Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

IMATINIB 400 MG TABLET

Facility

$36,516.67

Service Code	HCPCS J8999
Hospital Charge Code	36092
Hospital Revenue Code	636
Min. Negotiated Rate	$23,005.50
Max. Negotiated Rate	$32,865.00
Rate for Payer: Aetna Commercial	$31,039.17
Rate for Payer: Aetna New Business (MI Preferred)	$23,735.84
Rate for Payer: Cash Price	$29,213.34
Rate for Payer: Cofinity Commercial	$25,561.67
Rate for Payer: Cofinity Commercial	$31,404.34
Rate for Payer: Healthscope Commercial	$32,865.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31,039.17
Rate for Payer: PHP Commercial	$31,039.17
Rate for Payer: Priority Health Cigna Priority Health	$25,561.67
Rate for Payer: Priority Health SBD	$23,005.50

IMMUNE GLOB G 20 GRAM/200 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN

Facility

$8,228.38

Service Code	HCPCS J1561
Hospital Charge Code	107754
Hospital Revenue Code	636
Min. Negotiated Rate	$5,183.88
Max. Negotiated Rate	$7,405.54
Rate for Payer: Aetna Commercial	$6,994.12
Rate for Payer: Aetna New Business (MI Preferred)	$5,348.45
Rate for Payer: Cash Price	$6,582.70
Rate for Payer: Cofinity Commercial	$5,759.87
Rate for Payer: Cofinity Commercial	$7,076.41
Rate for Payer: Healthscope Commercial	$7,405.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,994.12
Rate for Payer: PHP Commercial	$6,994.12
Rate for Payer: Priority Health Cigna Priority Health	$5,759.87
Rate for Payer: Priority Health SBD	$5,183.88

IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN

Facility

$16,456.75

Service Code	HCPCS J1561
Hospital Charge Code	172845
Hospital Revenue Code	636
Min. Negotiated Rate	$10,367.75
Max. Negotiated Rate	$14,811.08
Rate for Payer: Aetna Commercial	$13,988.24
Rate for Payer: Aetna New Business (MI Preferred)	$10,696.89
Rate for Payer: Cash Price	$13,165.40
Rate for Payer: Cofinity Commercial	$11,519.72
Rate for Payer: Cofinity Commercial	$14,152.80
Rate for Payer: Healthscope Commercial	$14,811.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13,988.24
Rate for Payer: PHP Commercial	$13,988.24
Rate for Payer: Priority Health Cigna Priority Health	$11,519.72
Rate for Payer: Priority Health SBD	$10,367.75

IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION

Facility

$8,617.50

Service Code	HCPCS J1569
Hospital Charge Code	171062
Hospital Revenue Code	636
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$7,755.75
Rate for Payer: Aetna Commercial	$7,324.88
Rate for Payer: Aetna Commercial	$4,883.25
Rate for Payer: Aetna Medicare	$45.92
Rate for Payer: Aetna Medicare	$45.92
Rate for Payer: Aetna New Business (MI Preferred)	$3,734.25
Rate for Payer: Aetna New Business (MI Preferred)	$5,601.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$55.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$55.19
Rate for Payer: Amish Plain Church Group Commercial	$55.19
Rate for Payer: Amish Plain Church Group Commercial	$55.19
Rate for Payer: BCBS Complete	$25.36
Rate for Payer: BCBS Complete	$25.36
Rate for Payer: BCBS MAPPO	$44.15
Rate for Payer: BCBS MAPPO	$44.15
Rate for Payer: BCBS Trust/PPO	$130.70
Rate for Payer: BCBS Trust/PPO	$130.70
Rate for Payer: BCN Medicare Advantage	$44.15
Rate for Payer: BCN Medicare Advantage	$44.15
Rate for Payer: Cash Price	$6,894.00
Rate for Payer: Cash Price	$4,596.00
Rate for Payer: Cash Price	$6,894.00
Rate for Payer: Cash Price	$4,596.00
Rate for Payer: Cofinity Commercial	$4,940.70
Rate for Payer: Cofinity Commercial	$4,021.50
Rate for Payer: Cofinity Commercial	$6,032.25
Rate for Payer: Cofinity Commercial	$7,411.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.15
Rate for Payer: Healthscope Commercial	$5,170.50
Rate for Payer: Healthscope Commercial	$7,755.75
Rate for Payer: Mclaren Medicaid	$24.15
Rate for Payer: Mclaren Medicaid	$24.15
Rate for Payer: Mclaren Medicare	$44.15
Rate for Payer: Mclaren Medicare	$44.15
Rate for Payer: Meridian Medicaid	$25.36
Rate for Payer: Meridian Medicaid	$25.36
Rate for Payer: Meridian Wellcare - Medicare Advantage	$46.36
Rate for Payer: Meridian Wellcare - Medicare Advantage	$46.36
Rate for Payer: MI Amish Medical Board Commercial	$50.77
Rate for Payer: MI Amish Medical Board Commercial	$50.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,324.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,883.25
Rate for Payer: PACE Medicare	$41.94
Rate for Payer: PACE Medicare	$41.94
Rate for Payer: PACE SWMI	$44.15
Rate for Payer: PACE SWMI	$44.15
Rate for Payer: PHP Commercial	$7,324.88
Rate for Payer: PHP Commercial	$4,883.25
Rate for Payer: PHP Medicare Advantage	$44.15
Rate for Payer: PHP Medicare Advantage	$44.15
Rate for Payer: Priority Health Choice Medicaid	$24.15
Rate for Payer: Priority Health Choice Medicaid	$24.15
Rate for Payer: Priority Health Cigna Priority Health	$6,032.25
Rate for Payer: Priority Health Cigna Priority Health	$4,021.50
Rate for Payer: Priority Health Medicare	$44.15
Rate for Payer: Priority Health Medicare	$44.15
Rate for Payer: Priority Health SBD	$3,619.35
Rate for Payer: Priority Health SBD	$5,429.02
Rate for Payer: Railroad Medicare Medicare	$44.15
Rate for Payer: Railroad Medicare Medicare	$44.15
Rate for Payer: UHC Dual Complete DSNP	$44.15
Rate for Payer: UHC Dual Complete DSNP	$44.15
Rate for Payer: UHC Medicare Advantage	$45.48
Rate for Payer: UHC Medicare Advantage	$45.48
Rate for Payer: VA VA	$44.15
Rate for Payer: VA VA	$44.15

IMMUNE GLOB,GAMMA (IGG) 10 %-GLY-IGA OVER 50 MCG/ML INJECTION SOLUTION

Facility

$2,872.50

Service Code	HCPCS J1569
Hospital Charge Code	171062
Hospital Revenue Code	636
Min. Negotiated Rate	$1,809.68
Max. Negotiated Rate	$2,585.25
Rate for Payer: Aetna Commercial	$2,441.62
Rate for Payer: Aetna Commercial	$1,220.81
Rate for Payer: Aetna Commercial	$4,883.25
Rate for Payer: Aetna Commercial	$7,324.88
Rate for Payer: Aetna New Business (MI Preferred)	$1,867.12
Rate for Payer: Aetna New Business (MI Preferred)	$933.56
Rate for Payer: Aetna New Business (MI Preferred)	$5,601.38
Rate for Payer: Aetna New Business (MI Preferred)	$3,734.25
Rate for Payer: Cash Price	$2,298.00
Rate for Payer: Cash Price	$6,894.00
Rate for Payer: Cash Price	$4,596.00
Rate for Payer: Cash Price	$1,149.00
Rate for Payer: Cofinity Commercial	$2,010.75
Rate for Payer: Cofinity Commercial	$2,470.35
Rate for Payer: Cofinity Commercial	$7,411.05
Rate for Payer: Cofinity Commercial	$6,032.25
Rate for Payer: Cofinity Commercial	$1,005.38
Rate for Payer: Cofinity Commercial	$4,021.50
Rate for Payer: Cofinity Commercial	$4,940.70
Rate for Payer: Cofinity Commercial	$1,235.18
Rate for Payer: Healthscope Commercial	$5,170.50
Rate for Payer: Healthscope Commercial	$1,292.62
Rate for Payer: Healthscope Commercial	$2,585.25
Rate for Payer: Healthscope Commercial	$7,755.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,441.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,220.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4,883.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7,324.88
Rate for Payer: PHP Commercial	$2,441.62
Rate for Payer: PHP Commercial	$7,324.88
Rate for Payer: PHP Commercial	$1,220.81
Rate for Payer: PHP Commercial	$4,883.25
Rate for Payer: Priority Health Cigna Priority Health	$4,021.50
Rate for Payer: Priority Health Cigna Priority Health	$2,010.75
Rate for Payer: Priority Health Cigna Priority Health	$1,005.38
Rate for Payer: Priority Health Cigna Priority Health	$6,032.25
Rate for Payer: Priority Health SBD	$1,809.68
Rate for Payer: Priority Health SBD	$3,619.35
Rate for Payer: Priority Health SBD	$5,429.02
Rate for Payer: Priority Health SBD	$904.84

