Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$33,023.55

Service Code	MSDRG 419
Min. Negotiated Rate	$11,414.00
Max. Negotiated Rate	$33,023.55
Rate for Payer: Aetna Medicare	$12,495.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,018.42
Rate for Payer: Amish Plain Church Group Commercial	$15,018.42
Rate for Payer: BCBS MAPPO	$12,014.74
Rate for Payer: BCBS Trust/PPO	$33,023.55
Rate for Payer: BCN Commercial	$33,023.55
Rate for Payer: BCN Medicare Advantage	$12,014.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,014.74
Rate for Payer: Mclaren Medicare	$12,014.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,615.48
Rate for Payer: MI Amish Medical Board Commercial	$13,816.95
Rate for Payer: Molina Medicare/Medicaid	$13,216.21
Rate for Payer: Nomi Health Commercial	$17,618.82
Rate for Payer: PACE Medicare	$11,414.00
Rate for Payer: PACE SWMI	$12,014.74
Rate for Payer: PHP Medicare Advantage	$12,014.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$22,019.62
Rate for Payer: Priority Health Medicare	$12,014.74
Rate for Payer: Priority Health Tiered Network	$17,615.69
Rate for Payer: Railroad Medicare Medicare	$12,014.74
Rate for Payer: UHC All Payor (Choice/PPO)	$22,262.54
Rate for Payer: UHC Core	$18,625.41
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,014.74
Rate for Payer: UHC Exchange	$15,210.91
Rate for Payer: VA VA	$12,014.74

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY

Facility

$19,480.40

Service Code	CPT 59150
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$4,096.98
Rate for Payer: BCN Commercial	$4,096.98
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY

Facility

$19,480.40

Service Code	CPT 59151
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$6,242.21
Rate for Payer: BCN Commercial	$6,242.21
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Facility

$19,480.40

Service Code	CPT 49320
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$5,003.92
Rate for Payer: BCN Commercial	$5,003.92
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, ABLATION OF 1 OR MORE LIVER TUMOR(S); RADIOFREQUENCY

Facility

$34,252.33

Service Code	CPT 47370
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$7,864.35
Rate for Payer: BCN Commercial	$7,864.35
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, APPENDECTOMY

Facility

$19,480.40

Service Code	CPT 44970
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$6,106.05
Rate for Payer: BCN Commercial	$6,106.05
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY

Facility

$19,480.40

Service Code	CPT 47562
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$6,096.59
Rate for Payer: BCN Commercial	$6,096.59
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY

Facility

$19,480.40

Service Code	CPT 47563
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$6,633.59
Rate for Payer: BCN Commercial	$6,633.59
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT

Facility

$34,252.33

Service Code	CPT 47564
Hospital Revenue Code	360
Min. Negotiated Rate	$4,096.98
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$4,096.98
Rate for Payer: BCN Commercial	$4,096.98
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)

Facility

$34,252.33

Service Code	CPT 57425
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$11,817.21
Rate for Payer: BCN Commercial	$11,817.21
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)

Facility

$19,480.40

Service Code	CPT 44180
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$5,756.84
Rate for Payer: BCN Commercial	$5,756.84
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, ESOPHAGEAL LENGTHENING PROCEDURE (EG, COLLIS GASTROPLASTY OR WEDGE GASTROPLASTY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$703.68

Service Code	CPT 43283
Hospital Revenue Code	360
Min. Negotiated Rate	$703.68
Max. Negotiated Rate	$703.68
Rate for Payer: BCBS Trust/PPO	$703.68
Rate for Payer: BCN Commercial	$703.68

LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)

Facility

$34,252.33

Service Code	CPT 43280
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$8,689.66
Rate for Payer: BCN Commercial	$8,689.66
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)

Facility

$19,480.40

Service Code	CPT 43653
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$3,836.44
Rate for Payer: BCN Commercial	$3,836.44
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)

Facility

$19,480.40

Service Code	CPT 44186
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$4,738.06
Rate for Payer: BCN Commercial	$4,738.06
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS

Facility

$19,480.40

Service Code	CPT 58545
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$12,940.91
Rate for Payer: BCN Commercial	$12,940.91
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G

Facility

$34,252.33

Service Code	CPT 58546
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$12,313.29
Rate for Payer: BCN Commercial	$12,313.29
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS

