Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LAPAROSCOPY, SURGICAL, SPLENECTOMY

Facility

$28,582.07

Service Code	CPT 38120
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, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$28,582.07

Service Code	CPT 58541
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, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$28,582.07

Service Code	CPT 58542
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; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)

Facility

$16,017.15

Service Code	CPT 49322
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; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY

Facility

$28,582.07

Service Code	CPT 38571
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; WITH BIOPSY (SINGLE OR MULTIPLE)

Facility

$16,017.15

Service Code	CPT 49321
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; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)

Facility

$16,017.15

Service Code	CPT 58670
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; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD

Facility

$16,017.15

Service Code	CPT 58662
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; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$16,017.15

Service Code	CPT 49324
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; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)

Facility

$16,017.15

Service Code	CPT 58660
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; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)

Facility

$16,017.15

Service Code	CPT 58661
Hospital Revenue Code	360
Min. Negotiated Rate	$3,049.91
Max. Negotiated Rate	$16,017.15
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
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

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

Facility

$16,017.15

Service Code	CPT 38570
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; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED

Facility

$16,017.15

Service Code	CPT 49325
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$28,582.07

Service Code	CPT 58570
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$28,582.07

Service Code	CPT 58571
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;

Facility

$28,582.07

Service Code	CPT 58572
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$28,582.07

Service Code	CPT 58573
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, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$16,017.15

Service Code	CPT 58550
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, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$28,582.07

Service Code	CPT 58552
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, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$28,582.07

Service Code	CPT 58554
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

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

Facility

$10,121.85

Service Code	CPT 31536
Hospital Revenue Code	360
Min. Negotiated Rate	$1,927.35
Max. Negotiated Rate	$10,121.85
Rate for Payer: Aetna Medicare	$3,739.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,494.76
Rate for Payer: Amish Plain Church Group Commercial	$4,494.76
Rate for Payer: BCBS Complete	$2,023.72
Rate for Payer: BCBS MAPPO	$3,595.81
Rate for Payer: BCN Medicare Advantage	$3,595.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,595.81
Rate for Payer: Mclaren Medicaid	$1,927.35
Rate for Payer: Mclaren Medicare	$3,595.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,775.60
Rate for Payer: Meridian Medicaid	$2,023.72
Rate for Payer: MI Amish Medical Board Commercial	$4,135.18
Rate for Payer: PACE Medicare	$3,416.02
Rate for Payer: PACE SWMI	$3,595.81
Rate for Payer: PHP Medicare Advantage	$3,595.81
Rate for Payer: Priority Health Choice Medicaid	$1,927.35
Rate for Payer: Priority Health Medicare	$3,595.81
Rate for Payer: Railroad Medicare Medicare	$3,595.81
Rate for Payer: UHC All Payor (Choice/PPO)	$10,121.85
Rate for Payer: UHC Dual Complete DSNP	$3,595.81
Rate for Payer: UHC Medicare Advantage	$3,595.81
Rate for Payer: UHCCP Medicaid	$2,024.44
Rate for Payer: VA VA	$3,595.81

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

Facility

$10,121.85

Service Code	CPT 31541
Hospital Revenue Code	360
Min. Negotiated Rate	$1,927.35
Max. Negotiated Rate	$10,121.85
Rate for Payer: Aetna Medicare	$3,739.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,494.76
Rate for Payer: Amish Plain Church Group Commercial	$4,494.76
Rate for Payer: BCBS Complete	$2,023.72
Rate for Payer: BCBS MAPPO	$3,595.81
Rate for Payer: BCN Medicare Advantage	$3,595.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,595.81
Rate for Payer: Mclaren Medicaid	$1,927.35
Rate for Payer: Mclaren Medicare	$3,595.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,775.60
Rate for Payer: Meridian Medicaid	$2,023.72
Rate for Payer: MI Amish Medical Board Commercial	$4,135.18
Rate for Payer: PACE Medicare	$3,416.02
Rate for Payer: PACE SWMI	$3,595.81
Rate for Payer: PHP Medicare Advantage	$3,595.81
Rate for Payer: Priority Health Choice Medicaid	$1,927.35
Rate for Payer: Priority Health Medicare	$3,595.81
Rate for Payer: Railroad Medicare Medicare	$3,595.81
Rate for Payer: UHC All Payor (Choice/PPO)	$10,121.85
Rate for Payer: UHC Dual Complete DSNP	$3,595.81
Rate for Payer: UHC Medicare Advantage	$3,595.81
Rate for Payer: UHCCP Medicaid	$2,024.44
Rate for Payer: VA VA	$3,595.81

