Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED

Facility

$66.60

Service Code	NDC 43900097370
Hospital Charge Code	168957
Hospital Revenue Code	637
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: BCBS Complete	$26.64
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE/VITAL 1.5 CONTINUOUS FEED

Facility

$66.60

Service Code	NDC 43900097370
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: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED

Facility

$66.60

Service Code	NDC 43900097370
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: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE/VITAL 1.5 CYCLIC FEED

Facility

$66.60

Service Code	NDC 43900097370
Hospital Charge Code	200091
Hospital Revenue Code	637
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: BCBS Complete	$26.64
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED

Facility

$66.60

Service Code	NDC 43900097370
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna Commercial	$56.61
Rate for Payer: Aetna Medicare	$33.30
Rate for Payer: Aetna New Business (MI Preferred)	$43.29
Rate for Payer: BCBS Complete	$26.64
Rate for Payer: Cash Price	$53.28
Rate for Payer: Cofinity Commercial	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

IMPACT PEPTIDE/VITAL 1.5 INTERMITTENT FEED

Facility

$66.60

Service Code	NDC 43900097370
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: Cofinity Medicare Advantage	$46.62
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health Cigna Priority Health	$43.29
Rate for Payer: Priority Health SBD	$41.96

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

Facility

$1,680.50

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$1,680.50
Rate for Payer: Aetna Medicare	$620.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$746.25
Rate for Payer: Amish Plain Church Group Commercial	$746.25
Rate for Payer: BCBS Complete	$335.99
Rate for Payer: BCBS MAPPO	$597.00
Rate for Payer: BCN Medicare Advantage	$597.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$597.00
Rate for Payer: Mclaren Medicaid	$319.99
Rate for Payer: Mclaren Medicare	$597.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$626.85
Rate for Payer: Meridian Medicaid	$335.99
Rate for Payer: MI Amish Medical Board Commercial	$686.55
Rate for Payer: PACE Medicare	$567.15
Rate for Payer: PACE SWMI	$597.00
Rate for Payer: PHP Medicare Advantage	$597.00
Rate for Payer: Priority Health Choice Medicaid	$319.99
Rate for Payer: Priority Health Medicare	$597.00
Rate for Payer: Railroad Medicare Medicare	$597.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,680.50
Rate for Payer: UHC Dual Complete DSNP	$597.00
Rate for Payer: UHC Medicare Advantage	$597.00
Rate for Payer: UHCCP Medicaid	$336.11
Rate for Payer: VA VA	$597.00

INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION

Facility

$7,857.23

Service Code	CPT 10180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION

Facility

$7,857.23

Service Code	CPT 27301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

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

Facility

$7,857.23

Service Code	CPT 21501
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA

Facility

$7,857.23

Service Code	CPT 27603
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

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

Facility

$1,096.83

Service Code	CPT 10061
Hospital Revenue Code	360
Min. Negotiated Rate	$208.85
Max. Negotiated Rate	$1,096.83
Rate for Payer: Aetna Medicare	$405.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$487.06
Rate for Payer: Amish Plain Church Group Commercial	$487.06
Rate for Payer: BCBS Complete	$219.30
Rate for Payer: BCBS MAPPO	$389.65
Rate for Payer: BCN Medicare Advantage	$389.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.65
Rate for Payer: Mclaren Medicaid	$208.85
Rate for Payer: Mclaren Medicare	$389.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$409.13
Rate for Payer: Meridian Medicaid	$219.30
Rate for Payer: MI Amish Medical Board Commercial	$448.10
Rate for Payer: PACE Medicare	$370.17
Rate for Payer: PACE SWMI	$389.65
Rate for Payer: PHP Medicare Advantage	$389.65
Rate for Payer: Priority Health Choice Medicaid	$208.85
Rate for Payer: Priority Health Medicare	$389.65
Rate for Payer: Railroad Medicare Medicare	$389.65
Rate for Payer: UHC All Payor (Choice/PPO)	$1,096.83
Rate for Payer: UHC Dual Complete DSNP	$389.65
Rate for Payer: UHC Medicare Advantage	$389.65
Rate for Payer: UHCCP Medicaid	$219.37
Rate for Payer: VA VA	$389.65

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

Facility

$545.50

Service Code	CPT 10060
Hospital Revenue Code	360
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

