Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$24.05

Service Code	NDC 72485-107-10
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$21.64
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna New Business (MI Preferred)	$15.63
Rate for Payer: Cash Price	$19.24
Rate for Payer: Cofinity Commercial	$16.84
Rate for Payer: Cofinity Commercial	$20.68
Rate for Payer: Healthscope Commercial	$21.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.44
Rate for Payer: PHP Commercial	$20.44
Rate for Payer: Priority Health Cigna Priority Health	$16.84
Rate for Payer: Priority Health SBD	$15.15

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$18.21

Service Code	NDC 0013-1114-20
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$16.39
Rate for Payer: Aetna Commercial	$15.48
Rate for Payer: Aetna New Business (MI Preferred)	$11.84
Rate for Payer: Cash Price	$14.57
Rate for Payer: Cofinity Commercial	$12.75
Rate for Payer: Cofinity Commercial	$15.66
Rate for Payer: Healthscope Commercial	$16.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.48
Rate for Payer: PHP Commercial	$15.48
Rate for Payer: Priority Health Cigna Priority Health	$12.75
Rate for Payer: Priority Health SBD	$11.47

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$31.07

Service Code	NDC 0517-0960-10
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$27.96
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna New Business (MI Preferred)	$20.20
Rate for Payer: Cash Price	$24.86
Rate for Payer: Cofinity Commercial	$21.75
Rate for Payer: Cofinity Commercial	$26.72
Rate for Payer: Healthscope Commercial	$27.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.41
Rate for Payer: PHP Commercial	$26.41
Rate for Payer: Priority Health Cigna Priority Health	$21.75
Rate for Payer: Priority Health SBD	$19.57

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$31.07

Service Code	NDC 0517-0960-01
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$19.57
Max. Negotiated Rate	$27.96
Rate for Payer: Aetna Commercial	$26.41
Rate for Payer: Aetna New Business (MI Preferred)	$20.20
Rate for Payer: Cash Price	$24.86
Rate for Payer: Cofinity Commercial	$21.75
Rate for Payer: Cofinity Commercial	$26.72
Rate for Payer: Healthscope Commercial	$27.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$26.41
Rate for Payer: PHP Commercial	$26.41
Rate for Payer: Priority Health Cigna Priority Health	$21.75
Rate for Payer: Priority Health SBD	$19.57

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$38.59

Service Code	NDC 63323-563-10
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$24.31
Max. Negotiated Rate	$34.73
Rate for Payer: Aetna Commercial	$32.80
Rate for Payer: Aetna New Business (MI Preferred)	$25.08
Rate for Payer: Cash Price	$30.87
Rate for Payer: Cofinity Commercial	$27.01
Rate for Payer: Cofinity Commercial	$33.19
Rate for Payer: Healthscope Commercial	$34.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$32.80
Rate for Payer: PHP Commercial	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$27.01
Rate for Payer: Priority Health SBD	$24.31

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION

Facility

$18.21

Service Code	NDC 0013-1114-21
Hospital Charge Code	155937
Hospital Revenue Code	250
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$16.39
Rate for Payer: Aetna Commercial	$15.48
Rate for Payer: Aetna New Business (MI Preferred)	$11.84
Rate for Payer: Cash Price	$14.57
Rate for Payer: Cofinity Commercial	$12.75
Rate for Payer: Cofinity Commercial	$15.66
Rate for Payer: Healthscope Commercial	$16.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.48
Rate for Payer: PHP Commercial	$15.48
Rate for Payer: Priority Health Cigna Priority Health	$12.75
Rate for Payer: Priority Health SBD	$11.47

TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM

Facility

$25.90

Service Code	HCPCS J3490
Hospital Charge Code	300870
Hospital Revenue Code	250
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$23.31
Rate for Payer: Aetna Commercial	$22.02
Rate for Payer: Aetna Commercial	$20.44
Rate for Payer: Aetna New Business (MI Preferred)	$16.84
Rate for Payer: Aetna New Business (MI Preferred)	$15.63
Rate for Payer: Cash Price	$20.72
Rate for Payer: Cash Price	$19.24
Rate for Payer: Cofinity Commercial	$22.27
Rate for Payer: Cofinity Commercial	$18.13
Rate for Payer: Cofinity Commercial	$16.84
Rate for Payer: Cofinity Commercial	$20.68
Rate for Payer: Healthscope Commercial	$23.31
Rate for Payer: Healthscope Commercial	$21.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.02
Rate for Payer: PHP Commercial	$20.44
Rate for Payer: PHP Commercial	$22.02
Rate for Payer: Priority Health Cigna Priority Health	$18.13
Rate for Payer: Priority Health Cigna Priority Health	$16.84
Rate for Payer: Priority Health SBD	$15.15
Rate for Payer: Priority Health SBD	$16.32

TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S) (EXCEPT LOWER EXTREMITY ARTERY(S) FOR OCCLUSIVE DISEASE, CERVICAL CAROTID, EXTRACRANIAL VERTEBRAL OR INTRATHORACIC CAROTID, INTRACRANIAL, OR CORONARY), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ALL ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL ARTERY

Facility

$31,275.01

Service Code	CPT 37236
Hospital Revenue Code	360
Min. Negotiated Rate	$420.44
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$6,543.60
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$462.48
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$420.44
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

TRANSCATHETER PLACEMENT OF AN INTRAVASCULAR STENT(S), OPEN OR PERCUTANEOUS, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION AND INCLUDING ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED; INITIAL VEIN

Facility

$31,275.01

Service Code	CPT 37238
Hospital Revenue Code	360
Min. Negotiated Rate	$292.73
Max. Negotiated Rate	$31,275.01
Rate for Payer: Aetna Medicare	$10,180.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,235.94
Rate for Payer: Amish Plain Church Group Commercial	$12,235.94
Rate for Payer: BCBS Complete	$5,622.66
Rate for Payer: BCBS MAPPO	$9,788.75
Rate for Payer: BCBS Trust/PPO	$8,503.67
Rate for Payer: BCN Medicare Advantage	$9,788.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,788.75
Rate for Payer: Mclaren Medicaid	$5,354.45
Rate for Payer: Mclaren Medicare	$9,788.75
Rate for Payer: Meridian Medicaid	$5,622.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,278.19
Rate for Payer: MI Amish Medical Board Commercial	$11,257.06
Rate for Payer: PACE Medicare	$9,299.31
Rate for Payer: PACE SWMI	$9,788.75
Rate for Payer: PHP Medicare Advantage	$9,788.75
Rate for Payer: Priority Health Choice Medicaid	$5,354.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$31,275.01
Rate for Payer: Priority Health Medicare	$9,788.75
Rate for Payer: Priority Health Narrow Network	$25,020.01
Rate for Payer: Railroad Medicare Medicare	$9,788.75
Rate for Payer: UHC All Payor (Choice/PPO)	$322.00
Rate for Payer: UHC Core	$8,819.00
Rate for Payer: UHC Dual Complete DSNP	$9,788.75
Rate for Payer: UHC Exchange	$292.73
Rate for Payer: UHC Medicare Advantage	$10,082.41
Rate for Payer: VA VA	$9,788.75

TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE STENTING, AND ALL ANGIOPLASTY IN THE CENTRAL DIALYSIS SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$5,340.42

Service Code	CPT 36908
Hospital Revenue Code	360
Min. Negotiated Rate	$197.45
Max. Negotiated Rate	$5,340.42
Rate for Payer: BCBS Trust/PPO	$5,340.42
Rate for Payer: UHC All Payor (Choice/PPO)	$217.20
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$197.45

TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL

Facility

$5,389.95

Service Code	CPT 64772
Hospital Revenue Code	360
Min. Negotiated Rate	$554.36
Max. Negotiated Rate	$5,389.95
Rate for Payer: Aetna Medicare	$1,786.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,147.49
Rate for Payer: Amish Plain Church Group Commercial	$2,147.49
Rate for Payer: BCBS Complete	$986.81
Rate for Payer: BCBS MAPPO	$1,717.99
Rate for Payer: BCBS Trust/PPO	$884.54
Rate for Payer: BCN Medicare Advantage	$1,717.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,717.99
Rate for Payer: Mclaren Medicaid	$939.74
Rate for Payer: Mclaren Medicare	$1,717.99
Rate for Payer: Meridian Medicaid	$986.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,803.89
Rate for Payer: MI Amish Medical Board Commercial	$1,975.69
Rate for Payer: PACE Medicare	$1,632.09
Rate for Payer: PACE SWMI	$1,717.99
Rate for Payer: PHP Medicare Advantage	$1,717.99
Rate for Payer: Priority Health Choice Medicaid	$939.74
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,389.95
Rate for Payer: Priority Health Medicare	$1,717.99
Rate for Payer: Priority Health Narrow Network	$4,311.96
Rate for Payer: Railroad Medicare Medicare	$1,717.99
Rate for Payer: UHC All Payor (Choice/PPO)	$609.80
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,717.99
Rate for Payer: UHC Exchange	$554.36
Rate for Payer: UHC Medicare Advantage	$1,769.53
Rate for Payer: VA VA	$1,717.99

TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)

Facility

$19,834.21

Service Code	CPT 27691
Hospital Revenue Code	360
Min. Negotiated Rate	$737.40
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$2,299.99
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,834.21
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,867.37
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$811.14
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$737.40
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$16,010.31

Service Code	MS-DRG 069
Min. Negotiated Rate	$5,932.57
Max. Negotiated Rate	$16,010.31
Rate for Payer: Aetna Medicare	$6,494.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,806.01
Rate for Payer: Amish Plain Church Group Commercial	$7,806.01
Rate for Payer: BCBS MAPPO	$6,244.81
Rate for Payer: BCBS Trust/PPO	$16,010.31
Rate for Payer: BCN Medicare Advantage	$6,244.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,244.81
Rate for Payer: Mclaren Medicare	$6,244.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,557.05
Rate for Payer: MI Amish Medical Board Commercial	$7,181.53
Rate for Payer: PACE Medicare	$5,932.57
Rate for Payer: PACE SWMI	$6,244.81
Rate for Payer: PHP Medicare Advantage	$6,244.81
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,461.28
Rate for Payer: Priority Health Medicare	$6,244.81
Rate for Payer: Priority Health Narrow Network	$9,169.02
Rate for Payer: Railroad Medicare Medicare	$6,244.81
Rate for Payer: UHC All Payor (Choice/PPO)	$12,183.37
Rate for Payer: UHC Core	$7,475.83
Rate for Payer: UHC Dual Complete DSNP	$6,244.81
Rate for Payer: UHC Exchange	$8,006.97
Rate for Payer: UHC Medicare Advantage	$6,432.15
Rate for Payer: VA VA	$6,244.81

TRANSLUMINAL BALLOON ANGIOPLASTY, CENTRAL DIALYSIS SEGMENT, PERFORMED THROUGH DIALYSIS CIRCUIT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION REQUIRED TO PERFORM THE ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$1,449.89

Service Code	CPT 36907
Hospital Revenue Code	360
Min. Negotiated Rate	$139.16
Max. Negotiated Rate	$1,449.89
Rate for Payer: BCBS Trust/PPO	$1,449.89
Rate for Payer: UHC All Payor (Choice/PPO)	$153.08
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$139.16

TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN

Facility

$7,632.00

Service Code	CPT 37248
Hospital Revenue Code	360
Min. Negotiated Rate	$283.24
Max. Negotiated Rate	$7,632.00
Rate for Payer: Aetna Medicare	$5,289.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,357.20
Rate for Payer: Amish Plain Church Group Commercial	$6,357.20
Rate for Payer: BCBS Complete	$2,921.26
Rate for Payer: BCBS MAPPO	$5,085.76
Rate for Payer: BCBS Trust/PPO	$4,471.08
Rate for Payer: BCN Medicare Advantage	$5,085.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,085.76
Rate for Payer: Mclaren Medicaid	$2,781.91
Rate for Payer: Mclaren Medicare	$5,085.76
Rate for Payer: Meridian Medicaid	$2,921.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,340.05
Rate for Payer: MI Amish Medical Board Commercial	$5,848.62
Rate for Payer: PACE Medicare	$4,831.47
Rate for Payer: PACE SWMI	$5,085.76
Rate for Payer: PHP Medicare Advantage	$5,085.76
Rate for Payer: Priority Health Choice Medicaid	$2,781.91
Rate for Payer: Priority Health Medicare	$5,085.76
Rate for Payer: Railroad Medicare Medicare	$5,085.76
Rate for Payer: UHC All Payor (Choice/PPO)	$311.56
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$5,085.76
Rate for Payer: UHC Exchange	$283.24
Rate for Payer: UHC Medicare Advantage	$5,238.33
Rate for Payer: VA VA	$5,085.76

TRANSPERINEAL PLACEMENT OF BIODEGRADABLE MATERIAL, PERI-PROSTATIC, SINGLE OR MULTIPLE INJECTION(S), INCLUDING IMAGE GUIDANCE, WHEN PERFORMED

Facility

$7,632.00

Service Code	CPT 55874
Hospital Revenue Code	360
Min. Negotiated Rate	$159.46
Max. Negotiated Rate	$7,632.00
Rate for Payer: Aetna Medicare	$4,788.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,755.12
Rate for Payer: Amish Plain Church Group Commercial	$5,755.12
Rate for Payer: BCBS Complete	$2,644.60
Rate for Payer: BCBS MAPPO	$4,604.10
Rate for Payer: BCBS Trust/PPO	$4,808.08
Rate for Payer: BCN Medicare Advantage	$4,604.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,604.10
Rate for Payer: Mclaren Medicaid	$2,518.44
Rate for Payer: Mclaren Medicare	$4,604.10
Rate for Payer: Meridian Medicaid	$2,644.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,834.30
Rate for Payer: MI Amish Medical Board Commercial	$5,294.72
Rate for Payer: PACE Medicare	$4,373.90
Rate for Payer: PACE SWMI	$4,604.10
Rate for Payer: PHP Medicare Advantage	$4,604.10
Rate for Payer: Priority Health Choice Medicaid	$2,518.44
Rate for Payer: Priority Health Medicare	$4,604.10
Rate for Payer: Railroad Medicare Medicare	$4,604.10
Rate for Payer: UHC All Payor (Choice/PPO)	$175.41
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$4,604.10
Rate for Payer: UHC Exchange	$159.46
Rate for Payer: UHC Medicare Advantage	$4,742.22
Rate for Payer: VA VA	$4,604.10

