336.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$317.60
Rate for Payer: PHP Commercial	$317.60
Rate for Payer: Priority Health Cigna Priority Health	$242.87
Rate for Payer: Priority Health SBD	$235.40

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$406.60

Service Code	NDC 42192033901
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$162.64
Max. Negotiated Rate	$365.94
Rate for Payer: Aetna Commercial	$345.61
Rate for Payer: Aetna Medicare	$203.30
Rate for Payer: Aetna New Business (MI Preferred)	$264.29
Rate for Payer: BCBS Complete	$162.64
Rate for Payer: Cash Price	$325.28
Rate for Payer: Cofinity Commercial	$284.62
Rate for Payer: Cofinity Commercial	$349.68
Rate for Payer: Cofinity Medicare Advantage	$284.62
Rate for Payer: Encore Health Key Benefits Commercial	$325.28
Rate for Payer: Healthscope Commercial	$365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.61
Rate for Payer: PHP Commercial	$345.61
Rate for Payer: Priority Health Cigna Priority Health	$264.29
Rate for Payer: Priority Health SBD	$256.16

HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET

Facility

$203.30

Service Code	NDC 70156010501
Hospital Charge Code	17023
Hospital Revenue Code	637
Min. Negotiated Rate	$128.08
Max. Negotiated Rate	$182.97
Rate for Payer: Aetna Commercial	$172.81
Rate for Payer: Aetna New Business (MI Preferred)	$132.15
Rate for Payer: Cash Price	$162.64
Rate for Payer: Cofinity Commercial	$142.31
Rate for Payer: Cofinity Commercial	$174.84
Rate for Payer: Cofinity Medicare Advantage	$142.31
Rate for Payer: Encore Health Key Benefits Commercial	$162.64
Rate for Payer: Healthscope Commercial	$182.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$172.81
Rate for Payer: PHP Commercial	$172.81
Rate for Payer: Priority Health Cigna Priority Health	$132.15
Rate for Payer: Priority Health SBD	$128.08

HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)

Facility

$8,728.81

Service Code	CPT 58555
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

HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)

Facility

$13,552.11

Service Code	CPT 58563
Hospital Revenue Code	360
Min. Negotiated Rate	$2,580.53
Max. Negotiated Rate	$13,552.11
Rate for Payer: Aetna Medicare	$5,007.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,018.02
Rate for Payer: Amish Plain Church Group Commercial	$6,018.02
Rate for Payer: BCBS Complete	$2,709.56
Rate for Payer: BCBS MAPPO	$4,814.42
Rate for Payer: BCN Medicare Advantage	$4,814.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,814.42
Rate for Payer: Mclaren Medicaid	$2,580.53
Rate for Payer: Mclaren Medicare	$4,814.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,055.14
Rate for Payer: Meridian Medicaid	$2,709.56
Rate for Payer: MI Amish Medical Board Commercial	$5,536.58
Rate for Payer: PACE Medicare	$4,573.70
Rate for Payer: PACE SWMI	$4,814.42
Rate for Payer: PHP Medicare Advantage	$4,814.42
Rate for Payer: Priority Health Choice Medicaid	$2,580.53
Rate for Payer: Priority Health Medicare	$4,814.42
Rate for Payer: Railroad Medicare Medicare	$4,814.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13,552.11
Rate for Payer: UHC Dual Complete DSNP	$4,814.42
Rate for Payer: UHC Medicare Advantage	$4,814.42
Rate for Payer: UHCCP Medicaid	$2,710.52
Rate for Payer: VA VA	$4,814.42

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