Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR LAPAROSCOPY SURG CHOLECYSTECTOMY

Professional

Both

$2,952.00

Service Code	HCPCS 47562
Hospital Charge Code	47562
Min. Negotiated Rate	$424.30
Max. Negotiated Rate	$2,066.40
Rate for Payer: Aetna Commercial	$890.52
Rate for Payer: BCBS Complete	$445.52
Rate for Payer: BCBS Trust/PPO	$481.23
Rate for Payer: Cash Price	$2,361.60
Rate for Payer: Cash Price	$2,361.60
Rate for Payer: Mclaren Medicaid	$424.30
Rate for Payer: Meridian Medicaid	$445.52
Rate for Payer: Priority Health Choice Medicaid	$424.30
Rate for Payer: Priority Health Cigna Priority Health	$2,066.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,161.83
Rate for Payer: Priority Health Narrow Network	$1,161.83
Rate for Payer: Priority Health SBD	$1,161.83

PR LAPAROSCOPY SURG CHOLECYSTECTOMY

Professional

Both

$2,952.00

Service Code	HCPCS 47562
Min. Negotiated Rate	$424.30
Max. Negotiated Rate	$2,066.40
Rate for Payer: Aetna Commercial	$890.52
Rate for Payer: BCBS Complete	$445.52
Rate for Payer: BCBS Trust/PPO	$481.23
Rate for Payer: Cash Price	$2,361.60
Rate for Payer: Cash Price	$2,361.60
Rate for Payer: Mclaren Medicaid	$424.30
Rate for Payer: Meridian Medicaid	$445.52
Rate for Payer: Priority Health Choice Medicaid	$424.30
Rate for Payer: Priority Health Cigna Priority Health	$2,066.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,161.83
Rate for Payer: Priority Health Narrow Network	$1,161.83
Rate for Payer: Priority Health SBD	$1,161.83

PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY

Facility

$2,708.00

Service Code	CPT 44188
Hospital Charge Code	44188
Min. Negotiated Rate	$1,706.04
Max. Negotiated Rate	$2,437.20
Rate for Payer: Aetna Commercial	$2,301.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,760.20
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cofinity Commercial	$1,895.60
Rate for Payer: Cofinity Commercial	$2,328.88
Rate for Payer: Healthscope Commercial	$2,437.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,301.80
Rate for Payer: PHP Commercial	$2,301.80
Rate for Payer: Priority Health Cigna Priority Health	$1,895.60
Rate for Payer: Priority Health SBD	$1,706.04

PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY

Facility

$2,708.00

Service Code	CPT 44188
Hospital Charge Code	44188
Min. Negotiated Rate	$1,083.20
Max. Negotiated Rate	$2,499.80
Rate for Payer: Aetna Commercial	$2,301.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,760.20
Rate for Payer: BCBS Complete	$1,083.20
Rate for Payer: BCBS Trust/PPO	$2,499.80
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cofinity Commercial	$2,328.88
Rate for Payer: Cofinity Commercial	$1,895.60
Rate for Payer: Healthscope Commercial	$2,437.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,301.80
Rate for Payer: PHP Commercial	$2,301.80
Rate for Payer: Priority Health Cigna Priority Health	$1,895.60
Rate for Payer: Priority Health SBD	$1,706.04
Rate for Payer: UHC All Payor (Choice/PPO)	$1,306.76
Rate for Payer: UHC Exchange	$1,187.96

PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY

Professional

Both

$2,708.00

Service Code	HCPCS 44188
Min. Negotiated Rate	$772.76
Max. Negotiated Rate	$2,127.29
Rate for Payer: Aetna Commercial	$1,636.86
Rate for Payer: BCBS Complete	$811.40
Rate for Payer: BCBS Trust/PPO	$1,113.13
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Mclaren Medicaid	$772.76
Rate for Payer: Meridian Medicaid	$811.40
Rate for Payer: Priority Health Choice Medicaid	$772.76
Rate for Payer: Priority Health Cigna Priority Health	$1,895.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,127.29
Rate for Payer: Priority Health Narrow Network	$2,127.29
Rate for Payer: Priority Health SBD	$2,127.29

PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY

Professional

Both

$2,708.00

Service Code	HCPCS 44188
Hospital Charge Code	44188
Min. Negotiated Rate	$772.76
Max. Negotiated Rate	$2,127.29
Rate for Payer: Aetna Commercial	$1,636.86
Rate for Payer: BCBS Complete	$811.40
Rate for Payer: BCBS Trust/PPO	$1,113.13
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Mclaren Medicaid	$772.76
Rate for Payer: Meridian Medicaid	$811.40
Rate for Payer: Priority Health Choice Medicaid	$772.76
Rate for Payer: Priority Health Cigna Priority Health	$1,895.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,127.29
Rate for Payer: Priority Health Narrow Network	$2,127.29
Rate for Payer: Priority Health SBD	$2,127.29

PR LAPAROSCOPY SURGICAL JEJUNOSTOMY

Professional

Both

$1,959.00

Service Code	HCPCS 44186
Min. Negotiated Rate	$417.91
Max. Negotiated Rate	$1,371.30
Rate for Payer: Aetna Commercial	$878.77
Rate for Payer: BCBS Complete	$438.81
Rate for Payer: BCBS Trust/PPO	$1,287.47
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Mclaren Medicaid	$417.91
Rate for Payer: Meridian Medicaid	$438.81
Rate for Payer: Priority Health Choice Medicaid	$417.91
Rate for Payer: Priority Health Cigna Priority Health	$1,371.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,145.37
Rate for Payer: Priority Health Narrow Network	$1,145.37
Rate for Payer: Priority Health SBD	$1,145.37

PR LAPAROSCOPY SURGICAL ORCHIECTOMY

Professional

Both

$1,301.00

Service Code	HCPCS 54690
Min. Negotiated Rate	$417.48
Max. Negotiated Rate	$2,517.35
Rate for Payer: Aetna Commercial	$842.34
Rate for Payer: BCBS Complete	$438.35
Rate for Payer: BCBS Trust/PPO	$2,517.35
Rate for Payer: Cash Price	$1,040.80
Rate for Payer: Cash Price	$1,040.80
Rate for Payer: Mclaren Medicaid	$417.48
Rate for Payer: Meridian Medicaid	$438.35
Rate for Payer: Priority Health Choice Medicaid	$417.48
Rate for Payer: Priority Health Cigna Priority Health	$910.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,045.05
Rate for Payer: Priority Health Narrow Network	$1,045.05
Rate for Payer: Priority Health SBD	$1,045.05

PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE

Professional

Both

$2,964.00

Service Code	HCPCS 44187
Min. Negotiated Rate	$693.95
Max. Negotiated Rate	$2,074.80
Rate for Payer: Aetna Commercial	$1,467.80
Rate for Payer: BCBS Complete	$728.65
Rate for Payer: BCBS Trust/PPO	$828.90
Rate for Payer: Cash Price	$2,371.20
Rate for Payer: Cash Price	$2,371.20
Rate for Payer: Mclaren Medicaid	$693.95
Rate for Payer: Meridian Medicaid	$728.65
Rate for Payer: Priority Health Choice Medicaid	$693.95
Rate for Payer: Priority Health Cigna Priority Health	$2,074.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,910.33
Rate for Payer: Priority Health Narrow Network	$1,910.33
Rate for Payer: Priority Health SBD	$1,910.33

PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY

Professional

Both

$2,796.00

Service Code	HCPCS 50543
Min. Negotiated Rate	$942.95
Max. Negotiated Rate	$3,176.67
Rate for Payer: Aetna Commercial	$1,912.33
Rate for Payer: BCBS Complete	$990.10
Rate for Payer: BCBS Trust/PPO	$3,176.67
Rate for Payer: Cash Price	$2,236.80
Rate for Payer: Cash Price	$2,236.80
Rate for Payer: Mclaren Medicaid	$942.95
Rate for Payer: Meridian Medicaid	$990.10
Rate for Payer: Priority Health Choice Medicaid	$942.95
Rate for Payer: Priority Health Cigna Priority Health	$1,957.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,365.68
Rate for Payer: Priority Health Narrow Network	$2,365.68
Rate for Payer: Priority Health SBD	$2,365.68

PR LAPAROSCOPY SURG PYELOPLASTY

Professional

Both

$2,350.00

Service Code	HCPCS 50544
Min. Negotiated Rate	$784.05
Max. Negotiated Rate	$2,666.86
Rate for Payer: Aetna Commercial	$1,596.98
Rate for Payer: BCBS Complete	$823.25
Rate for Payer: BCBS Trust/PPO	$2,666.86
Rate for Payer: Cash Price	$1,880.00
Rate for Payer: Cash Price	$1,880.00
Rate for Payer: Mclaren Medicaid	$784.05
Rate for Payer: Meridian Medicaid	$823.25
Rate for Payer: Priority Health Choice Medicaid	$784.05
Rate for Payer: Priority Health Cigna Priority Health	$1,645.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,970.69
Rate for Payer: Priority Health Narrow Network	$1,970.69
Rate for Payer: Priority Health SBD	$1,970.69

PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA

Professional

Both

$1,530.00

Service Code	HCPCS 49650
Min. Negotiated Rate	$279.46
Max. Negotiated Rate	$4,463.08
Rate for Payer: Aetna Commercial	$580.39
Rate for Payer: BCBS Complete	$293.43
Rate for Payer: BCBS Trust/PPO	$4,463.08
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Mclaren Medicaid	$279.46
Rate for Payer: Meridian Medicaid	$293.43
Rate for Payer: Priority Health Choice Medicaid	$279.46
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$764.36
Rate for Payer: Priority Health Narrow Network	$764.36
Rate for Payer: Priority Health SBD	$764.36

PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA

Facility

$1,530.00

Service Code	CPT 49650
Hospital Charge Code	49650
Hospital Revenue Code	960
Min. Negotiated Rate	$963.90
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health SBD	$963.90

PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA

Professional

Both

$1,530.00

Service Code	HCPCS 49650
Hospital Charge Code	49650
Min. Negotiated Rate	$279.46
Max. Negotiated Rate	$4,463.08
Rate for Payer: Aetna Commercial	$580.39
Rate for Payer: BCBS Complete	$293.43
Rate for Payer: BCBS Trust/PPO	$4,463.08
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Mclaren Medicaid	$279.46
Rate for Payer: Meridian Medicaid	$293.43
Rate for Payer: Priority Health Choice Medicaid	$279.46
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$764.36
Rate for Payer: Priority Health Narrow Network	$764.36
Rate for Payer: Priority Health SBD	$764.36

PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA

Facility

$1,530.00

Service Code	CPT 49650
Hospital Charge Code	49650
Hospital Revenue Code	960
Min. Negotiated Rate	$429.60
Max. Negotiated Rate	$15,754.72
Rate for Payer: Aetna Commercial	$1,300.50
Rate for Payer: Aetna Medicare	$5,339.45
Rate for Payer: Aetna New Business (MI Preferred)	$994.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,417.61
Rate for Payer: Amish Plain Church Group Commercial	$6,417.61
Rate for Payer: BCBS Complete	$2,949.02
Rate for Payer: BCBS MAPPO	$5,134.09
Rate for Payer: BCBS Trust/PPO	$3,107.98
Rate for Payer: BCN Medicare Advantage	$5,134.09
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Cofinity Commercial	$1,071.00
Rate for Payer: Cofinity Commercial	$1,315.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,134.09
Rate for Payer: Healthscope Commercial	$1,377.00
Rate for Payer: Mclaren Medicaid	$2,808.35
Rate for Payer: Mclaren Medicare	$5,134.09
Rate for Payer: Meridian Medicaid	$2,949.02
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,390.79
Rate for Payer: MI Amish Medical Board Commercial	$5,904.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,300.50
Rate for Payer: PACE Medicare	$4,877.39
Rate for Payer: PACE SWMI	$5,134.09
Rate for Payer: PHP Commercial	$1,300.50
Rate for Payer: PHP Medicare Advantage	$5,134.09
Rate for Payer: Priority Health Choice Medicaid	$2,808.35
Rate for Payer: Priority Health Cigna Priority Health	$1,071.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,754.72
Rate for Payer: Priority Health Medicare	$5,134.09
Rate for Payer: Priority Health Narrow Network	$12,603.78
Rate for Payer: Priority Health SBD	$963.90
Rate for Payer: Railroad Medicare Medicare	$5,134.09
Rate for Payer: UHC All Payor (Choice/PPO)	$472.56
Rate for Payer: UHC Dual Complete DSNP	$5,134.09
Rate for Payer: UHC Exchange	$429.60
Rate for Payer: UHC Medicare Advantage	$5,288.11
Rate for Payer: VA VA	$5,134.09

PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE

Professional

Both

$1,539.00

Service Code	HCPCS 49321
Min. Negotiated Rate	$221.31
Max. Negotiated Rate	$1,478.18
Rate for Payer: Aetna Commercial	$463.87
Rate for Payer: BCBS Complete	$232.38
Rate for Payer: BCBS Trust/PPO	$1,478.18
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Cash Price	$1,231.20
Rate for Payer: Mclaren Medicaid	$221.31
Rate for Payer: Meridian Medicaid	$232.38
Rate for Payer: Priority Health Choice Medicaid	$221.31
Rate for Payer: Priority Health Cigna Priority Health	$1,077.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$606.21
Rate for Payer: Priority Health Narrow Network	$606.21
Rate for Payer: Priority Health SBD	$606.21

PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM

Professional

Both

$2,912.00

Service Code	HCPCS 58572
Min. Negotiated Rate	$61.81
Max. Negotiated Rate	$2,038.40
Rate for Payer: Aetna Commercial	$1,237.81
Rate for Payer: BCBS Complete	$683.48
Rate for Payer: BCBS Trust/PPO	$61.81
Rate for Payer: Cash Price	$2,329.60
Rate for Payer: Cash Price	$2,329.60
Rate for Payer: Mclaren Medicaid	$650.93
Rate for Payer: Meridian Medicaid	$683.48
Rate for Payer: Priority Health Choice Medicaid	$650.93
Rate for Payer: Priority Health Cigna Priority Health	$2,038.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,472.35
Rate for Payer: Priority Health Narrow Network	$1,472.35
Rate for Payer: Priority Health SBD	$1,472.35

PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR

Professional

Both

$3,397.00

Service Code	HCPCS 58573
Min. Negotiated Rate	$61.81
Max. Negotiated Rate	$2,377.90
Rate for Payer: Aetna Commercial	$1,450.88
Rate for Payer: BCBS Complete	$821.25
Rate for Payer: BCBS Trust/PPO	$61.81
Rate for Payer: Cash Price	$2,717.60
Rate for Payer: Cash Price	$2,717.60
Rate for Payer: Mclaren Medicaid	$782.14
Rate for Payer: Meridian Medicaid	$821.25
Rate for Payer: Priority Health Choice Medicaid	$782.14
Rate for Payer: Priority Health Cigna Priority Health	$2,377.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,723.73
Rate for Payer: Priority Health Narrow Network	$1,723.73
Rate for Payer: Priority Health SBD	$1,723.73

PR LAPAROSCOPY W/LYSIS OF ADHESIONS

Professional

Both

$2,634.00

Service Code	HCPCS 58660
Min. Negotiated Rate	$439.85
Max. Negotiated Rate	$1,843.80
Rate for Payer: Aetna Commercial	$813.78
Rate for Payer: BCBS Complete	$461.84
Rate for Payer: BCBS Trust/PPO	$540.45
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Mclaren Medicaid	$439.85
Rate for Payer: Meridian Medicaid	$461.84
Rate for Payer: Priority Health Choice Medicaid	$439.85
Rate for Payer: Priority Health Cigna Priority Health	$1,843.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$968.15
Rate for Payer: Priority Health Narrow Network	$968.15
Rate for Payer: Priority Health SBD	$968.15

PR LAPAROSCOPY W/OMENTOPEXY

Professional

Both

$337.00

Service Code	HCPCS 49326
Min. Negotiated Rate	$119.07
Max. Negotiated Rate	$1,426.41
Rate for Payer: Aetna Commercial	$255.96
Rate for Payer: BCBS Complete	$125.02
Rate for Payer: BCBS Trust/PPO	$1,426.41
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Mclaren Medicaid	$119.07
Rate for Payer: Meridian Medicaid	$125.02
Rate for Payer: Priority Health Choice Medicaid	$119.07
Rate for Payer: Priority Health Cigna Priority Health	$235.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$327.50
Rate for Payer: Priority Health Narrow Network	$327.50
Rate for Payer: Priority Health SBD	$327.50

PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS

Professional

Both

$1,496.00

Service Code	HCPCS 58671
Min. Negotiated Rate	$48.39
Max. Negotiated Rate	$1,047.20
Rate for Payer: Aetna Commercial	$442.77
Rate for Payer: BCBS Complete	$251.61
Rate for Payer: BCBS Trust/PPO	$48.39
Rate for Payer: Cash Price	$1,196.80
Rate for Payer: Cash Price	$1,196.80
Rate for Payer: Mclaren Medicaid	$239.63
Rate for Payer: Meridian Medicaid	$251.61
Rate for Payer: Priority Health Choice Medicaid	$239.63
Rate for Payer: Priority Health Cigna Priority Health	$1,047.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$529.29
Rate for Payer: Priority Health Narrow Network	$529.29
Rate for Payer: Priority Health SBD	$529.29

PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

Professional

Both

$2,690.00

Service Code	HCPCS 58661
Hospital Charge Code	58661
Min. Negotiated Rate	$183.85
Max. Negotiated Rate	$1,883.00
Rate for Payer: Aetna Commercial	$780.25
Rate for Payer: BCBS Complete	$439.48
Rate for Payer: BCBS Trust/PPO	$183.85
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Mclaren Medicaid	$418.55
Rate for Payer: Meridian Medicaid	$439.48
Rate for Payer: Priority Health Choice Medicaid	$418.55
Rate for Payer: Priority Health Cigna Priority Health	$1,883.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$926.01
Rate for Payer: Priority Health Narrow Network	$926.01
Rate for Payer: Priority Health SBD	$926.01

PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

Facility

$2,690.00

Service Code	CPT 58661
Hospital Charge Code	58661
Hospital Revenue Code	960
Min. Negotiated Rate	$1,694.70
Max. Negotiated Rate	$2,421.00
Rate for Payer: Aetna Commercial	$2,286.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,748.50
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cofinity Commercial	$1,883.00
Rate for Payer: Cofinity Commercial	$2,313.40
Rate for Payer: Healthscope Commercial	$2,421.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,286.50
Rate for Payer: PHP Commercial	$2,286.50
Rate for Payer: Priority Health Cigna Priority Health	$1,883.00
Rate for Payer: Priority Health SBD	$1,694.70

PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

Professional

Both

$2,690.00

Service Code	HCPCS 58661
Min. Negotiated Rate	$183.85
Max. Negotiated Rate	$1,883.00
Rate for Payer: Aetna Commercial	$780.25
Rate for Payer: BCBS Complete	$439.48
Rate for Payer: BCBS Trust/PPO	$183.85
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Mclaren Medicaid	$418.55
Rate for Payer: Meridian Medicaid	$439.48
Rate for Payer: Priority Health Choice Medicaid	$418.55
Rate for Payer: Priority Health Cigna Priority Health	$1,883.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$926.01
Rate for Payer: Priority Health Narrow Network	$926.01
Rate for Payer: Priority Health SBD	$926.01

PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES

Facility

$2,690.00

Service Code	CPT 58661
Hospital Charge Code	58661
Hospital Revenue Code	960
Min. Negotiated Rate	$643.42
Max. Negotiated Rate	$15,754.72
Rate for Payer: Aetna Commercial	$2,286.50
Rate for Payer: Aetna Medicare	$5,339.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,748.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,417.61
Rate for Payer: Amish Plain Church Group Commercial	$6,417.61
Rate for Payer: BCBS Complete	$2,949.02
Rate for Payer: BCBS MAPPO	$5,134.09
Rate for Payer: BCBS Trust/PPO	$2,695.79
Rate for Payer: BCN Medicare Advantage	$5,134.09
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cofinity Commercial	$2,313.40
Rate for Payer: Cofinity Commercial	$1,883.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,134.09
Rate for Payer: Healthscope Commercial	$2,421.00
Rate for Payer: Mclaren Medicaid	$2,808.35
Rate for Payer: Mclaren Medicare	$5,134.09
Rate for Payer: Meridian Medicaid	$2,949.02
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,390.79
Rate for Payer: MI Amish Medical Board Commercial	$5,904.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,286.50
Rate for Payer: PACE Medicare	$4,877.39
Rate for Payer: PACE SWMI	$5,134.09
Rate for Payer: PHP Commercial	$2,286.50
Rate for Payer: PHP Medicare Advantage	$5,134.09
Rate for Payer: Priority Health Choice Medicaid	$2,808.35
Rate for Payer: Priority Health Cigna Priority Health	$1,883.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,754.72
Rate for Payer: Priority Health Medicare	$5,134.09
Rate for Payer: Priority Health Narrow Network	$12,603.78
Rate for Payer: Priority Health SBD	$1,694.70
Rate for Payer: Railroad Medicare Medicare	$5,134.09
Rate for Payer: UHC All Payor (Choice/PPO)	$707.76
Rate for Payer: UHC Dual Complete DSNP	$5,134.09
Rate for Payer: UHC Exchange	$643.42
Rate for Payer: UHC Medicare Advantage	$5,288.11
Rate for Payer: VA VA	$5,134.09

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