TRANSTRACHEAL (PERCUTANEOUS) INTRODUCTION OF NEEDLE WIRE DILATOR/STENT OR INDWELLING TUBE FOR OXYGEN THERAPY

Facility

$4,658.40

Service Code	CPT 31730
Hospital Revenue Code	360
Min. Negotiated Rate	$143.75
Max. Negotiated Rate	$4,658.40
Rate for Payer: Aetna Medicare	$1,570.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,887.76
Rate for Payer: Amish Plain Church Group Commercial	$1,887.76
Rate for Payer: BCBS Complete	$867.46
Rate for Payer: BCBS MAPPO	$1,510.21
Rate for Payer: BCBS Trust/PPO	$494.11
Rate for Payer: BCN Medicare Advantage	$1,510.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,510.21
Rate for Payer: Mclaren Medicaid	$826.08
Rate for Payer: Mclaren Medicare	$1,510.21
Rate for Payer: Meridian Medicaid	$867.46
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,585.72
Rate for Payer: MI Amish Medical Board Commercial	$1,736.74
Rate for Payer: PACE Medicare	$1,434.70
Rate for Payer: PACE SWMI	$1,510.21
Rate for Payer: PHP Medicare Advantage	$1,510.21
Rate for Payer: Priority Health Choice Medicaid	$826.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,658.40
Rate for Payer: Priority Health Medicare	$1,510.21
Rate for Payer: Priority Health Narrow Network	$3,726.72
Rate for Payer: Railroad Medicare Medicare	$1,510.21
Rate for Payer: UHC All Payor (Choice/PPO)	$158.12
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,510.21
Rate for Payer: UHC Exchange	$143.75
Rate for Payer: UHC Medicare Advantage	$1,555.52
Rate for Payer: VA VA	$1,510.21

TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)

Facility

$13,737.10

Service Code	CPT 52601
Hospital Revenue Code	360
Min. Negotiated Rate	$711.53
Max. Negotiated Rate	$13,737.10
Rate for Payer: Aetna Medicare	$4,788.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$5,755.12
Rate for Payer: Amish Plain Church Group Commercial	$5,755.12
Rate for Payer: BCBS Complete	$2,644.60
Rate for Payer: BCBS MAPPO	$4,604.10
Rate for Payer: BCBS Trust/PPO	$2,277.10
Rate for Payer: BCN Medicare Advantage	$4,604.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,604.10
Rate for Payer: Mclaren Medicaid	$2,518.44
Rate for Payer: Mclaren Medicare	$4,604.10
Rate for Payer: Meridian Medicaid	$2,644.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4,834.30
Rate for Payer: MI Amish Medical Board Commercial	$5,294.72
Rate for Payer: PACE Medicare	$4,373.90
Rate for Payer: PACE SWMI	$4,604.10
Rate for Payer: PHP Medicare Advantage	$4,604.10
Rate for Payer: Priority Health Choice Medicaid	$2,518.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,737.10
Rate for Payer: Priority Health Medicare	$4,604.10
Rate for Payer: Priority Health Narrow Network	$10,989.68
Rate for Payer: Railroad Medicare Medicare	$4,604.10
Rate for Payer: UHC All Payor (Choice/PPO)	$782.68
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$4,604.10
Rate for Payer: UHC Exchange	$711.53
Rate for Payer: UHC Medicare Advantage	$4,742.22
Rate for Payer: VA VA	$4,604.10

TRANSURETHRAL PROCEDURES WITH CC

Facility

$29,324.05

Service Code	MS-DRG 669
Min. Negotiated Rate	$10,967.37
Max. Negotiated Rate	$29,324.05
Rate for Payer: Aetna Medicare	$12,006.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,430.75
Rate for Payer: Amish Plain Church Group Commercial	$14,430.75
Rate for Payer: BCBS MAPPO	$11,544.60
Rate for Payer: BCBS Trust/PPO	$29,324.05
Rate for Payer: BCN Medicare Advantage	$11,544.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,544.60
Rate for Payer: Mclaren Medicare	$11,544.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,121.83
Rate for Payer: MI Amish Medical Board Commercial	$13,276.29
Rate for Payer: PACE Medicare	$10,967.37
Rate for Payer: PACE SWMI	$11,544.60
Rate for Payer: PHP Medicare Advantage	$11,544.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,021.39
Rate for Payer: Priority Health Medicare	$11,544.60
Rate for Payer: Priority Health Narrow Network	$17,617.11
Rate for Payer: Railroad Medicare Medicare	$11,544.60
Rate for Payer: UHC All Payor (Choice/PPO)	$23,408.79
Rate for Payer: UHC Core	$14,363.86
Rate for Payer: UHC Dual Complete DSNP	$11,544.60
Rate for Payer: UHC Exchange	$15,384.37
Rate for Payer: UHC Medicare Advantage	$11,890.94
Rate for Payer: VA VA	$11,544.60