Facility

$19,480.40

Service Code	CPT 54692
Hospital Revenue Code	360
Min. Negotiated Rate	$3,150.44
Max. Negotiated Rate	$19,480.40
Rate for Payer: Aetna Medicare	$6,264.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,529.74
Rate for Payer: Amish Plain Church Group Commercial	$7,529.74
Rate for Payer: BCBS Complete	$3,308.27
Rate for Payer: BCBS MAPPO	$6,023.79
Rate for Payer: BCBS Trust/PPO	$5,115.25
Rate for Payer: BCN Commercial	$5,115.25
Rate for Payer: BCN Medicare Advantage	$6,023.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,023.79
Rate for Payer: Mclaren Medicaid	$6,023.79
Rate for Payer: Mclaren Medicare	$6,023.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,324.98
Rate for Payer: Meridian Medicaid	$6,324.98
Rate for Payer: MI Amish Medical Board Commercial	$6,927.36
Rate for Payer: Molina Medicare/Medicaid	$6,626.17
Rate for Payer: Nomi Health Commercial	$18,071.37
Rate for Payer: PACE Medicare	$5,722.60
Rate for Payer: PACE SWMI	$6,023.79
Rate for Payer: PHP Medicare Advantage	$6,023.79
Rate for Payer: Priority Health Choice Medicaid	$3,150.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,480.40
Rate for Payer: Priority Health Medicare	$6,023.79
Rate for Payer: Priority Health Tiered Network	$15,584.32
Rate for Payer: Railroad Medicare Medicare	$6,023.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,023.79
Rate for Payer: UHC Medicaid	$3,150.44
Rate for Payer: UHCCP Medicaid	$3,150.44
Rate for Payer: VA VA	$6,023.79

LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY

Facility

$34,252.33

Service Code	CPT 50543
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$12,239.28
Rate for Payer: BCN Commercial	$12,239.28
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED;

Facility

$34,252.33

Service Code	CPT 55866
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$16,937.50
Rate for Payer: BCN Commercial	$16,937.50
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED; WITH BILATERAL PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC, AND OBTURATOR NODES

Facility

$34,252.33

Service Code	CPT 55869
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED; WITH LYMPH NODE BIOPSY(IES) (LIMITED PELVIC LYMPHADENECTOMY)

Facility

$34,252.33

Service Code	CPT 55868
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL PROSTATECTOMY, SIMPLE SUBTOTAL (INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, VASECTOMY, MEATOTOMY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY), INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED

Facility

$34,252.33

Service Code	CPT 55867
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$8,865.58
Rate for Payer: BCN Commercial	$8,865.58
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL; PYELOPLASTY

Facility

$34,252.33

Service Code	CPT 50544
Hospital Revenue Code	360
Min. Negotiated Rate	$5,539.41
Max. Negotiated Rate	$34,252.33
Rate for Payer: Aetna Medicare	$11,015.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,239.51
Rate for Payer: Amish Plain Church Group Commercial	$13,239.51
Rate for Payer: BCBS Complete	$5,816.91
Rate for Payer: BCBS MAPPO	$10,591.61
Rate for Payer: BCBS Trust/PPO	$12,859.70
Rate for Payer: BCN Commercial	$12,859.70
Rate for Payer: BCN Medicare Advantage	$10,591.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,591.61
Rate for Payer: Mclaren Medicaid	$10,591.61
Rate for Payer: Mclaren Medicare	$10,591.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,121.19
Rate for Payer: Meridian Medicaid	$11,121.19
Rate for Payer: MI Amish Medical Board Commercial	$12,180.35
Rate for Payer: Molina Medicare/Medicaid	$11,650.77
Rate for Payer: Nomi Health Commercial	$31,774.83
Rate for Payer: PACE Medicare	$10,062.03
Rate for Payer: PACE SWMI	$10,591.61
Rate for Payer: PHP Medicare Advantage	$10,591.61
Rate for Payer: Priority Health Choice Medicaid	$5,539.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34,252.33
Rate for Payer: Priority Health Medicare	$10,591.61
Rate for Payer: Priority Health Tiered Network	$27,401.86
Rate for Payer: Railroad Medicare Medicare	$10,591.61
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,591.61
Rate for Payer: UHC Medicaid	$5,539.41
Rate for Payer: UHCCP Medicaid	$5,539.41
Rate for Payer: VA VA	$10,591.61

LAPAROSCOPY, SURGICAL; RADICAL NEPHRECTOMY (INCLUDES REMOVAL OF GEROTA'S FASCIA AND SURROUNDING FATTY TISSUE, REMOVAL OF REGIONAL LYMPH NODES, AND ADRENALECTOMY)

Facility

$5,913.27

Service Code	CPT 50545
Hospital Revenue Code	360
Min. Negotiated Rate	$5,913.27
Max. Negotiated Rate	$5,913.27
Rate for Payer: BCBS Trust/PPO	$5,913.27
Rate for Payer: BCN Commercial	$5,913.27

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