Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR HYMENOTOMY SIMPLE INCISION

Professional

Both

$153.00

Service Code	HCPCS 56442
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$2,246.86
Rate for Payer: Aetna Commercial	$55.11
Rate for Payer: BCBS Complete	$31.98
Rate for Payer: BCBS Trust/PPO	$2,246.86
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Mclaren Medicaid	$30.46
Rate for Payer: Meridian Medicaid	$31.98
Rate for Payer: Priority Health Choice Medicaid	$30.46
Rate for Payer: Priority Health Cigna Priority Health	$107.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.23
Rate for Payer: Priority Health Narrow Network	$67.23
Rate for Payer: Priority Health SBD	$67.23

PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL

Professional

Both

$8,323.00

Service Code	HCPCS 61548
Min. Negotiated Rate	$712.15
Max. Negotiated Rate	$5,826.10
Rate for Payer: Aetna Commercial	$2,027.19
Rate for Payer: BCBS Complete	$1,065.25
Rate for Payer: BCBS Trust/PPO	$712.15
Rate for Payer: Cash Price	$6,658.40
Rate for Payer: Cash Price	$6,658.40
Rate for Payer: Mclaren Medicaid	$1,014.52
Rate for Payer: Meridian Medicaid	$1,065.25
Rate for Payer: Priority Health Choice Medicaid	$1,014.52
Rate for Payer: Priority Health Cigna Priority Health	$5,826.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,671.45
Rate for Payer: Priority Health Narrow Network	$2,671.45
Rate for Payer: Priority Health SBD	$2,671.45

PR HYSTERORRHAPHY RUPTURED UTERUS

Professional

Both

$1,286.00

Service Code	HCPCS 59350
Min. Negotiated Rate	$178.07
Max. Negotiated Rate	$900.20
Rate for Payer: Aetna Commercial	$307.58
Rate for Payer: BCBS Complete	$186.97
Rate for Payer: BCBS Trust/PPO	$296.90
Rate for Payer: Cash Price	$1,028.80
Rate for Payer: Cash Price	$1,028.80
Rate for Payer: Mclaren Medicaid	$178.07
Rate for Payer: Meridian Medicaid	$186.97
Rate for Payer: Priority Health Choice Medicaid	$178.07
Rate for Payer: Priority Health Cigna Priority Health	$900.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$393.79
Rate for Payer: Priority Health Narrow Network	$393.79
Rate for Payer: Priority Health SBD	$393.79

PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS

Professional

Both

$3,300.00

Service Code	HCPCS 58565
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$2,310.00
Rate for Payer: Aetna Commercial	$542.07
Rate for Payer: BCBS Complete	$1,320.00
Rate for Payer: BCBS Trust/PPO	$3.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Cash Price	$2,640.00
Rate for Payer: Priority Health Cigna Priority Health	$2,310.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$652.38
Rate for Payer: Priority Health Narrow Network	$652.38
Rate for Payer: Priority Health SBD	$652.38

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Facility

$1,344.00

Service Code	CPT 58558
Hospital Charge Code	58558
Hospital Revenue Code	960
Min. Negotiated Rate	$226.59
Max. Negotiated Rate	$3,477.26
Rate for Payer: Aetna Commercial	$1,142.40
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$873.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$1,799.23
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cofinity Commercial	$940.80
Rate for Payer: Cofinity Commercial	$1,155.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$1,209.60
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,142.40
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$1,142.40
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$940.80
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$846.72
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$249.25
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$226.59
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Professional

Both

$1,344.00

Service Code	HCPCS 58558
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$940.80
Rate for Payer: Aetna Commercial	$276.01
Rate for Payer: BCBS Complete	$154.77
Rate for Payer: BCBS Trust/PPO	$650.87
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Mclaren Medicaid	$147.40
Rate for Payer: Meridian Medicaid	$154.77
Rate for Payer: Priority Health Choice Medicaid	$147.40
Rate for Payer: Priority Health Cigna Priority Health	$940.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.19
Rate for Payer: Priority Health Narrow Network	$326.19
Rate for Payer: Priority Health SBD	$326.19

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Facility

$1,344.00

Service Code	CPT 58558
Hospital Charge Code	58558
Hospital Revenue Code	960
Min. Negotiated Rate	$846.72
Max. Negotiated Rate	$1,209.60
Rate for Payer: Aetna Commercial	$1,142.40
Rate for Payer: Aetna New Business (MI Preferred)	$873.60
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cofinity Commercial	$1,155.84
Rate for Payer: Cofinity Commercial	$940.80
Rate for Payer: Healthscope Commercial	$1,209.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,142.40
Rate for Payer: PHP Commercial	$1,142.40
Rate for Payer: Priority Health Cigna Priority Health	$940.80
Rate for Payer: Priority Health SBD	$846.72