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

Facility

$545.50

Service Code	CPT 10060
Hospital Revenue Code	361
Min. Negotiated Rate	$103.87
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Medicare	$201.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$242.24
Rate for Payer: Amish Plain Church Group Commercial	$242.24
Rate for Payer: BCBS Complete	$109.07
Rate for Payer: BCBS MAPPO	$193.79
Rate for Payer: BCN Medicare Advantage	$193.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.79
Rate for Payer: Mclaren Medicaid	$103.87
Rate for Payer: Mclaren Medicare	$193.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.48
Rate for Payer: Meridian Medicaid	$109.07
Rate for Payer: MI Amish Medical Board Commercial	$222.86
Rate for Payer: PACE Medicare	$184.10
Rate for Payer: PACE SWMI	$193.79
Rate for Payer: PHP Medicare Advantage	$193.79
Rate for Payer: Priority Health Choice Medicaid	$103.87
Rate for Payer: Priority Health Medicare	$193.79
Rate for Payer: Railroad Medicare Medicare	$193.79
Rate for Payer: UHC All Payor (Choice/PPO)	$545.50
Rate for Payer: UHC Dual Complete DSNP	$193.79
Rate for Payer: UHC Medicare Advantage	$193.79
Rate for Payer: UHCCP Medicaid	$109.10
Rate for Payer: VA VA	$193.79

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

Facility

$5,623.80

Service Code	CPT 54700
Hospital Revenue Code	360
Min. Negotiated Rate	$1,070.86
Max. Negotiated Rate	$5,623.80
Rate for Payer: Aetna Medicare	$2,077.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,497.34
Rate for Payer: Amish Plain Church Group Commercial	$2,497.34
Rate for Payer: BCBS Complete	$1,124.40
Rate for Payer: BCBS MAPPO	$1,997.87
Rate for Payer: BCN Medicare Advantage	$1,997.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,997.87
Rate for Payer: Mclaren Medicaid	$1,070.86
Rate for Payer: Mclaren Medicare	$1,997.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,097.76
Rate for Payer: Meridian Medicaid	$1,124.40
Rate for Payer: MI Amish Medical Board Commercial	$2,297.55
Rate for Payer: PACE Medicare	$1,897.98
Rate for Payer: PACE SWMI	$1,997.87
Rate for Payer: PHP Medicare Advantage	$1,997.87
Rate for Payer: Priority Health Choice Medicaid	$1,070.86
Rate for Payer: Priority Health Medicare	$1,997.87
Rate for Payer: Railroad Medicare Medicare	$1,997.87
Rate for Payer: UHC All Payor (Choice/PPO)	$5,623.80
Rate for Payer: UHC Dual Complete DSNP	$1,997.87
Rate for Payer: UHC Medicare Advantage	$1,997.87
Rate for Payer: UHCCP Medicaid	$1,124.80
Rate for Payer: VA VA	$1,997.87

INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION

Facility

$4,448.08

Service Code	CPT 10140
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$889.65
Rate for Payer: VA VA	$1,580.19

INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULAR, OR SUBMUCOSAL ABSCESS, TRANSANAL, UNDER ANESTHESIA

Facility

$7,528.73

Service Code	CPT 46045
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

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

Facility

$3,236.94

Service Code	CPT 46040
Hospital Revenue Code	360
Min. Negotiated Rate	$616.36
Max. Negotiated Rate	$3,236.94
Rate for Payer: Aetna Medicare	$1,195.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,437.41
Rate for Payer: Amish Plain Church Group Commercial	$1,437.41
Rate for Payer: BCBS Complete	$647.18
Rate for Payer: BCBS MAPPO	$1,149.93
Rate for Payer: BCN Medicare Advantage	$1,149.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,149.93
Rate for Payer: Mclaren Medicaid	$616.36
Rate for Payer: Mclaren Medicare	$1,149.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,207.43
Rate for Payer: Meridian Medicaid	$647.18
Rate for Payer: MI Amish Medical Board Commercial	$1,322.42
Rate for Payer: PACE Medicare	$1,092.43
Rate for Payer: PACE SWMI	$1,149.93
Rate for Payer: PHP Medicare Advantage	$1,149.93
Rate for Payer: Priority Health Choice Medicaid	$616.36
Rate for Payer: Priority Health Medicare	$1,149.93
Rate for Payer: Railroad Medicare Medicare	$1,149.93
Rate for Payer: UHC All Payor (Choice/PPO)	$3,236.94
Rate for Payer: UHC Dual Complete DSNP	$1,149.93
Rate for Payer: UHC Medicare Advantage	$1,149.93
Rate for Payer: UHCCP Medicaid	$647.41
Rate for Payer: VA VA	$1,149.93

