Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC

Facility

$16,660.29

Service Code	MS-DRG 437
Min. Negotiated Rate	$6,154.23
Max. Negotiated Rate	$16,660.29
Rate for Payer: Aetna Medicare	$6,737.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,097.68
Rate for Payer: Amish Plain Church Group Commercial	$8,097.68
Rate for Payer: BCBS MAPPO	$6,478.14
Rate for Payer: BCBS Trust/PPO	$16,660.29
Rate for Payer: BCN Medicare Advantage	$6,478.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,478.14
Rate for Payer: Mclaren Medicare	$6,478.14
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,802.05
Rate for Payer: MI Amish Medical Board Commercial	$7,449.86
Rate for Payer: PACE Medicare	$6,154.23
Rate for Payer: PACE SWMI	$6,478.14
Rate for Payer: PHP Medicare Advantage	$6,478.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11,926.22
Rate for Payer: Priority Health Medicare	$6,478.14
Rate for Payer: Priority Health Narrow Network	$9,540.98
Rate for Payer: Railroad Medicare Medicare	$6,478.14
Rate for Payer: UHC All Payor (Choice/PPO)	$12,677.60
Rate for Payer: UHC Core	$7,779.10
Rate for Payer: UHC Dual Complete DSNP	$6,478.14
Rate for Payer: UHC Exchange	$8,331.78
Rate for Payer: UHC Medicare Advantage	$6,672.48
Rate for Payer: VA VA	$6,478.14

MALIGNANT BREAST DISORDERS WITH CC

Facility

$18,286.50

Service Code	MS-DRG 598
Min. Negotiated Rate	$8,669.93
Max. Negotiated Rate	$18,286.50
Rate for Payer: Aetna Medicare	$9,491.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,407.80
Rate for Payer: Amish Plain Church Group Commercial	$11,407.80
Rate for Payer: BCBS MAPPO	$9,126.24
Rate for Payer: BCBS Trust/PPO	$15,795.11
Rate for Payer: BCN Medicare Advantage	$9,126.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,126.24
Rate for Payer: Mclaren Medicare	$9,126.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,582.55
Rate for Payer: MI Amish Medical Board Commercial	$10,495.18
Rate for Payer: PACE Medicare	$8,669.93
Rate for Payer: PACE SWMI	$9,126.24
Rate for Payer: PHP Medicare Advantage	$9,126.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,202.68
Rate for Payer: Priority Health Medicare	$9,126.24
Rate for Payer: Priority Health Narrow Network	$13,762.14
Rate for Payer: Railroad Medicare Medicare	$9,126.24
Rate for Payer: UHC All Payor (Choice/PPO)	$18,286.50
Rate for Payer: UHC Core	$11,220.77
Rate for Payer: UHC Dual Complete DSNP	$9,126.24
Rate for Payer: UHC Exchange	$12,017.97
Rate for Payer: UHC Medicare Advantage	$9,400.03
Rate for Payer: VA VA	$9,126.24

MALIGNANT BREAST DISORDERS WITH MCC

Facility

$29,888.39

Service Code	MS-DRG 597
Min. Negotiated Rate	$11,418.24
Max. Negotiated Rate	$29,888.39
Rate for Payer: Aetna Medicare	$12,499.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,024.00
Rate for Payer: Amish Plain Church Group Commercial	$15,024.00
Rate for Payer: BCBS MAPPO	$12,019.20
Rate for Payer: BCBS Trust/PPO	$29,888.39
Rate for Payer: BCN Medicare Advantage	$12,019.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,019.20
Rate for Payer: Mclaren Medicare	$12,019.20
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,620.16
Rate for Payer: MI Amish Medical Board Commercial	$13,822.08
Rate for Payer: PACE Medicare	$11,418.24
Rate for Payer: PACE SWMI	$12,019.20
Rate for Payer: PHP Medicare Advantage	$12,019.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,967.05
Rate for Payer: Priority Health Medicare	$12,019.20
Rate for Payer: Priority Health Narrow Network	$18,373.64
Rate for Payer: Railroad Medicare Medicare	$12,019.20
Rate for Payer: UHC All Payor (Choice/PPO)	$24,414.03
Rate for Payer: UHC Core	$14,980.68
Rate for Payer: UHC Dual Complete DSNP	$12,019.20
Rate for Payer: UHC Exchange	$16,045.01
Rate for Payer: UHC Medicare Advantage	$12,379.78
Rate for Payer: VA VA	$12,019.20

MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$10,937.78

Service Code	MS-DRG 599
Min. Negotiated Rate	$5,071.20
Max. Negotiated Rate	$10,937.78
Rate for Payer: Aetna Medicare	$5,551.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,672.62
Rate for Payer: Amish Plain Church Group Commercial	$6,672.62
Rate for Payer: BCBS MAPPO	$5,338.10
Rate for Payer: BCBS Trust/PPO	$10,937.78
Rate for Payer: BCN Medicare Advantage	$5,338.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,338.10
Rate for Payer: Mclaren Medicare	$5,338.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,605.00
Rate for Payer: MI Amish Medical Board Commercial	$6,138.82
Rate for Payer: PACE Medicare	$5,071.20
Rate for Payer: PACE SWMI	$5,338.10
Rate for Payer: PHP Medicare Advantage	$5,338.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,917.04
Rate for Payer: Priority Health Medicare	$5,338.10
Rate for Payer: Priority Health Narrow Network	$7,133.63
Rate for Payer: Railroad Medicare Medicare	$5,338.10
Rate for Payer: UHC All Payor (Choice/PPO)	$9,478.84
Rate for Payer: UHC Core	$5,816.30
Rate for Payer: UHC Dual Complete DSNP	$5,338.10
Rate for Payer: UHC Exchange	$6,229.54
Rate for Payer: UHC Medicare Advantage	$5,498.24
Rate for Payer: VA VA	$5,338.10

MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)

Facility

$4,301.45

Service Code	CPT 27570
Hospital Revenue Code	360
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$4,301.45
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$996.18
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,301.45
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health Narrow Network	$3,441.16
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$169.29
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$153.90
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)

Facility

$3,138.00

Service Code	CPT 23700
Hospital Revenue Code	360
Min. Negotiated Rate	$195.16
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$704.34
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$214.68
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$195.16
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$137.30

Service Code	NDC 0990-7715-12
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$123.57
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna New Business (MI Preferred)	$89.24
Rate for Payer: Cash Price	$109.84
Rate for Payer: Cofinity Commercial	$118.08
Rate for Payer: Cofinity Commercial	$96.11
Rate for Payer: Healthscope Commercial	$123.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$116.70
Rate for Payer: PHP Commercial	$116.70
Rate for Payer: Priority Health Cigna Priority Health	$96.11
Rate for Payer: Priority Health SBD	$86.50

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$94.92

Service Code	NDC 0338-0357-03
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$37.97
Max. Negotiated Rate	$85.43
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: Aetna New Business (MI Preferred)	$61.70
Rate for Payer: BCBS Complete	$37.97
Rate for Payer: Cash Price	$75.94
Rate for Payer: Cofinity Commercial	$66.44
Rate for Payer: Cofinity Commercial	$81.63
Rate for Payer: Healthscope Commercial	$85.43
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.68
Rate for Payer: PHP Commercial	$80.68
Rate for Payer: Priority Health Cigna Priority Health	$66.44
Rate for Payer: Priority Health SBD	$59.80

MANNITOL 20 % INTRAVENOUS SOLUTION

Facility

$137.30

Service Code	NDC 0990-7715-02
Hospital Charge Code	4749
Hospital Revenue Code	250
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$123.57
Rate for Payer: Aetna Commercial	$116.70
Rate for Payer: Aetna New Business (MI Preferred)	$89.24
Rate for Payer: Cash Price	$109.84
Rate for Payer: Cofinity Commercial	$118.08
Rate for Payer: Cofinity Commercial	$96.11
Rate for Payer: Healthscope Commercial	$123.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$116.70
Rate for Payer: PHP Commercial	$116.70
Rate for Payer: Priority Health Cigna Priority Health	$96.11
Rate for Payer: Priority Health SBD	$86.50