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Professional

Both

$1,344.00

Service Code	HCPCS 58558
Hospital Charge Code	58558
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$940.80
Rate for Payer: Aetna Commercial	$276.01
Rate for Payer: BCBS Complete	$154.77
Rate for Payer: BCBS Trust/PPO	$650.87
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Mclaren Medicaid	$147.40
Rate for Payer: Meridian Medicaid	$154.77
Rate for Payer: Priority Health Choice Medicaid	$147.40
Rate for Payer: Priority Health Cigna Priority Health	$940.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.19
Rate for Payer: Priority Health Narrow Network	$326.19
Rate for Payer: Priority Health SBD	$326.19

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Facility

$797.00

Service Code	CPT 58555
Hospital Charge Code	58555
Min. Negotiated Rate	$148.33
Max. Negotiated Rate	$3,477.26
Rate for Payer: Aetna Commercial	$677.45
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$518.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$939.15
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cofinity Commercial	$685.42
Rate for Payer: Cofinity Commercial	$557.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$717.30
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$677.45
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$677.45
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$557.90
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$502.11
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$163.16
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$148.33
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Professional

Both

$797.00

Service Code	HCPCS 58555
Min. Negotiated Rate	$96.49
Max. Negotiated Rate	$1,037.58
Rate for Payer: Aetna Commercial	$181.23
Rate for Payer: BCBS Complete	$101.31
Rate for Payer: BCBS Trust/PPO	$1,037.58
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cash Price	$637.60
Rate for Payer: Mclaren Medicaid	$96.49
Rate for Payer: Meridian Medicaid	$101.31
Rate for Payer: Priority Health Choice Medicaid	$96.49
Rate for Payer: Priority Health Cigna Priority Health	$557.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.51
Rate for Payer: Priority Health Narrow Network	$213.51
Rate for Payer: Priority Health SBD	$213.51

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Facility

$797.00

Service Code	CPT 58555
Hospital Charge Code	58555
Min. Negotiated Rate	$502.11
Max. Negotiated Rate	$717.30
Rate for Payer: Aetna Commercial	$677.45
Rate for Payer: Aetna New Business (MI Preferred)	$518.05
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cofinity Commercial	$557.90
Rate for Payer: Cofinity Commercial	$685.42
Rate for Payer: Healthscope Commercial	$717.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$677.45
Rate for Payer: PHP Commercial	$677.45
Rate for Payer: Priority Health Cigna Priority Health	$557.90
Rate for Payer: Priority Health SBD	$502.11

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Professional

Both

$797.00

Service Code	HCPCS 58555
Hospital Charge Code	58555
Min. Negotiated Rate	$96.49
Max. Negotiated Rate	$1,037.58
Rate for Payer: Aetna Commercial	$181.23
Rate for Payer: BCBS Complete	$101.31
Rate for Payer: BCBS Trust/PPO	$1,037.58
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cash Price	$637.60
Rate for Payer: Mclaren Medicaid	$96.49
Rate for Payer: Meridian Medicaid	$101.31
Rate for Payer: Priority Health Choice Medicaid	$96.49
Rate for Payer: Priority Health Cigna Priority Health	$557.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.51
Rate for Payer: Priority Health Narrow Network	$213.51
Rate for Payer: Priority Health SBD	$213.51

PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM

Professional

Both

$1,640.00

Service Code	HCPCS 58560
Min. Negotiated Rate	$29.58
Max. Negotiated Rate	$1,148.00
Rate for Payer: Aetna Commercial	$375.75
Rate for Payer: BCBS Complete	$209.12
Rate for Payer: BCBS Trust/PPO	$29.58
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Cash Price	$1,312.00
Rate for Payer: Mclaren Medicaid	$199.16
Rate for Payer: Meridian Medicaid	$209.12
Rate for Payer: Priority Health Choice Medicaid	$199.16
Rate for Payer: Priority Health Cigna Priority Health	$1,148.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$440.28
Rate for Payer: Priority Health Narrow Network	$440.28
Rate for Payer: Priority Health SBD	$440.28