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$42,985.77

Service Code	MS-DRG 668
Min. Negotiated Rate	$19,748.00
Max. Negotiated Rate	$42,985.77
Rate for Payer: Aetna Medicare	$21,618.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$25,984.21
Rate for Payer: Amish Plain Church Group Commercial	$25,984.21
Rate for Payer: BCBS MAPPO	$20,787.37
Rate for Payer: BCBS Trust/PPO	$41,190.69
Rate for Payer: BCN Medicare Advantage	$20,787.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,787.37
Rate for Payer: Mclaren Medicare	$20,787.37
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21,826.74
Rate for Payer: MI Amish Medical Board Commercial	$23,905.48
Rate for Payer: PACE Medicare	$19,748.00
Rate for Payer: PACE SWMI	$20,787.37
Rate for Payer: PHP Medicare Advantage	$20,787.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$40,438.07
Rate for Payer: Priority Health Medicare	$20,787.37
Rate for Payer: Priority Health Narrow Network	$32,350.46
Rate for Payer: Railroad Medicare Medicare	$20,787.37
Rate for Payer: UHC All Payor (Choice/PPO)	$42,985.77
Rate for Payer: UHC Core	$26,376.48
Rate for Payer: UHC Dual Complete DSNP	$20,787.37
Rate for Payer: UHC Exchange	$28,250.45
Rate for Payer: UHC Medicare Advantage	$21,410.99
Rate for Payer: VA VA	$20,787.37

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$17,496.93

Service Code	MS-DRG 670
Min. Negotiated Rate	$7,053.93
Max. Negotiated Rate	$17,496.93
Rate for Payer: Aetna Medicare	$7,722.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,281.49
Rate for Payer: Amish Plain Church Group Commercial	$9,281.49
Rate for Payer: BCBS MAPPO	$7,425.19
Rate for Payer: BCBS Trust/PPO	$17,496.93
Rate for Payer: BCN Medicare Advantage	$7,425.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,425.19
Rate for Payer: Mclaren Medicare	$7,425.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,796.45
Rate for Payer: MI Amish Medical Board Commercial	$8,538.97
Rate for Payer: PACE Medicare	$7,053.93
Rate for Payer: PACE SWMI	$7,425.19
Rate for Payer: PHP Medicare Advantage	$7,425.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,813.23
Rate for Payer: Priority Health Medicare	$7,425.19
Rate for Payer: Priority Health Narrow Network	$11,050.58
Rate for Payer: Railroad Medicare Medicare	$7,425.19
Rate for Payer: UHC All Payor (Choice/PPO)	$14,683.50
Rate for Payer: UHC Core	$9,009.94
Rate for Payer: UHC Dual Complete DSNP	$7,425.19
Rate for Payer: UHC Exchange	$9,650.07
Rate for Payer: UHC Medicare Advantage	$7,647.95
Rate for Payer: VA VA	$7,425.19

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$23,482.95

Service Code	MS-DRG 713
Min. Negotiated Rate	$10,393.35
Max. Negotiated Rate	$23,482.95
Rate for Payer: Aetna Medicare	$11,377.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,675.46
Rate for Payer: Amish Plain Church Group Commercial	$13,675.46
Rate for Payer: BCBS MAPPO	$10,940.37
Rate for Payer: BCBS Trust/PPO	$23,482.95
Rate for Payer: BCN Medicare Advantage	$10,940.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,940.37
Rate for Payer: Mclaren Medicare	$10,940.37
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,487.39
Rate for Payer: MI Amish Medical Board Commercial	$12,581.43
Rate for Payer: PACE Medicare	$10,393.35
Rate for Payer: PACE SWMI	$10,940.37
Rate for Payer: PHP Medicare Advantage	$10,940.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,817.43
Rate for Payer: Priority Health Medicare	$10,940.37
Rate for Payer: Priority Health Narrow Network	$16,653.94
Rate for Payer: Railroad Medicare Medicare	$10,940.37
Rate for Payer: UHC All Payor (Choice/PPO)	$22,128.98
Rate for Payer: UHC Core	$13,578.55
Rate for Payer: UHC Dual Complete DSNP	$10,940.37
Rate for Payer: UHC Exchange	$14,543.27
Rate for Payer: UHC Medicare Advantage	$11,268.58
Rate for Payer: VA VA	$10,940.37

