Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD

Facility

$19,480.40

Service Code	CPT 58662
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$3,583.97
Rate for Payer: BCN Commercial	$3,583.97
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$19,480.40

Service Code	CPT 49324
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$3,639.07
Rate for Payer: BCN Commercial	$3,639.07
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE

Facility

$19,480.40

Service Code	CPT 55550
Hospital Revenue Code	360
Min. Negotiated Rate	$2,109.42
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$2,109.42
Rate for Payer: BCN Commercial	$2,109.42
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)

Facility

$19,480.40

Service Code	CPT 58660
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$3,388.62
Rate for Payer: BCN Commercial	$3,388.62
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)

Facility

$19,480.40

Service Code	CPT 58661
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$3,555.71
Rate for Payer: BCN Commercial	$3,555.71
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE

Facility

$19,480.40

Service Code	CPT 38570
Hospital Revenue Code	360
Min. Negotiated Rate	$2,492.96
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$2,492.96
Rate for Payer: BCN Commercial	$2,492.96
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED

Facility

$19,480.40

Service Code	CPT 49325
Hospital Revenue Code	360
Min. Negotiated Rate	$2,334.42
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$2,334.42
Rate for Payer: BCN Commercial	$2,334.42
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$3,150.44
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$34,252.33

Service Code	CPT 58570
Hospital Revenue Code	360
Min. Negotiated Rate	$4,998.93
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$4,998.93
Rate for Payer: BCN Commercial	$4,998.93
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$5,539.41
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58571
Hospital Revenue Code	360
Min. Negotiated Rate	$5,303.79
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$5,303.79
Rate for Payer: BCN Commercial	$5,303.79
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$5,539.41
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58573
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$6,815.86
Rate for Payer: BCN Commercial	$6,815.86
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$5,539.41
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58552
Hospital Revenue Code	360
Min. Negotiated Rate	$5,105.58
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$5,105.58
Rate for Payer: BCN Commercial	$5,105.58
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$5,539.41
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;

Facility

$12,013.78

Service Code	CPT 31535
Hospital Revenue Code	360
Min. Negotiated Rate	$1,942.91
Max. Negotiated Rate	$12,013.78
Rate for Payer: Aetna Medicare	$3,863.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,643.68
Rate for Payer: Amish Plain Church Group Commercial	$4,643.68
Rate for Payer: BCBS Complete	$2,040.25
Rate for Payer: BCBS MAPPO	$3,714.94
Rate for Payer: BCBS Trust/PPO	$2,102.50
Rate for Payer: BCN Commercial	$2,102.50
Rate for Payer: BCN Medicare Advantage	$3,714.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,714.94
Rate for Payer: Mclaren Medicaid	$1,942.91
Rate for Payer: Mclaren Medicare	$3,714.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,900.69
Rate for Payer: Meridian Medicaid	$3,900.69
Rate for Payer: MI Amish Medical Board Commercial	$4,272.18
Rate for Payer: Molina Medicare/Medicaid	$4,086.43
Rate for Payer: Nomi Health Commercial	$11,144.82
Rate for Payer: PACE Medicare	$3,529.19
Rate for Payer: PACE SWMI	$3,714.94
Rate for Payer: PHP Medicare Advantage	$3,714.94
Rate for Payer: Priority Health Choice Medicaid	$1,942.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$12,013.78
Rate for Payer: Priority Health Medicare	$3,714.94
Rate for Payer: Priority Health Tiered Network	$9,611.02
Rate for Payer: Railroad Medicare Medicare	$3,714.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,714.94
Rate for Payer: UHC Medicaid	$1,942.91
Rate for Payer: UHCCP Medicaid	$1,942.91
Rate for Payer: VA VA	$3,714.94

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITH OPERATING MICROSCOPE OR TELESCOPE