IMMUNE GLOB,GAMMA(IGG) 5 GRAM-GLY-GLUC-IGA 0 TO 50 MCG/ML IV SOLUTION

Facility

$2,833.44

Service Code	HCPCS J1566
Hospital Charge Code	171071
Hospital Revenue Code	636
Min. Negotiated Rate	$1,785.07
Max. Negotiated Rate	$2,550.10
Rate for Payer: Aetna Commercial	$2,408.42
Rate for Payer: Aetna New Business (MI Preferred)	$1,841.74
Rate for Payer: Cash Price	$2,266.75
Rate for Payer: Cofinity Commercial	$1,983.41
Rate for Payer: Cofinity Commercial	$2,436.76
Rate for Payer: Healthscope Commercial	$2,550.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,408.42
Rate for Payer: PHP Commercial	$2,408.42
Rate for Payer: Priority Health Cigna Priority Health	$1,983.41
Rate for Payer: Priority Health SBD	$1,785.07

IMPACT PEPTIDE 1.5 BOLUS FEED

Facility

$66.60

Service Code	NDC 4390097370
Hospital Charge Code	150765
Hospital Revenue Code	637
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$46.62
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE 1.5 CONTINUOUS FEED

Facility

$66.60

Service Code	NDC 4390097370
Hospital Charge Code	168957
Hospital Revenue Code	637
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$46.62
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE 1.5 CYCLIC FEED

Facility

$66.60

Service Code	NDC 4390097370
Hospital Charge Code	200091
Hospital Revenue Code	637
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$46.62
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE 1.5 INTERMITTENT FEED

Facility

$66.60

Service Code	NDC 4390097370
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$41.96
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$46.62
Rate for Payer: Priority Health SBD	$41.96

IMPLANTABLE TISSUE MARKER

Professional

Both

$1,200.00

Service Code	HCPCS A4648
Min. Negotiated Rate	$102.14
Max. Negotiated Rate	$840.00
Rate for Payer: Aetna Commercial	$102.14
Rate for Payer: BCBS Complete	$480.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Priority Health Cigna Priority Health	$840.00

IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$3,444.05

Service Code	CPT 15777
Hospital Revenue Code	360
Min. Negotiated Rate	$208.58
Max. Negotiated Rate	$3,444.05
Rate for Payer: BCBS Trust/PPO	$3,444.05
Rate for Payer: UHC All Payor (Choice/PPO)	$229.44
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$208.58

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$37,877.08

Service Code	MS-DRG 642
Min. Negotiated Rate	$9,384.88
Max. Negotiated Rate	$37,877.08
Rate for Payer: Aetna Medicare	$10,273.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,348.52
Rate for Payer: Amish Plain Church Group Commercial	$12,348.52
Rate for Payer: BCBS MAPPO	$9,878.82
Rate for Payer: BCBS Trust/PPO	$37,877.08
Rate for Payer: BCN Medicare Advantage	$9,878.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,878.82
Rate for Payer: Mclaren Medicare	$9,878.82
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,372.76
Rate for Payer: MI Amish Medical Board Commercial	$11,360.64
Rate for Payer: PACE Medicare	$9,384.88
Rate for Payer: PACE SWMI	$9,878.82
Rate for Payer: PHP Medicare Advantage	$9,878.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18,702.25
Rate for Payer: Priority Health Medicare	$9,878.82
Rate for Payer: Priority Health Narrow Network	$14,961.80
Rate for Payer: Railroad Medicare Medicare	$9,878.82
Rate for Payer: UHC All Payor (Choice/PPO)	$19,880.54
Rate for Payer: UHC Core	$12,198.89
Rate for Payer: UHC Dual Complete DSNP	$9,878.82
Rate for Payer: UHC Exchange	$13,065.58
Rate for Payer: UHC Medicare Advantage	$10,175.18
Rate for Payer: VA VA	$9,878.82

INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION

Facility

$1,757.43

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$1,757.43
Rate for Payer: Aetna Medicare	$581.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$698.54
Rate for Payer: Amish Plain Church Group Commercial	$698.54
Rate for Payer: BCBS Complete	$320.99
Rate for Payer: BCBS MAPPO	$558.83
Rate for Payer: BCBS Trust/PPO	$135.20
Rate for Payer: BCN Medicare Advantage	$558.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$558.83
Rate for Payer: Mclaren Medicaid	$305.68
Rate for Payer: Mclaren Medicare	$558.83
Rate for Payer: Meridian Medicaid	$320.99
Rate for Payer: Meridian Wellcare - Medicare Advantage	$586.77
Rate for Payer: MI Amish Medical Board Commercial	$642.65
Rate for Payer: PACE Medicare	$530.89
Rate for Payer: PACE SWMI	$558.83
Rate for Payer: PHP Medicare Advantage	$558.83
Rate for Payer: Priority Health Choice Medicaid	$305.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,757.43
Rate for Payer: Priority Health Medicare	$558.83
Rate for Payer: Priority Health Narrow Network	$1,405.94
Rate for Payer: Railroad Medicare Medicare	$558.83
Rate for Payer: UHC All Payor (Choice/PPO)	$60.51
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$558.83
Rate for Payer: UHC Exchange	$55.01
Rate for Payer: UHC Medicare Advantage	$575.59
Rate for Payer: VA VA	$558.83

INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION

Facility

$7,382.58

Service Code	CPT 10180
Hospital Revenue Code	360
Min. Negotiated Rate	$176.49
Max. Negotiated Rate	$7,382.58
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,480.90
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,382.58
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health Narrow Network	$5,906.06
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$194.14
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$176.49
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT TISSUES OF NECK OR THORAX;

Facility

$4,155.00

Service Code	CPT 21501
Hospital Revenue Code	360
Min. Negotiated Rate	$335.63
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,614.79
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$369.19
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$335.63
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE

Facility

$1,076.20

Service Code	CPT 10061
Hospital Revenue Code	360
Min. Negotiated Rate	$182.06
Max. Negotiated Rate	$1,076.20
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$233.21
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$860.96
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$200.27
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$182.06
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$878.00

Service Code	CPT 10060
Hospital Revenue Code	361
Min. Negotiated Rate	$97.44
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$146.34
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$115.98
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$105.44
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE

Facility

$878.00

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$97.44
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$146.34
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$115.98
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$105.44
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA)

Facility

$5,575.00

Service Code	CPT 54700
Hospital Revenue Code	360
Min. Negotiated Rate	$209.89
Max. Negotiated Rate	$5,575.00
Rate for Payer: Aetna Medicare	$1,884.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,265.42
Rate for Payer: Amish Plain Church Group Commercial	$2,265.42
Rate for Payer: BCBS Complete	$1,041.01
Rate for Payer: BCBS MAPPO	$1,812.34
Rate for Payer: BCBS Trust/PPO	$831.08
Rate for Payer: BCN Medicare Advantage	$1,812.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,812.34
Rate for Payer: Mclaren Medicaid	$991.35
Rate for Payer: Mclaren Medicare	$1,812.34
Rate for Payer: Meridian Medicaid	$1,041.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,902.96
Rate for Payer: MI Amish Medical Board Commercial	$2,084.19
Rate for Payer: PACE Medicare	$1,721.72
Rate for Payer: PACE SWMI	$1,812.34
Rate for Payer: PHP Medicare Advantage	$1,812.34
Rate for Payer: Priority Health Choice Medicaid	$991.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,575.00
Rate for Payer: Priority Health Medicare	$1,812.34
Rate for Payer: Priority Health Narrow Network	$4,460.00
Rate for Payer: Railroad Medicare Medicare	$1,812.34
Rate for Payer: UHC All Payor (Choice/PPO)	$230.88
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,812.34
Rate for Payer: UHC Exchange	$209.89
Rate for Payer: UHC Medicare Advantage	$1,866.71
Rate for Payer: VA VA	$1,812.34

INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION

Facility

$4,536.73

Service Code	CPT 10140
Hospital Revenue Code	360
Min. Negotiated Rate	$116.90
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$937.37
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$128.59
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$116.90
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE)

Facility

$3,138.00

Service Code	CPT 46040
Hospital Revenue Code	360
Min. Negotiated Rate	$422.40
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$1,162.01
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$464.64
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$422.40
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS, WITH FISTULECTOMY OR FISTULOTOMY, SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON

Facility

$3,138.00

Service Code	CPT 46060
Hospital Revenue Code	360
Min. Negotiated Rate	$481.99
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Medicare	$2,598.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,122.94
Rate for Payer: Amish Plain Church Group Commercial	$3,122.94
Rate for Payer: BCBS Complete	$1,435.05
Rate for Payer: BCBS MAPPO	$2,498.35
Rate for Payer: BCBS Trust/PPO	$967.07
Rate for Payer: BCN Medicare Advantage	$2,498.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,498.35
Rate for Payer: Mclaren Medicaid	$1,366.60
Rate for Payer: Mclaren Medicare	$2,498.35
Rate for Payer: Meridian Medicaid	$1,435.05
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,623.27
Rate for Payer: MI Amish Medical Board Commercial	$2,873.10
Rate for Payer: PACE Medicare	$2,373.43
Rate for Payer: PACE SWMI	$2,498.35
Rate for Payer: PHP Medicare Advantage	$2,498.35
Rate for Payer: Priority Health Choice Medicaid	$1,366.60
Rate for Payer: Priority Health Medicare	$2,498.35
Rate for Payer: Railroad Medicare Medicare	$2,498.35
Rate for Payer: UHC All Payor (Choice/PPO)	$530.19
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$2,498.35
Rate for Payer: UHC Exchange	$481.99
Rate for Payer: UHC Medicare Advantage	$2,573.30
Rate for Payer: VA VA	$2,498.35

INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE

Facility

$1,937.58

Service Code	CPT 10080
Hospital Revenue Code	360
Min. Negotiated Rate	$104.13
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$235.94
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,937.58
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,550.06
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$114.54
Rate for Payer: UHC Core	$1,463.00
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$104.13
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS

Facility

$878.00

Service Code	CPT 56405
Hospital Revenue Code	360
Min. Negotiated Rate	$126.07
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Medicare	$296.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$356.81
Rate for Payer: Amish Plain Church Group Commercial	$356.81
Rate for Payer: BCBS Complete	$163.96
Rate for Payer: BCBS MAPPO	$285.45
Rate for Payer: BCBS Trust/PPO	$182.50
Rate for Payer: BCN Medicare Advantage	$285.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$285.45
Rate for Payer: Mclaren Medicaid	$156.14
Rate for Payer: Mclaren Medicare	$285.45
Rate for Payer: Meridian Medicaid	$163.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$299.72
Rate for Payer: MI Amish Medical Board Commercial	$328.27
Rate for Payer: PACE Medicare	$271.18
Rate for Payer: PACE SWMI	$285.45
Rate for Payer: PHP Medicare Advantage	$285.45
Rate for Payer: Priority Health Choice Medicaid	$156.14
Rate for Payer: Priority Health Medicare	$285.45
Rate for Payer: Railroad Medicare Medicare	$285.45
Rate for Payer: UHC All Payor (Choice/PPO)	$138.68
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$285.45
Rate for Payer: UHC Exchange	$126.07
Rate for Payer: UHC Medicare Advantage	$294.01
Rate for Payer: VA VA	$285.45

Know your out-of-pocket cost for care.

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