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Facility

$1,533.00

Service Code	CPT 58563
Hospital Charge Code	58563
Min. Negotiated Rate	$240.67
Max. Negotiated Rate	$5,532.19
Rate for Payer: Aetna Commercial	$1,303.05
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Aetna New Business (MI Preferred)	$996.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$1,983.85
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cofinity Commercial	$1,073.10
Rate for Payer: Cofinity Commercial	$1,318.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Healthscope Commercial	$1,379.70
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,303.05
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Commercial	$1,303.05
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Cigna Priority Health	$1,073.10
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Priority Health SBD	$965.79
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$264.74
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$240.67
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Facility

$1,533.00

Service Code	CPT 58563
Hospital Charge Code	58563
Min. Negotiated Rate	$965.79
Max. Negotiated Rate	$1,379.70
Rate for Payer: Aetna Commercial	$1,303.05
Rate for Payer: Aetna New Business (MI Preferred)	$996.45
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cofinity Commercial	$1,073.10
Rate for Payer: Cofinity Commercial	$1,318.38
Rate for Payer: Healthscope Commercial	$1,379.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,303.05
Rate for Payer: PHP Commercial	$1,303.05
Rate for Payer: Priority Health Cigna Priority Health	$1,073.10
Rate for Payer: Priority Health SBD	$965.79

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Professional

Both

$1,533.00

Service Code	HCPCS 58563
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$1,073.10
Rate for Payer: Aetna Commercial	$294.85
Rate for Payer: BCBS Complete	$164.39
Rate for Payer: BCBS Trust/PPO	$14.26
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Mclaren Medicaid	$156.56
Rate for Payer: Meridian Medicaid	$164.39
Rate for Payer: Priority Health Choice Medicaid	$156.56
Rate for Payer: Priority Health Cigna Priority Health	$1,073.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$347.02
Rate for Payer: Priority Health Narrow Network	$347.02
Rate for Payer: Priority Health SBD	$347.02

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Professional

Both

$1,533.00

Service Code	HCPCS 58563
Hospital Charge Code	58563
Min. Negotiated Rate	$14.26
Max. Negotiated Rate	$1,073.10
Rate for Payer: Aetna Commercial	$294.85
Rate for Payer: BCBS Complete	$164.39
Rate for Payer: BCBS Trust/PPO	$14.26
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Cash Price	$1,226.40
Rate for Payer: Mclaren Medicaid	$156.56
Rate for Payer: Meridian Medicaid	$164.39
Rate for Payer: Priority Health Choice Medicaid	$156.56
Rate for Payer: Priority Health Cigna Priority Health	$1,073.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$347.02
Rate for Payer: Priority Health Narrow Network	$347.02
Rate for Payer: Priority Health SBD	$347.02

PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS

Professional

Both

$1,485.00

Service Code	HCPCS 58559
Min. Negotiated Rate	$180.84
Max. Negotiated Rate	$1,039.50
Rate for Payer: Aetna Commercial	$340.58
Rate for Payer: BCBS Complete	$189.88
Rate for Payer: BCBS Trust/PPO	$498.19
Rate for Payer: Cash Price	$1,188.00
Rate for Payer: Cash Price	$1,188.00
Rate for Payer: Mclaren Medicaid	$180.84
Rate for Payer: Meridian Medicaid	$189.88
Rate for Payer: Priority Health Choice Medicaid	$180.84
Rate for Payer: Priority Health Cigna Priority Health	$1,039.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$400.05
Rate for Payer: Priority Health Narrow Network	$400.05
Rate for Payer: Priority Health SBD	$400.05

PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY

Professional

Both

$1,154.00

Service Code	HCPCS 58562
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$807.80
Rate for Payer: Aetna Commercial	$265.43
Rate for Payer: BCBS Complete	$148.28
Rate for Payer: BCBS Trust/PPO	$13.74
Rate for Payer: Cash Price	$923.20
Rate for Payer: Cash Price	$923.20
Rate for Payer: Mclaren Medicaid	$141.22
Rate for Payer: Meridian Medicaid	$148.28
Rate for Payer: Priority Health Choice Medicaid	$141.22
Rate for Payer: Priority Health Cigna Priority Health	$807.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$312.47
Rate for Payer: Priority Health Narrow Network	$312.47
Rate for Payer: Priority Health SBD	$312.47

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Facility

$923.00

Service Code	CPT 58561
Hospital Charge Code	58561
Min. Negotiated Rate	$581.49
Max. Negotiated Rate	$830.70
Rate for Payer: Aetna Commercial	$784.55
Rate for Payer: Aetna New Business (MI Preferred)	$599.95
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cofinity Commercial	$646.10
Rate for Payer: Cofinity Commercial	$793.78
Rate for Payer: Healthscope Commercial	$830.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$784.55
Rate for Payer: PHP Commercial	$784.55
Rate for Payer: Priority Health Cigna Priority Health	$646.10
Rate for Payer: Priority Health SBD	$581.49