Facility

$12,013.78

Service Code	CPT 31536
Hospital Revenue Code	360
Min. Negotiated Rate	$1,942.91
Max. Negotiated Rate	$12,013.78
Rate for Payer: Aetna Medicare	$3,863.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,643.68
Rate for Payer: Amish Plain Church Group Commercial	$4,643.68
Rate for Payer: BCBS Complete	$2,040.25
Rate for Payer: BCBS MAPPO	$3,714.94
Rate for Payer: BCBS Trust/PPO	$2,577.76
Rate for Payer: BCN Commercial	$2,577.76
Rate for Payer: BCN Medicare Advantage	$3,714.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,714.94
Rate for Payer: Mclaren Medicaid	$1,942.91
Rate for Payer: Mclaren Medicare	$3,714.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,900.69
Rate for Payer: Meridian Medicaid	$3,900.69
Rate for Payer: MI Amish Medical Board Commercial	$4,272.18
Rate for Payer: Molina Medicare/Medicaid	$4,086.43
Rate for Payer: Nomi Health Commercial	$11,144.82
Rate for Payer: PACE Medicare	$3,529.19
Rate for Payer: PACE SWMI	$3,714.94
Rate for Payer: PHP Medicare Advantage	$3,714.94
Rate for Payer: Priority Health Choice Medicaid	$1,942.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$12,013.78
Rate for Payer: Priority Health Medicare	$3,714.94
Rate for Payer: Priority Health Tiered Network	$9,611.02
Rate for Payer: Railroad Medicare Medicare	$3,714.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,714.94
Rate for Payer: UHC Medicaid	$1,942.91
Rate for Payer: UHCCP Medicaid	$1,942.91
Rate for Payer: VA VA	$3,714.94

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMOR AND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE OR TELESCOPE

Facility

$12,013.78

Service Code	CPT 31541
Hospital Revenue Code	360
Min. Negotiated Rate	$1,942.91
Max. Negotiated Rate	$12,013.78
Rate for Payer: Aetna Medicare	$3,863.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,643.68
Rate for Payer: Amish Plain Church Group Commercial	$4,643.68
Rate for Payer: BCBS Complete	$2,040.25
Rate for Payer: BCBS MAPPO	$3,714.94
Rate for Payer: BCBS Trust/PPO	$3,200.49
Rate for Payer: BCN Commercial	$3,200.49
Rate for Payer: BCN Medicare Advantage	$3,714.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,714.94
Rate for Payer: Mclaren Medicaid	$1,942.91
Rate for Payer: Mclaren Medicare	$3,714.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,900.69
Rate for Payer: Meridian Medicaid	$3,900.69
Rate for Payer: MI Amish Medical Board Commercial	$4,272.18
Rate for Payer: Molina Medicare/Medicaid	$4,086.43
Rate for Payer: Nomi Health Commercial	$11,144.82
Rate for Payer: PACE Medicare	$3,529.19
Rate for Payer: PACE SWMI	$3,714.94
Rate for Payer: PHP Medicare Advantage	$3,714.94
Rate for Payer: Priority Health Choice Medicaid	$1,942.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$12,013.78
Rate for Payer: Priority Health Medicare	$3,714.94
Rate for Payer: Priority Health Tiered Network	$9,611.02
Rate for Payer: Railroad Medicare Medicare	$3,714.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,714.94
Rate for Payer: UHC Medicaid	$1,942.91
Rate for Payer: UHCCP Medicaid	$1,942.91
Rate for Payer: VA VA	$3,714.94

LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S), THERAPEUTIC; WITH OPERATING MICROSCOPE OR TELESCOPE

Facility

$12,013.78

Service Code	CPT 31571
Hospital Revenue Code	360
Min. Negotiated Rate	$1,942.91
Max. Negotiated Rate	$12,013.78
Rate for Payer: Aetna Medicare	$3,863.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,643.68
Rate for Payer: Amish Plain Church Group Commercial	$4,643.68
Rate for Payer: BCBS Complete	$2,040.25
Rate for Payer: BCBS MAPPO	$3,714.94
Rate for Payer: BCBS Trust/PPO	$3,079.17
Rate for Payer: BCN Commercial	$3,079.17
Rate for Payer: BCN Medicare Advantage	$3,714.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,714.94
Rate for Payer: Mclaren Medicaid	$1,942.91
Rate for Payer: Mclaren Medicare	$3,714.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,900.69
Rate for Payer: Meridian Medicaid	$3,900.69
Rate for Payer: MI Amish Medical Board Commercial	$4,272.18
Rate for Payer: Molina Medicare/Medicaid	$4,086.43
Rate for Payer: Nomi Health Commercial	$11,144.82
Rate for Payer: PACE Medicare	$3,529.19
Rate for Payer: PACE SWMI	$3,714.94
Rate for Payer: PHP Medicare Advantage	$3,714.94
Rate for Payer: Priority Health Choice Medicaid	$1,942.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$12,013.78
Rate for Payer: Priority Health Medicare	$3,714.94
Rate for Payer: Priority Health Tiered Network	$9,611.02
Rate for Payer: Railroad Medicare Medicare	$3,714.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,714.94
Rate for Payer: UHC Medicaid	$1,942.91
Rate for Payer: UHCCP Medicaid	$1,942.91
Rate for Payer: VA VA	$3,714.94