MANNITOL 25 % INTRAVENOUS SOLUTION

Facility

$61.18

Service Code	HCPCS J2150
Hospital Charge Code	4750
Hospital Revenue Code	636
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$55.06
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Commercial	$67.12
Rate for Payer: Aetna New Business (MI Preferred)	$51.32
Rate for Payer: Aetna New Business (MI Preferred)	$39.77
Rate for Payer: Cash Price	$63.17
Rate for Payer: Cash Price	$48.94
Rate for Payer: Cofinity Commercial	$52.61
Rate for Payer: Cofinity Commercial	$42.83
Rate for Payer: Cofinity Commercial	$67.91
Rate for Payer: Cofinity Commercial	$55.27
Rate for Payer: Healthscope Commercial	$71.06
Rate for Payer: Healthscope Commercial	$55.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$67.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.00
Rate for Payer: PHP Commercial	$52.00
Rate for Payer: PHP Commercial	$67.12
Rate for Payer: Priority Health Cigna Priority Health	$55.27
Rate for Payer: Priority Health Cigna Priority Health	$42.83
Rate for Payer: Priority Health SBD	$38.54
Rate for Payer: Priority Health SBD	$49.74

MANUAL PREPARATION AND INSERTION OF DRUG-DELIVERY DEVICE(S), DEEP (EG, SUBFASCIAL) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$878.00

Service Code	CPT 20700
Hospital Revenue Code	360
Min. Negotiated Rate	$82.52
Max. Negotiated Rate	$878.00
Rate for Payer: BCBS Trust/PPO	$166.99
Rate for Payer: UHC All Payor (Choice/PPO)	$90.77
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Exchange	$82.52

MASTECTOMY FOR GYNECOMASTIA

Facility

$10,308.37

Service Code	CPT 19300
Hospital Revenue Code	360
Min. Negotiated Rate	$427.97
Max. Negotiated Rate	$10,308.37
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$2,998.80
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,308.37
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health Narrow Network	$8,246.70
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$470.77
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$427.97
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

MASTECTOMY FOR MALIGNANCY WITH CC/MCC

Facility

$69,566.11

Service Code	MS-DRG 582
Min. Negotiated Rate	$12,381.54
Max. Negotiated Rate	$69,566.11
Rate for Payer: Aetna Medicare	$13,554.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,291.50
Rate for Payer: Amish Plain Church Group Commercial	$16,291.50
Rate for Payer: BCBS MAPPO	$13,033.20
Rate for Payer: BCBS Trust/PPO	$69,566.11
Rate for Payer: BCN Medicare Advantage	$13,033.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,033.20
Rate for Payer: Mclaren Medicare	$13,033.20
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,684.86
Rate for Payer: MI Amish Medical Board Commercial	$14,988.18
Rate for Payer: PACE Medicare	$12,381.54
Rate for Payer: PACE SWMI	$13,033.20
Rate for Payer: PHP Medicare Advantage	$13,033.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,922.75
Rate for Payer: Priority Health Medicare	$13,033.20
Rate for Payer: Priority Health Narrow Network	$19,138.20
Rate for Payer: Railroad Medicare Medicare	$13,033.20
Rate for Payer: UHC All Payor (Choice/PPO)	$25,429.94
Rate for Payer: UHC Core	$15,604.06
Rate for Payer: UHC Dual Complete DSNP	$13,033.20
Rate for Payer: UHC Exchange	$16,712.68
Rate for Payer: UHC Medicare Advantage	$13,424.20
Rate for Payer: VA VA	$13,033.20

MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC

Facility

$62,903.75

Service Code	MS-DRG 583
Min. Negotiated Rate	$10,880.47
Max. Negotiated Rate	$62,903.75
Rate for Payer: Aetna Medicare	$11,911.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,316.41
Rate for Payer: Amish Plain Church Group Commercial	$14,316.41
Rate for Payer: BCBS MAPPO	$11,453.13
Rate for Payer: BCBS Trust/PPO	$62,903.75
Rate for Payer: BCN Medicare Advantage	$11,453.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,453.13
Rate for Payer: Mclaren Medicare	$11,453.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,025.79
Rate for Payer: MI Amish Medical Board Commercial	$13,171.10
Rate for Payer: PACE Medicare	$10,880.47
Rate for Payer: PACE SWMI	$11,453.13
Rate for Payer: PHP Medicare Advantage	$11,453.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$21,839.14
Rate for Payer: Priority Health Medicare	$11,453.13
Rate for Payer: Priority Health Narrow Network	$17,471.31
Rate for Payer: Railroad Medicare Medicare	$11,453.13
Rate for Payer: UHC All Payor (Choice/PPO)	$23,215.06
Rate for Payer: UHC Core	$14,244.98
Rate for Payer: UHC Dual Complete DSNP	$11,453.13
Rate for Payer: UHC Exchange	$15,257.05
Rate for Payer: UHC Medicare Advantage	$11,796.72
Rate for Payer: VA VA	$11,453.13

MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE

Facility

$17,231.52

Service Code	CPT 19307
Hospital Revenue Code	360
Min. Negotiated Rate	$1,164.06
Max. Negotiated Rate	$17,231.52
Rate for Payer: Aetna Medicare	$6,034.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,253.02
Rate for Payer: Amish Plain Church Group Commercial	$7,253.02
Rate for Payer: BCBS Complete	$3,332.91
Rate for Payer: BCBS MAPPO	$5,802.42
Rate for Payer: BCBS Trust/PPO	$3,933.18
Rate for Payer: BCN Medicare Advantage	$5,802.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,802.42
Rate for Payer: Mclaren Medicaid	$3,173.92
Rate for Payer: Mclaren Medicare	$5,802.42
Rate for Payer: Meridian Medicaid	$3,332.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,092.54
Rate for Payer: MI Amish Medical Board Commercial	$6,672.78
Rate for Payer: PACE Medicare	$5,512.30
Rate for Payer: PACE SWMI	$5,802.42
Rate for Payer: PHP Medicare Advantage	$5,802.42
Rate for Payer: Priority Health Choice Medicaid	$3,173.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,231.52
Rate for Payer: Priority Health Medicare	$5,802.42
Rate for Payer: Priority Health Narrow Network	$13,785.22
Rate for Payer: Railroad Medicare Medicare	$5,802.42
Rate for Payer: UHC All Payor (Choice/PPO)	$1,280.47
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$5,802.42
Rate for Payer: UHC Exchange	$1,164.06
Rate for Payer: UHC Medicare Advantage	$5,976.49
Rate for Payer: VA VA	$5,802.42

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);

Facility

$10,308.37

Service Code	CPT 19301
Hospital Revenue Code	360
Min. Negotiated Rate	$652.59
Max. Negotiated Rate	$10,308.37
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$2,210.04
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,308.37
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health Narrow Network	$8,246.70
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$717.85
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$652.59
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY

Facility

$17,231.52

Service Code	CPT 19302
Hospital Revenue Code	360
Min. Negotiated Rate	$895.88
Max. Negotiated Rate	$17,231.52
Rate for Payer: Aetna Medicare	$6,034.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,253.02
Rate for Payer: Amish Plain Church Group Commercial	$7,253.02
Rate for Payer: BCBS Complete	$3,332.91
Rate for Payer: BCBS MAPPO	$5,802.42
Rate for Payer: BCBS Trust/PPO	$1,960.05
Rate for Payer: BCN Medicare Advantage	$5,802.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,802.42
Rate for Payer: Mclaren Medicaid	$3,173.92
Rate for Payer: Mclaren Medicare	$5,802.42
Rate for Payer: Meridian Medicaid	$3,332.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,092.54
Rate for Payer: MI Amish Medical Board Commercial	$6,672.78
Rate for Payer: PACE Medicare	$5,512.30
Rate for Payer: PACE SWMI	$5,802.42
Rate for Payer: PHP Medicare Advantage	$5,802.42
Rate for Payer: Priority Health Choice Medicaid	$3,173.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,231.52
Rate for Payer: Priority Health Medicare	$5,802.42
Rate for Payer: Priority Health Narrow Network	$13,785.22
Rate for Payer: Railroad Medicare Medicare	$5,802.42
Rate for Payer: UHC All Payor (Choice/PPO)	$985.47
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$5,802.42
Rate for Payer: UHC Exchange	$895.88
Rate for Payer: UHC Medicare Advantage	$5,976.49
Rate for Payer: VA VA	$5,802.42