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$19,956.34

Service Code	MS-DRG 714
Min. Negotiated Rate	$7,025.87
Max. Negotiated Rate	$19,956.34
Rate for Payer: Aetna Medicare	$7,691.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,244.56
Rate for Payer: Amish Plain Church Group Commercial	$9,244.56
Rate for Payer: BCBS MAPPO	$7,395.65
Rate for Payer: BCBS Trust/PPO	$19,956.34
Rate for Payer: BCN Medicare Advantage	$7,395.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,395.65
Rate for Payer: Mclaren Medicare	$7,395.65
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,765.43
Rate for Payer: MI Amish Medical Board Commercial	$8,505.00
Rate for Payer: PACE Medicare	$7,025.87
Rate for Payer: PACE SWMI	$7,395.65
Rate for Payer: PHP Medicare Advantage	$7,395.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,754.40
Rate for Payer: Priority Health Medicare	$7,395.65
Rate for Payer: Priority Health Narrow Network	$11,003.52
Rate for Payer: Railroad Medicare Medicare	$7,395.65
Rate for Payer: UHC All Payor (Choice/PPO)	$14,620.96
Rate for Payer: UHC Core	$8,971.56
Rate for Payer: UHC Dual Complete DSNP	$7,395.65
Rate for Payer: UHC Exchange	$9,608.96
Rate for Payer: UHC Medicare Advantage	$7,617.52
Rate for Payer: VA VA	$7,395.65

TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)

Facility

$9,573.02

Service Code	CPT 52500
Hospital Revenue Code	360
Min. Negotiated Rate	$485.27
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$1,195.90
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$533.80
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$485.27
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE

Facility

$9,573.02

Service Code	CPT 52640
Hospital Revenue Code	360
Min. Negotiated Rate	$318.93
Max. Negotiated Rate	$9,573.02
Rate for Payer: Aetna Medicare	$3,226.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,877.45
Rate for Payer: Amish Plain Church Group Commercial	$3,877.45
Rate for Payer: BCBS Complete	$1,781.77
Rate for Payer: BCBS MAPPO	$3,101.96
Rate for Payer: BCBS Trust/PPO	$1,025.05
Rate for Payer: BCN Medicare Advantage	$3,101.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,101.96
Rate for Payer: Mclaren Medicaid	$1,696.77
Rate for Payer: Mclaren Medicare	$3,101.96
Rate for Payer: Meridian Medicaid	$1,781.77
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,257.06
Rate for Payer: MI Amish Medical Board Commercial	$3,567.25
Rate for Payer: PACE Medicare	$2,946.86
Rate for Payer: PACE SWMI	$3,101.96
Rate for Payer: PHP Medicare Advantage	$3,101.96
Rate for Payer: Priority Health Choice Medicaid	$1,696.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,573.02
Rate for Payer: Priority Health Medicare	$3,101.96
Rate for Payer: Priority Health Narrow Network	$7,658.42
Rate for Payer: Railroad Medicare Medicare	$3,101.96
Rate for Payer: UHC All Payor (Choice/PPO)	$350.82
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,101.96
Rate for Payer: UHC Exchange	$318.93
Rate for Payer: UHC Medicare Advantage	$3,195.02
Rate for Payer: VA VA	$3,101.96

Know your out-of-pocket cost for care.

All Charges