Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION

Facility

$7,528.73

Service Code	CPT 45390
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Exchange	$5,111.43
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,433.59
Rate for Payer: VA VA	$2,674.60

COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE RECTUM, SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM, AND ADJACENT STRUCTURES

Facility

$3,236.94

Service Code	CPT 45391
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)

Facility

$3,236.94

Service Code	CPT 45379
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$3,236.94

Service Code	CPT 45384
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$3,236.94

Service Code	CPT 45385
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION

Facility

$3,236.94

Service Code	CPT 45386
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE RECTUM, SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM, AND ADJACENT STRUCTURES

Facility

$3,236.94

Service Code	CPT 45392
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,502.92

Service Code	CPT 44388
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Exchange	$1,699.29
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$476.60
Rate for Payer: VA VA	$889.17

COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$3,236.94

Service Code	CPT 44389
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC MUCOSAL RESECTION

Facility

$3,236.94

Service Code	CPT 44403
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$3,236.94

Service Code	CPT 44392
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$3,236.94

Service Code	CPT 44394
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Exchange	$2,197.63
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$616.36
Rate for Payer: VA VA	$1,149.93

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

Facility

$2,502.92

Service Code	CPT G0105
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Exchange	$1,699.29
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$476.60
Rate for Payer: VA VA	$889.17

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK

Facility

$2,502.92

Service Code	CPT G0121
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Exchange	$1,699.29
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$476.60
Rate for Payer: VA VA	$889.17

COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

Facility

$2,502.92

Service Code	CPT G0104
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Exchange	$1,699.29
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$476.60
Rate for Payer: VA VA	$889.17

COLPOCLEISIS (LE FORT TYPE)

Facility

$13,552.11

Service Code	CPT 57120
Hospital Revenue Code	360
Min. Negotiated Rate	$2,580.53
Max. Negotiated Rate	$13,552.11
Rate for Payer: Aetna Medicare	$5,007.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,018.02
Rate for Payer: Amish Plain Church Group Commercial	$6,018.02
Rate for Payer: BCBS Complete	$2,709.56
Rate for Payer: BCBS MAPPO	$4,814.42
Rate for Payer: BCN Medicare Advantage	$4,814.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$4,814.42
Rate for Payer: Mclaren Medicaid	$2,580.53
Rate for Payer: Mclaren Medicare	$4,814.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,055.14
Rate for Payer: Meridian Medicaid	$2,709.56
Rate for Payer: MI Amish Medical Board Commercial	$5,536.58
Rate for Payer: PACE Medicare	$4,573.70
Rate for Payer: PACE SWMI	$4,814.42
Rate for Payer: PHP Medicare Advantage	$4,814.42
Rate for Payer: Priority Health Choice Medicaid	$2,580.53
Rate for Payer: Priority Health Medicare	$4,814.42
Rate for Payer: Railroad Medicare Medicare	$4,814.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13,552.11
Rate for Payer: UHC Dual Complete DSNP	$4,814.42
Rate for Payer: UHC Exchange	$9,200.84
Rate for Payer: UHC Medicare Advantage	$4,814.42
Rate for Payer: UHCCP Medicaid	$2,580.53
Rate for Payer: VA VA	$4,814.42

COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)

Facility

$8,728.81

Service Code	CPT 57210
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Exchange	$5,926.19
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,662.10
Rate for Payer: VA VA	$3,100.93

COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)

Facility

$20,301.09

Service Code	CPT 57282
Hospital Revenue Code	360
Min. Negotiated Rate	$3,865.64
Max. Negotiated Rate	$20,301.09
Rate for Payer: Aetna Medicare	$7,500.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,015.01
Rate for Payer: Amish Plain Church Group Commercial	$9,015.01
Rate for Payer: BCBS Complete	$4,058.92
Rate for Payer: BCBS MAPPO	$7,212.01
Rate for Payer: BCN Medicare Advantage	$7,212.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,212.01
Rate for Payer: Mclaren Medicaid	$3,865.64
Rate for Payer: Mclaren Medicare	$7,212.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,572.61
Rate for Payer: Meridian Medicaid	$4,058.92
Rate for Payer: MI Amish Medical Board Commercial	$8,293.81
Rate for Payer: PACE Medicare	$6,851.41
Rate for Payer: PACE SWMI	$7,212.01
Rate for Payer: PHP Medicare Advantage	$7,212.01
Rate for Payer: Priority Health Choice Medicaid	$3,865.64
Rate for Payer: Priority Health Medicare	$7,212.01
Rate for Payer: Railroad Medicare Medicare	$7,212.01
Rate for Payer: UHC All Payor (Choice/PPO)	$20,301.09
Rate for Payer: UHC Dual Complete DSNP	$7,212.01
Rate for Payer: UHC Exchange	$13,782.87
Rate for Payer: UHC Medicare Advantage	$7,212.01
Rate for Payer: UHCCP Medicaid	$3,865.64
Rate for Payer: VA VA	$7,212.01

COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)

Facility

$20,301.09

Service Code	CPT 57283
Hospital Revenue Code	360
Min. Negotiated Rate	$3,865.64
Max. Negotiated Rate	$20,301.09
Rate for Payer: Aetna Medicare	$7,500.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,015.01
Rate for Payer: Amish Plain Church Group Commercial	$9,015.01
Rate for Payer: BCBS Complete	$4,058.92
Rate for Payer: BCBS MAPPO	$7,212.01
Rate for Payer: BCN Medicare Advantage	$7,212.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,212.01
Rate for Payer: Mclaren Medicaid	$3,865.64
Rate for Payer: Mclaren Medicare	$7,212.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,572.61
Rate for Payer: Meridian Medicaid	$4,058.92
Rate for Payer: MI Amish Medical Board Commercial	$8,293.81
Rate for Payer: PACE Medicare	$6,851.41
Rate for Payer: PACE SWMI	$7,212.01
Rate for Payer: PHP Medicare Advantage	$7,212.01
Rate for Payer: Priority Health Choice Medicaid	$3,865.64
Rate for Payer: Priority Health Medicare	$7,212.01
Rate for Payer: Railroad Medicare Medicare	$7,212.01
Rate for Payer: UHC All Payor (Choice/PPO)	$20,301.09
Rate for Payer: UHC Dual Complete DSNP	$7,212.01
Rate for Payer: UHC Exchange	$13,782.87
Rate for Payer: UHC Medicare Advantage	$7,212.01
Rate for Payer: UHCCP Medicaid	$3,865.64
Rate for Payer: VA VA	$7,212.01

COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)

Facility

$8,728.81

Service Code	CPT 57200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Exchange	$5,926.19
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,662.10
Rate for Payer: VA VA	$3,100.93

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;

Facility

$552.28

Service Code	CPT 57452
Hospital Revenue Code	360
Min. Negotiated Rate	$105.16
Max. Negotiated Rate	$552.28
Rate for Payer: Aetna Medicare	$204.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$245.25
Rate for Payer: Amish Plain Church Group Commercial	$245.25
Rate for Payer: BCBS Complete	$110.42
Rate for Payer: BCBS MAPPO	$196.20
Rate for Payer: BCN Medicare Advantage	$196.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$196.20
Rate for Payer: Mclaren Medicaid	$105.16
Rate for Payer: Mclaren Medicare	$196.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$206.01
Rate for Payer: Meridian Medicaid	$110.42
Rate for Payer: MI Amish Medical Board Commercial	$225.63
Rate for Payer: PACE Medicare	$186.39
Rate for Payer: PACE SWMI	$196.20
Rate for Payer: PHP Medicare Advantage	$196.20
Rate for Payer: Priority Health Choice Medicaid	$105.16
Rate for Payer: Priority Health Medicare	$196.20
Rate for Payer: Railroad Medicare Medicare	$196.20
Rate for Payer: UHC All Payor (Choice/PPO)	$552.28
Rate for Payer: UHC Dual Complete DSNP	$196.20
Rate for Payer: UHC Exchange	$374.96
Rate for Payer: UHC Medicare Advantage	$196.20
Rate for Payer: UHCCP Medicaid	$105.16
Rate for Payer: VA VA	$196.20

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX

Facility

$835.10

Service Code	CPT 57455
Hospital Revenue Code	360
Min. Negotiated Rate	$159.02
Max. Negotiated Rate	$835.10
Rate for Payer: Aetna Medicare	$308.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$370.84
Rate for Payer: Amish Plain Church Group Commercial	$370.84
Rate for Payer: BCBS Complete	$166.97
Rate for Payer: BCBS MAPPO	$296.67
Rate for Payer: BCN Medicare Advantage	$296.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.67
Rate for Payer: Mclaren Medicaid	$159.02
Rate for Payer: Mclaren Medicare	$296.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.50
Rate for Payer: Meridian Medicaid	$166.97
Rate for Payer: MI Amish Medical Board Commercial	$341.17
Rate for Payer: PACE Medicare	$281.84
Rate for Payer: PACE SWMI	$296.67
Rate for Payer: PHP Medicare Advantage	$296.67
Rate for Payer: Priority Health Choice Medicaid	$159.02
Rate for Payer: Priority Health Medicare	$296.67
Rate for Payer: Railroad Medicare Medicare	$296.67
Rate for Payer: UHC All Payor (Choice/PPO)	$835.10
Rate for Payer: UHC Dual Complete DSNP	$296.67
Rate for Payer: UHC Exchange	$566.97
Rate for Payer: UHC Medicare Advantage	$296.67
Rate for Payer: UHCCP Medicaid	$159.02
Rate for Payer: VA VA	$296.67