LATANOPROST 0.005 % EYE DROPS

Facility

$52.13

Service Code	NDC 61314054703
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$46.92
Rate for Payer: Aetna Commercial	$44.31
Rate for Payer: Aetna Medicare	$26.07
Rate for Payer: Aetna New Business (MI Preferred)	$33.88
Rate for Payer: BCBS Complete	$20.85
Rate for Payer: Cash Price	$41.70
Rate for Payer: Cofinity Advantage	$36.49
Rate for Payer: Cofinity Commercial	$44.83
Rate for Payer: Encore Health Key Benefits Commercial	$41.70
Rate for Payer: Healthscope Commercial	$46.92
Rate for Payer: MI Amish Medical Board Commercial	$41.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.10
Rate for Payer: PHP Commercial	$44.31
Rate for Payer: Priority Health SBD	$32.84
Rate for Payer: UHC All Payor (Choice/PPO)	$33.88
Rate for Payer: UHC Core	$27.16
Rate for Payer: UHC Exchange	$20.49

LATANOPROST 0.005 % EYE DROPS

Facility

$52.13

Service Code	NDC 61314054703
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$32.84
Max. Negotiated Rate	$46.92
Rate for Payer: Aetna Commercial	$44.31
Rate for Payer: Aetna New Business (MI Preferred)	$33.88
Rate for Payer: Cash Price	$41.70
Rate for Payer: Cofinity Advantage	$36.49
Rate for Payer: Cofinity Commercial	$44.83
Rate for Payer: Encore Health Key Benefits Commercial	$41.70
Rate for Payer: Healthscope Commercial	$46.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.10
Rate for Payer: PHP Commercial	$44.31
Rate for Payer: Priority Health SBD	$32.84

LATANOPROST 0.005 % EYE DROPS

Facility

$26.28

Service Code	NDC 61314054701
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$10.33
Max. Negotiated Rate	$23.65
Rate for Payer: Aetna Commercial	$22.34
Rate for Payer: Aetna Medicare	$13.14
Rate for Payer: Aetna New Business (MI Preferred)	$17.08
Rate for Payer: BCBS Complete	$10.51
Rate for Payer: Cash Price	$21.02
Rate for Payer: Cofinity Advantage	$18.40
Rate for Payer: Cofinity Commercial	$22.60
Rate for Payer: Encore Health Key Benefits Commercial	$21.02
Rate for Payer: Healthscope Commercial	$23.65
Rate for Payer: MI Amish Medical Board Commercial	$21.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.71
Rate for Payer: PHP Commercial	$22.34
Rate for Payer: Priority Health SBD	$16.56
Rate for Payer: UHC All Payor (Choice/PPO)	$17.08
Rate for Payer: UHC Core	$13.69
Rate for Payer: UHC Exchange	$10.33

LATANOPROST 0.005 % EYE DROPS

Facility

$29.96

Service Code	NDC 24208046325
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$18.87
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Advantage	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health SBD	$18.87

LATANOPROST 0.005 % EYE DROPS

Facility

$50.75

Service Code	NDC 17478062512
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$19.94
Max. Negotiated Rate	$45.67
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna Medicare	$25.38
Rate for Payer: Aetna New Business (MI Preferred)	$32.99
Rate for Payer: BCBS Complete	$20.30
Rate for Payer: Cash Price	$40.60
Rate for Payer: Cofinity Advantage	$35.52
Rate for Payer: Cofinity Commercial	$43.65
Rate for Payer: Encore Health Key Benefits Commercial	$40.60
Rate for Payer: Healthscope Commercial	$45.67
Rate for Payer: MI Amish Medical Board Commercial	$40.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.06
Rate for Payer: PHP Commercial	$43.14
Rate for Payer: Priority Health SBD	$31.97
Rate for Payer: UHC All Payor (Choice/PPO)	$32.99
Rate for Payer: UHC Core	$26.44
Rate for Payer: UHC Exchange	$19.94

