Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LANTHANUM 500 MG CHEWABLE TABLET

Facility

$1,720.62

Service Code	NDC 68180081942
Hospital Charge Code	39975
Hospital Revenue Code	637
Min. Negotiated Rate	$1,083.99
Max. Negotiated Rate	$1,548.56
Rate for Payer: Aetna Commercial	$1,462.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,118.40
Rate for Payer: Cash Price	$1,376.50
Rate for Payer: Cofinity Commercial	$1,204.43
Rate for Payer: Cofinity Commercial	$1,479.73
Rate for Payer: Cofinity Medicare Advantage	$1,204.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,376.50
Rate for Payer: Healthscope Commercial	$1,548.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,462.53
Rate for Payer: PHP Commercial	$1,462.53
Rate for Payer: Priority Health Cigna Priority Health	$1,118.40
Rate for Payer: Priority Health SBD	$1,083.99

LANTHANUM 500 MG CHEWABLE TABLET

Facility

$1,720.62

Service Code	NDC 68180081942
Hospital Charge Code	39975
Hospital Revenue Code	637
Min. Negotiated Rate	$688.25
Max. Negotiated Rate	$1,548.56
Rate for Payer: Aetna Commercial	$1,462.53
Rate for Payer: Aetna Medicare	$860.31
Rate for Payer: Aetna New Business (MI Preferred)	$1,118.40
Rate for Payer: BCBS Complete	$688.25
Rate for Payer: Cash Price	$1,376.50
Rate for Payer: Cofinity Commercial	$1,204.43
Rate for Payer: Cofinity Commercial	$1,479.73
Rate for Payer: Cofinity Medicare Advantage	$1,204.43
Rate for Payer: Encore Health Key Benefits Commercial	$1,376.50
Rate for Payer: Healthscope Commercial	$1,548.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,462.53
Rate for Payer: PHP Commercial	$1,462.53
Rate for Payer: Priority Health Cigna Priority Health	$1,118.40
Rate for Payer: Priority Health SBD	$1,083.99

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY

Facility

$16,017.15

Service Code	CPT 59150
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY

Facility

$16,017.15

Service Code	CPT 59151
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Facility

$16,017.15

Service Code	CPT 49320
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; ABLATION OF RENAL CYSTS

Facility

$28,582.07

Service Code	CPT 50541
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S), INCLUDING INTRAOPERATIVE ULTRASOUND GUIDANCE AND MONITORING, WHEN PERFORMED

Facility

$28,582.07

Service Code	CPT 50542
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL, APPENDECTOMY

Facility

$16,017.15

Service Code	CPT 44970
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY

Facility

$16,017.15

Service Code	CPT 47562
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY

Facility

$16,017.15

Service Code	CPT 47563
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT

Facility

$28,582.07

Service Code	CPT 47564
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)

Facility

$28,582.07

Service Code	CPT 57425
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)

Facility

$16,017.15

Service Code	CPT 44180
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)

Facility

$28,582.07

Service Code	CPT 43280
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)

Facility

$16,017.15

Service Code	CPT 43653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)

Facility

$16,017.15

Service Code	CPT 44186
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS

Facility

$16,017.15

Service Code	CPT 58545
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G

Facility

$28,582.07

Service Code	CPT 58546
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; ORCHIECTOMY

Facility

$16,017.15

Service Code	CPT 54690
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY

Facility

$28,582.07

Service Code	CPT 50543
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED

Facility

$28,582.07

Service Code	CPT 55866
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; PYELOPLASTY

Facility

$28,582.07

Service Code	CPT 50544
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA

Facility

$16,017.15

Service Code	CPT 49650
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH

Facility

$28,582.07

Service Code	CPT 43282
Hospital Revenue Code	360
Min. Negotiated Rate	$5,442.46
Max. Negotiated Rate	$28,582.07
Rate for Payer: Aetna Medicare	$10,560.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,692.31
Rate for Payer: Amish Plain Church Group Commercial	$12,692.31
Rate for Payer: BCBS Complete	$5,714.59
Rate for Payer: BCBS MAPPO	$10,153.85
Rate for Payer: BCN Medicare Advantage	$10,153.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,153.85
Rate for Payer: Mclaren Medicaid	$5,442.46
Rate for Payer: Mclaren Medicare	$10,153.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,661.54
Rate for Payer: Meridian Medicaid	$5,714.59
Rate for Payer: MI Amish Medical Board Commercial	$11,676.93
Rate for Payer: PACE Medicare	$9,646.16
Rate for Payer: PACE SWMI	$10,153.85
Rate for Payer: PHP Medicare Advantage	$10,153.85
Rate for Payer: Priority Health Choice Medicaid	$5,442.46
Rate for Payer: Priority Health Medicare	$10,153.85
Rate for Payer: Railroad Medicare Medicare	$10,153.85
Rate for Payer: UHC All Payor (Choice/PPO)	$28,582.07
Rate for Payer: UHC Dual Complete DSNP	$10,153.85
Rate for Payer: UHC Medicare Advantage	$10,153.85
Rate for Payer: UHCCP Medicaid	$5,716.62
Rate for Payer: VA VA	$10,153.85

LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA

Facility

$16,017.15

Service Code	CPT 49651
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
Rate for Payer: Aetna Medicare	$5,917.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,112.66
Rate for Payer: Amish Plain Church Group Commercial	$7,112.66
Rate for Payer: BCBS Complete	$3,202.41
Rate for Payer: BCBS MAPPO	$5,690.13
Rate for Payer: BCN Medicare Advantage	$5,690.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,690.13
Rate for Payer: Mclaren Medicaid	$3,049.91
Rate for Payer: Mclaren Medicare	$5,690.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,974.64
Rate for Payer: Meridian Medicaid	$3,202.41
Rate for Payer: MI Amish Medical Board Commercial	$6,543.65
Rate for Payer: PACE Medicare	$5,405.62
Rate for Payer: PACE SWMI	$5,690.13
Rate for Payer: PHP Medicare Advantage	$5,690.13
Rate for Payer: Priority Health Choice Medicaid	$3,049.91
Rate for Payer: Priority Health Medicare	$5,690.13
Rate for Payer: Railroad Medicare Medicare	$5,690.13
Rate for Payer: UHC All Payor (Choice/PPO)	$16,017.15
Rate for Payer: UHC Dual Complete DSNP	$5,690.13
Rate for Payer: UHC Medicare Advantage	$5,690.13
Rate for Payer: UHCCP Medicaid	$3,203.54
Rate for Payer: VA VA	$5,690.13

Know your out-of-pocket cost for care.

All Charges