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE

Facility

$835.10

Service Code	CPT 57454
Hospital Revenue Code	360
Min. Negotiated Rate	$159.02
Max. Negotiated Rate	$835.10
Rate for Payer: Aetna Medicare	$308.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$370.84
Rate for Payer: Amish Plain Church Group Commercial	$370.84
Rate for Payer: BCBS Complete	$166.97
Rate for Payer: BCBS MAPPO	$296.67
Rate for Payer: BCN Medicare Advantage	$296.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.67
Rate for Payer: Mclaren Medicaid	$159.02
Rate for Payer: Mclaren Medicare	$296.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.50
Rate for Payer: Meridian Medicaid	$166.97
Rate for Payer: MI Amish Medical Board Commercial	$341.17
Rate for Payer: PACE Medicare	$281.84
Rate for Payer: PACE SWMI	$296.67
Rate for Payer: PHP Medicare Advantage	$296.67
Rate for Payer: Priority Health Choice Medicaid	$159.02
Rate for Payer: Priority Health Medicare	$296.67
Rate for Payer: Railroad Medicare Medicare	$296.67
Rate for Payer: UHC All Payor (Choice/PPO)	$835.10
Rate for Payer: UHC Dual Complete DSNP	$296.67
Rate for Payer: UHC Exchange	$566.97
Rate for Payer: UHC Medicare Advantage	$296.67
Rate for Payer: UHCCP Medicaid	$159.02
Rate for Payer: VA VA	$296.67

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE

Facility

$835.10

Service Code	CPT 57456
Hospital Revenue Code	360
Min. Negotiated Rate	$159.02
Max. Negotiated Rate	$835.10
Rate for Payer: Aetna Medicare	$308.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$370.84
Rate for Payer: Amish Plain Church Group Commercial	$370.84
Rate for Payer: BCBS Complete	$166.97
Rate for Payer: BCBS MAPPO	$296.67
Rate for Payer: BCN Medicare Advantage	$296.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.67
Rate for Payer: Mclaren Medicaid	$159.02
Rate for Payer: Mclaren Medicare	$296.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.50
Rate for Payer: Meridian Medicaid	$166.97
Rate for Payer: MI Amish Medical Board Commercial	$341.17
Rate for Payer: PACE Medicare	$281.84
Rate for Payer: PACE SWMI	$296.67
Rate for Payer: PHP Medicare Advantage	$296.67
Rate for Payer: Priority Health Choice Medicaid	$159.02
Rate for Payer: Priority Health Medicare	$296.67
Rate for Payer: Railroad Medicare Medicare	$296.67
Rate for Payer: UHC All Payor (Choice/PPO)	$835.10
Rate for Payer: UHC Dual Complete DSNP	$296.67
Rate for Payer: UHC Exchange	$566.97
Rate for Payer: UHC Medicare Advantage	$296.67
Rate for Payer: UHCCP Medicaid	$159.02
Rate for Payer: VA VA	$296.67

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX

Facility

$8,728.81

Service Code	CPT 57460
Hospital Revenue Code	360
Min. Negotiated Rate	$1,662.10
Max. Negotiated Rate	$8,728.81
Rate for Payer: Aetna Medicare	$3,224.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,876.16
Rate for Payer: Amish Plain Church Group Commercial	$3,876.16
Rate for Payer: BCBS Complete	$1,745.20
Rate for Payer: BCBS MAPPO	$3,100.93
Rate for Payer: BCN Medicare Advantage	$3,100.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,100.93
Rate for Payer: Mclaren Medicaid	$1,662.10
Rate for Payer: Mclaren Medicare	$3,100.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,255.98
Rate for Payer: Meridian Medicaid	$1,745.20
Rate for Payer: MI Amish Medical Board Commercial	$3,566.07
Rate for Payer: PACE Medicare	$2,945.88
Rate for Payer: PACE SWMI	$3,100.93
Rate for Payer: PHP Medicare Advantage	$3,100.93
Rate for Payer: Priority Health Choice Medicaid	$1,662.10
Rate for Payer: Priority Health Medicare	$3,100.93
Rate for Payer: Railroad Medicare Medicare	$3,100.93
Rate for Payer: UHC All Payor (Choice/PPO)	$8,728.81
Rate for Payer: UHC Dual Complete DSNP	$3,100.93
Rate for Payer: UHC Exchange	$5,926.19
Rate for Payer: UHC Medicare Advantage	$3,100.93
Rate for Payer: UHCCP Medicaid	$1,662.10
Rate for Payer: VA VA	$3,100.93

Know your out-of-pocket cost for care.

All Charges