Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA

Facility

$19,480.40

Service Code	CPT 49650
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	$6,737.02
Rate for Payer: BCN Commercial	$6,737.02
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, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH

Facility

$34,252.33

Service Code	CPT 43282
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	$9,432.17
Rate for Payer: BCN Commercial	$9,432.17
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, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH

Facility

$34,252.33

Service Code	CPT 43281
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	$9,770.58
Rate for Payer: BCN Commercial	$9,770.58
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; REPAIR RECURRENT INGUINAL HERNIA

Facility

$19,480.40

Service Code	CPT 49651
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	$7,118.03
Rate for Payer: BCN Commercial	$7,118.03
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; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)

Facility

$19,480.40

Service Code	CPT 51992
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	$4,475.86
Rate for Payer: BCN Commercial	$4,475.86
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, SPLENECTOMY

Facility

$34,252.33

Service Code	CPT 38120
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; URETERONEOCYSTOSTOMY WITHOUT CYSTOSCOPY AND URETERAL STENT PLACEMENT

Facility

$34,252.33

Service Code	CPT 50948
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	$6,163.58
Rate for Payer: BCN Commercial	$6,163.58
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, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL

Facility

$13,526.46

Service Code	CPT 60650
Hospital Revenue Code	360
Min. Negotiated Rate	$13,526.46
Max. Negotiated Rate	$13,526.46
Rate for Payer: BCBS Trust/PPO	$13,526.46
Rate for Payer: BCN Commercial	$13,526.46

LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)

Facility

$19,480.40

Service Code	CPT 49322
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	$4,820.25
Rate for Payer: BCN Commercial	$4,820.25
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; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY

Facility

$34,252.33

Service Code	CPT 38571
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	$9,324.15
Rate for Payer: BCN Commercial	$9,324.15
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; WITH BIOPSY (SINGLE OR MULTIPLE)

Facility

$19,480.40

Service Code	CPT 49321
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	$6,299.98
Rate for Payer: BCN Commercial	$6,299.98
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

LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)

Facility

$19,480.40

Service Code	CPT 58670
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	$4,151.90
Rate for Payer: BCN Commercial	$4,151.90
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; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD

Facility

$19,480.40

Service Code	CPT 58662
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	$5,889.97
Rate for Payer: BCN Commercial	$5,889.97
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; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$19,480.40

Service Code	CPT 49324
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	$5,980.52
Rate for Payer: BCN Commercial	$5,980.52
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; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)

Facility

$19,480.40

Service Code	CPT 58660
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	$5,568.93
Rate for Payer: BCN Commercial	$5,568.93
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; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)

Facility

$19,480.40

Service Code	CPT 58671
Hospital Revenue Code	360
Min. Negotiated Rate	$3,013.03
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	$3,013.03
Rate for Payer: BCN Commercial	$3,013.03
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, WITH RADICAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY), WITH REMOVAL OF TUBE(S) AND OVARY(S), IF PERFORMED

Facility

$8,312.33

Service Code	CPT 58548
Hospital Revenue Code	360
Min. Negotiated Rate	$8,312.33
Max. Negotiated Rate	$8,312.33
Rate for Payer: BCBS Trust/PPO	$8,312.33
Rate for Payer: BCN Commercial	$8,312.33

LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)

Facility

$19,480.40

Service Code	CPT 58661
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	$5,843.53
Rate for Payer: BCN Commercial	$5,843.53
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; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE

Facility

$19,480.40

Service Code	CPT 38570
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

LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED

Facility

$19,480.40

Service Code	CPT 49325
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; WITH SALPINGOSTOMY (SALPINGONEOSTOMY)

Facility

$34,252.33

Service Code	CPT 58673
Hospital Revenue Code	360
Min. Negotiated Rate	$4,475.86
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	$4,475.86
Rate for Payer: BCN Commercial	$4,475.86
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$34,252.33

Service Code	CPT 58570
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	$8,215.34
Rate for Payer: BCN Commercial	$8,215.34
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58571
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	$8,716.36
Rate for Payer: BCN Commercial	$8,716.36
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, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58573
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	$11,201.32
Rate for Payer: BCN Commercial	$11,201.32
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, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$34,252.33

Service Code	CPT 58552
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	$8,390.62
Rate for Payer: BCN Commercial	$8,390.62
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

Know your out-of-pocket cost for care.

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