LATANOPROST 0.005 % EYE DROPS

Facility

$861.95

Service Code	NDC 00013830304
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$543.03
Max. Negotiated Rate	$775.75
Rate for Payer: Aetna Commercial	$732.66
Rate for Payer: Aetna New Business (MI Preferred)	$560.27
Rate for Payer: Cash Price	$689.56
Rate for Payer: Cofinity Advantage	$603.37
Rate for Payer: Cofinity Commercial	$741.28
Rate for Payer: Encore Health Key Benefits Commercial	$689.56
Rate for Payer: Healthscope Commercial	$775.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$732.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$646.46
Rate for Payer: PHP Commercial	$732.66
Rate for Payer: Priority Health SBD	$543.03

LATANOPROST 0.005 % EYE DROPS

Facility

$26.28

Service Code	NDC 61314054701
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$23.65
Rate for Payer: Aetna Commercial	$22.34
Rate for Payer: Aetna New Business (MI Preferred)	$17.08
Rate for Payer: Cash Price	$21.02
Rate for Payer: Cofinity Advantage	$18.40
Rate for Payer: Cofinity Commercial	$22.60
Rate for Payer: Encore Health Key Benefits Commercial	$21.02
Rate for Payer: Healthscope Commercial	$23.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.71
Rate for Payer: PHP Commercial	$22.34
Rate for Payer: Priority Health SBD	$16.56

LATANOPROST 0.005 % EYE DROPS

Facility

$29.96

Service Code	NDC 24208046325
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$11.77
Max. Negotiated Rate	$26.96
Rate for Payer: Aetna Commercial	$25.47
Rate for Payer: Aetna Medicare	$14.98
Rate for Payer: Aetna New Business (MI Preferred)	$19.47
Rate for Payer: BCBS Complete	$11.98
Rate for Payer: Cash Price	$23.97
Rate for Payer: Cofinity Advantage	$20.97
Rate for Payer: Cofinity Commercial	$25.77
Rate for Payer: Encore Health Key Benefits Commercial	$23.97
Rate for Payer: Healthscope Commercial	$26.96
Rate for Payer: MI Amish Medical Board Commercial	$23.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$25.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.47
Rate for Payer: PHP Commercial	$25.47
Rate for Payer: Priority Health SBD	$18.87
Rate for Payer: UHC All Payor (Choice/PPO)	$19.47
Rate for Payer: UHC Core	$15.61
Rate for Payer: UHC Exchange	$11.77

LATANOPROST 0.005 % EYE DROPS

Facility

$50.75

Service Code	NDC 17478062512
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$31.97
Max. Negotiated Rate	$45.67
Rate for Payer: Aetna Commercial	$43.14
Rate for Payer: Aetna New Business (MI Preferred)	$32.99
Rate for Payer: Cash Price	$40.60
Rate for Payer: Cofinity Advantage	$35.52
Rate for Payer: Cofinity Commercial	$43.65
Rate for Payer: Encore Health Key Benefits Commercial	$40.60
Rate for Payer: Healthscope Commercial	$45.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.06
Rate for Payer: PHP Commercial	$43.14
Rate for Payer: Priority Health SBD	$31.97

LATANOPROST 0.005 % EYE DROPS

Facility

$861.95

Service Code	NDC 00013830304
Hospital Charge Code	18621
Hospital Revenue Code	637
Min. Negotiated Rate	$338.75
Max. Negotiated Rate	$775.75
Rate for Payer: Aetna Commercial	$732.66
Rate for Payer: Aetna Medicare	$430.98
Rate for Payer: Aetna New Business (MI Preferred)	$560.27
Rate for Payer: BCBS Complete	$344.78
Rate for Payer: Cash Price	$689.56
Rate for Payer: Cofinity Advantage	$603.37
Rate for Payer: Cofinity Commercial	$741.28
Rate for Payer: Encore Health Key Benefits Commercial	$689.56
Rate for Payer: Healthscope Commercial	$775.75
Rate for Payer: MI Amish Medical Board Commercial	$689.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$732.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$646.46
Rate for Payer: PHP Commercial	$732.66
Rate for Payer: Priority Health SBD	$543.03
Rate for Payer: UHC All Payor (Choice/PPO)	$560.27
Rate for Payer: UHC Core	$449.08
Rate for Payer: UHC Exchange	$338.75

Know your out-of-pocket cost for care.

All Charges