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Professional

Both

$923.00

Service Code	HCPCS 58561
Hospital Charge Code	58561
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$646.10
Rate for Payer: Aetna Commercial	$428.81
Rate for Payer: BCBS Complete	$239.31
Rate for Payer: BCBS Trust/PPO	$23.25
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Mclaren Medicaid	$227.91
Rate for Payer: Meridian Medicaid	$239.31
Rate for Payer: Priority Health Choice Medicaid	$227.91
Rate for Payer: Priority Health Cigna Priority Health	$646.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$504.20
Rate for Payer: Priority Health Narrow Network	$504.20
Rate for Payer: Priority Health SBD	$504.20

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Facility

$923.00

Service Code	CPT 58561
Hospital Charge Code	58561
Min. Negotiated Rate	$350.36
Max. Negotiated Rate	$5,532.19
Rate for Payer: Aetna Commercial	$784.55
Rate for Payer: Aetna Medicare	$4,602.78
Rate for Payer: Aetna New Business (MI Preferred)	$599.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,532.19
Rate for Payer: Amish Plain Church Group Commercial	$5,532.19
Rate for Payer: BCBS Complete	$2,542.15
Rate for Payer: BCBS MAPPO	$4,425.75
Rate for Payer: BCBS Trust/PPO	$2,395.50
Rate for Payer: BCN Medicare Advantage	$4,425.75
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cofinity Commercial	$793.78
Rate for Payer: Cofinity Commercial	$646.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,425.75
Rate for Payer: Healthscope Commercial	$830.70
Rate for Payer: Mclaren Medicaid	$2,420.89
Rate for Payer: Mclaren Medicare	$4,425.75
Rate for Payer: Meridian Medicaid	$2,542.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,647.04
Rate for Payer: MI Amish Medical Board Commercial	$5,089.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$784.55
Rate for Payer: PACE Medicare	$4,204.46
Rate for Payer: PACE SWMI	$4,425.75
Rate for Payer: PHP Commercial	$784.55
Rate for Payer: PHP Medicare Advantage	$4,425.75
Rate for Payer: Priority Health Choice Medicaid	$2,420.89
Rate for Payer: Priority Health Cigna Priority Health	$646.10
Rate for Payer: Priority Health Medicare	$4,425.75
Rate for Payer: Priority Health SBD	$581.49
Rate for Payer: Railroad Medicare Medicare	$4,425.75
Rate for Payer: UHC All Payor (Choice/PPO)	$385.40
Rate for Payer: UHC Dual Complete DSNP	$4,425.75
Rate for Payer: UHC Exchange	$350.36
Rate for Payer: UHC Medicare Advantage	$4,558.52
Rate for Payer: VA VA	$4,425.75

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Professional

Both

$923.00

Service Code	HCPCS 58561
Min. Negotiated Rate	$23.25
Max. Negotiated Rate	$646.10
Rate for Payer: Aetna Commercial	$428.81
Rate for Payer: BCBS Complete	$239.31
Rate for Payer: BCBS Trust/PPO	$23.25
Rate for Payer: Cash Price	$738.40
Rate for Payer: Cash Price	$738.40
Rate for Payer: Mclaren Medicaid	$227.91
Rate for Payer: Meridian Medicaid	$239.31
Rate for Payer: Priority Health Choice Medicaid	$227.91
Rate for Payer: Priority Health Cigna Priority Health	$646.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$504.20
Rate for Payer: Priority Health Narrow Network	$504.20
Rate for Payer: Priority Health SBD	$504.20

PR HYSTEROTOMY ABDOMINAL

Professional

Both

$1,500.00

Service Code	HCPCS 59100
Min. Negotiated Rate	$130.49
Max. Negotiated Rate	$1,217.73
Rate for Payer: Aetna Commercial	$936.56
Rate for Payer: BCBS Complete	$580.38
Rate for Payer: BCBS Trust/PPO	$130.49
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Mclaren Medicaid	$552.74
Rate for Payer: Meridian Medicaid	$580.38
Rate for Payer: Priority Health Choice Medicaid	$552.74
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,217.73
Rate for Payer: Priority Health Narrow Network	$1,217.73
Rate for Payer: Priority Health SBD	$1,217.73

PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE

Professional

Both

$168.00

Service Code	HCPCS 90750
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$187.08
Rate for Payer: Aetna Commercial	$187.08
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Trust/PPO	$175.26
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$117.60

Know your out-of-pocket cost for care.

All Charges