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

Facility

$10,121.85

Service Code	CPT 31571
Hospital Revenue Code	360
Min. Negotiated Rate	$1,927.35
Max. Negotiated Rate	$10,121.85
Rate for Payer: Aetna Medicare	$3,739.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,494.76
Rate for Payer: Amish Plain Church Group Commercial	$4,494.76
Rate for Payer: BCBS Complete	$2,023.72
Rate for Payer: BCBS MAPPO	$3,595.81
Rate for Payer: BCN Medicare Advantage	$3,595.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,595.81
Rate for Payer: Mclaren Medicaid	$1,927.35
Rate for Payer: Mclaren Medicare	$3,595.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,775.60
Rate for Payer: Meridian Medicaid	$2,023.72
Rate for Payer: MI Amish Medical Board Commercial	$4,135.18
Rate for Payer: PACE Medicare	$3,416.02
Rate for Payer: PACE SWMI	$3,595.81
Rate for Payer: PHP Medicare Advantage	$3,595.81
Rate for Payer: Priority Health Choice Medicaid	$1,927.35
Rate for Payer: Priority Health Medicare	$3,595.81
Rate for Payer: Railroad Medicare Medicare	$3,595.81
Rate for Payer: UHC All Payor (Choice/PPO)	$10,121.85
Rate for Payer: UHC Dual Complete DSNP	$3,595.81
Rate for Payer: UHC Medicare Advantage	$3,595.81
Rate for Payer: UHCCP Medicaid	$2,024.44
Rate for Payer: VA VA	$3,595.81

LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, EXCEPT NEWBORN

Facility

$4,734.21

Service Code	CPT 31525
Hospital Revenue Code	361
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; DIAGNOSTIC, WITH OPERATING MICROSCOPE OR TELESCOPE

Facility

$4,734.21

Service Code	CPT 31526
Hospital Revenue Code	360
Min. Negotiated Rate	$901.47
Max. Negotiated Rate	$4,734.21
Rate for Payer: Aetna Medicare	$1,749.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,102.30
Rate for Payer: Amish Plain Church Group Commercial	$2,102.30
Rate for Payer: BCBS Complete	$946.54
Rate for Payer: BCBS MAPPO	$1,681.84
Rate for Payer: BCN Medicare Advantage	$1,681.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,681.84
Rate for Payer: Mclaren Medicaid	$901.47
Rate for Payer: Mclaren Medicare	$1,681.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,765.93
Rate for Payer: Meridian Medicaid	$946.54
Rate for Payer: MI Amish Medical Board Commercial	$1,934.12
Rate for Payer: PACE Medicare	$1,597.75
Rate for Payer: PACE SWMI	$1,681.84
Rate for Payer: PHP Medicare Advantage	$1,681.84
Rate for Payer: Priority Health Choice Medicaid	$901.47
Rate for Payer: Priority Health Medicare	$1,681.84
Rate for Payer: Railroad Medicare Medicare	$1,681.84
Rate for Payer: UHC All Payor (Choice/PPO)	$4,734.21
Rate for Payer: UHC Dual Complete DSNP	$1,681.84
Rate for Payer: UHC Medicare Advantage	$1,681.84
Rate for Payer: UHCCP Medicaid	$946.88
Rate for Payer: VA VA	$1,681.84

Know your out-of-pocket cost for care.

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