MASTECTOMY, SIMPLE, COMPLETE

Facility

$17,231.52

Service Code	CPT 19303
Hospital Revenue Code	360
Min. Negotiated Rate	$945.65
Max. Negotiated Rate	$17,231.52
Rate for Payer: Aetna Medicare	$6,034.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,253.02
Rate for Payer: Amish Plain Church Group Commercial	$7,253.02
Rate for Payer: BCBS Complete	$3,332.91
Rate for Payer: BCBS MAPPO	$5,802.42
Rate for Payer: BCBS Trust/PPO	$4,286.03
Rate for Payer: BCN Medicare Advantage	$5,802.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,802.42
Rate for Payer: Mclaren Medicaid	$3,173.92
Rate for Payer: Mclaren Medicare	$5,802.42
Rate for Payer: Meridian Medicaid	$3,332.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,092.54
Rate for Payer: MI Amish Medical Board Commercial	$6,672.78
Rate for Payer: PACE Medicare	$5,512.30
Rate for Payer: PACE SWMI	$5,802.42
Rate for Payer: PHP Medicare Advantage	$5,802.42
Rate for Payer: Priority Health Choice Medicaid	$3,173.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,231.52
Rate for Payer: Priority Health Medicare	$5,802.42
Rate for Payer: Priority Health Narrow Network	$13,785.22
Rate for Payer: Railroad Medicare Medicare	$5,802.42
Rate for Payer: UHC All Payor (Choice/PPO)	$1,040.22
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$5,802.42
Rate for Payer: UHC Exchange	$945.65
Rate for Payer: UHC Medicare Advantage	$5,976.49
Rate for Payer: VA VA	$5,802.42

MASTOPEXY

Facility

$17,231.52

Service Code	CPT 19316
Hospital Revenue Code	360
Min. Negotiated Rate	$781.28
Max. Negotiated Rate	$17,231.52
Rate for Payer: Aetna Medicare	$6,034.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,253.02
Rate for Payer: Amish Plain Church Group Commercial	$7,253.02
Rate for Payer: BCBS Complete	$3,332.91
Rate for Payer: BCBS MAPPO	$5,802.42
Rate for Payer: BCBS Trust/PPO	$3,711.66
Rate for Payer: BCN Medicare Advantage	$5,802.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,802.42
Rate for Payer: Mclaren Medicaid	$3,173.92
Rate for Payer: Mclaren Medicare	$5,802.42
Rate for Payer: Meridian Medicaid	$3,332.91
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,092.54
Rate for Payer: MI Amish Medical Board Commercial	$6,672.78
Rate for Payer: PACE Medicare	$5,512.30
Rate for Payer: PACE SWMI	$5,802.42
Rate for Payer: PHP Medicare Advantage	$5,802.42
Rate for Payer: Priority Health Choice Medicaid	$3,173.92
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,231.52
Rate for Payer: Priority Health Medicare	$5,802.42
Rate for Payer: Priority Health Narrow Network	$13,785.22
Rate for Payer: Railroad Medicare Medicare	$5,802.42
Rate for Payer: UHC All Payor (Choice/PPO)	$859.41
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$5,802.42
Rate for Payer: UHC Exchange	$781.28
Rate for Payer: UHC Medicare Advantage	$5,976.49
Rate for Payer: VA VA	$5,802.42

MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP

Facility

$4,496.47

Service Code	CPT 19020
Hospital Revenue Code	360
Min. Negotiated Rate	$311.72
Max. Negotiated Rate	$4,496.47
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	$1,301.15
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	$4,496.47
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,597.18
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$342.89
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$311.72
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT

Facility

$291.04

Service Code	HCPCS 90707
Hospital Charge Code	10512
Hospital Revenue Code	636
Min. Negotiated Rate	$183.36
Max. Negotiated Rate	$261.94
Rate for Payer: Aetna Commercial	$247.38
Rate for Payer: Aetna New Business (MI Preferred)	$189.18
Rate for Payer: Cash Price	$232.83
Rate for Payer: Cofinity Commercial	$203.73
Rate for Payer: Cofinity Commercial	$250.29
Rate for Payer: Healthscope Commercial	$261.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$247.38
Rate for Payer: PHP Commercial	$247.38
Rate for Payer: Priority Health Cigna Priority Health	$203.73
Rate for Payer: Priority Health SBD	$183.36

MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON-IMAGING

Facility

$878.00

Service Code	CPT 51798
Hospital Revenue Code	361
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$878.00
Rate for Payer: Aetna Medicare	$56.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$68.04
Rate for Payer: Amish Plain Church Group Commercial	$68.04
Rate for Payer: BCBS Complete	$31.26
Rate for Payer: BCBS MAPPO	$54.43
Rate for Payer: BCBS Trust/PPO	$69.54
Rate for Payer: BCN Medicare Advantage	$54.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$54.43
Rate for Payer: Mclaren Medicaid	$29.77
Rate for Payer: Mclaren Medicare	$54.43
Rate for Payer: Meridian Medicaid	$31.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$57.15
Rate for Payer: MI Amish Medical Board Commercial	$62.59
Rate for Payer: PACE Medicare	$51.71
Rate for Payer: PACE SWMI	$54.43
Rate for Payer: PHP Medicare Advantage	$54.43
Rate for Payer: Priority Health Choice Medicaid	$29.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.33
Rate for Payer: Priority Health Medicare	$54.43
Rate for Payer: Priority Health Narrow Network	$138.66
Rate for Payer: Railroad Medicare Medicare	$54.43
Rate for Payer: UHC All Payor (Choice/PPO)	$12.24
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$54.43
Rate for Payer: UHC Exchange	$11.13
Rate for Payer: UHC Medicare Advantage	$56.06
Rate for Payer: VA VA	$54.43

MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT

Facility

$5,575.00

Service Code	CPT 53020
Hospital Revenue Code	360
Min. Negotiated Rate	$93.98
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	$802.43
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)	$103.38
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$1,812.34
Rate for Payer: UHC Exchange	$93.98
Rate for Payer: UHC Medicare Advantage	$1,866.71
Rate for Payer: VA VA	$1,812.34

MECLIZINE 12.5 MG TABLET

Facility

$161.03

Service Code	NDC 50268-522-15
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$101.45
Max. Negotiated Rate	$144.93
Rate for Payer: Aetna Commercial	$136.88
Rate for Payer: Aetna New Business (MI Preferred)	$104.67
Rate for Payer: Cash Price	$128.82
Rate for Payer: Cofinity Commercial	$112.72
Rate for Payer: Cofinity Commercial	$138.49
Rate for Payer: Healthscope Commercial	$144.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$136.88
Rate for Payer: PHP Commercial	$136.88
Rate for Payer: Priority Health Cigna Priority Health	$112.72
Rate for Payer: Priority Health SBD	$101.45

MECLIZINE 12.5 MG TABLET

Facility

$366.70

Service Code	NDC 0904-6516-61
Hospital Charge Code	12024
Hospital Revenue Code	637
Min. Negotiated Rate	$231.02
Max. Negotiated Rate	$330.03
Rate for Payer: Aetna Commercial	$311.70
Rate for Payer: Aetna New Business (MI Preferred)	$238.36
Rate for Payer: Cash Price	$293.36
Rate for Payer: Cofinity Commercial	$256.69
Rate for Payer: Cofinity Commercial	$315.36
Rate for Payer: Healthscope Commercial	$330.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$311.70
Rate for Payer: PHP Commercial	$311.70
Rate for Payer: Priority Health Cigna Priority Health	$256.69
Rate for Payer: Priority Health SBD	$231.02

Know your out-of-pocket cost for care.

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