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

Facility

$7,528.73

Service Code	CPT 46060
Hospital Revenue Code	360
Min. Negotiated Rate	$1,433.59
Max. Negotiated Rate	$7,528.73
Rate for Payer: Aetna Medicare	$2,781.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,343.25
Rate for Payer: Amish Plain Church Group Commercial	$3,343.25
Rate for Payer: BCBS Complete	$1,505.26
Rate for Payer: BCBS MAPPO	$2,674.60
Rate for Payer: BCN Medicare Advantage	$2,674.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,674.60
Rate for Payer: Mclaren Medicaid	$1,433.59
Rate for Payer: Mclaren Medicare	$2,674.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,808.33
Rate for Payer: Meridian Medicaid	$1,505.26
Rate for Payer: MI Amish Medical Board Commercial	$3,075.79
Rate for Payer: PACE Medicare	$2,540.87
Rate for Payer: PACE SWMI	$2,674.60
Rate for Payer: PHP Medicare Advantage	$2,674.60
Rate for Payer: Priority Health Choice Medicaid	$1,433.59
Rate for Payer: Priority Health Medicare	$2,674.60
Rate for Payer: Railroad Medicare Medicare	$2,674.60
Rate for Payer: UHC All Payor (Choice/PPO)	$7,528.73
Rate for Payer: UHC Dual Complete DSNP	$2,674.60
Rate for Payer: UHC Medicare Advantage	$2,674.60
Rate for Payer: UHCCP Medicaid	$1,505.80
Rate for Payer: VA VA	$2,674.60

INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE

Facility

$1,931.58

Service Code	CPT 10080
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$386.33
Rate for Payer: VA VA	$686.20

INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS

Facility

$835.10

Service Code	CPT 56405
Hospital Revenue Code	360
Min. Negotiated Rate	$159.02
Max. Negotiated Rate	$835.10
Rate for Payer: Aetna Medicare	$308.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$370.84
Rate for Payer: Amish Plain Church Group Commercial	$370.84
Rate for Payer: BCBS Complete	$166.97
Rate for Payer: BCBS MAPPO	$296.67
Rate for Payer: BCN Medicare Advantage	$296.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.67
Rate for Payer: Mclaren Medicaid	$159.02
Rate for Payer: Mclaren Medicare	$296.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.50
Rate for Payer: Meridian Medicaid	$166.97
Rate for Payer: MI Amish Medical Board Commercial	$341.17
Rate for Payer: PACE Medicare	$281.84
Rate for Payer: PACE SWMI	$296.67
Rate for Payer: PHP Medicare Advantage	$296.67
Rate for Payer: Priority Health Choice Medicaid	$159.02
Rate for Payer: Priority Health Medicare	$296.67
Rate for Payer: Railroad Medicare Medicare	$296.67
Rate for Payer: UHC All Payor (Choice/PPO)	$835.10
Rate for Payer: UHC Dual Complete DSNP	$296.67
Rate for Payer: UHC Medicare Advantage	$296.67
Rate for Payer: UHCCP Medicaid	$167.03
Rate for Payer: VA VA	$296.67

INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEP ABSCESS OR HEMATOMA

Facility

$8,907.47

Service Code	CPT 26990
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,781.56
Rate for Payer: VA VA	$3,164.40

INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL

Facility

$2,502.92

Service Code	CPT 46050
Hospital Revenue Code	360
Min. Negotiated Rate	$476.60
Max. Negotiated Rate	$2,502.92
Rate for Payer: Aetna Medicare	$924.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,111.46
Rate for Payer: Amish Plain Church Group Commercial	$1,111.46
Rate for Payer: BCBS Complete	$500.42
Rate for Payer: BCBS MAPPO	$889.17
Rate for Payer: BCN Medicare Advantage	$889.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$889.17
Rate for Payer: Mclaren Medicaid	$476.60
Rate for Payer: Mclaren Medicare	$889.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$933.63
Rate for Payer: Meridian Medicaid	$500.42
Rate for Payer: MI Amish Medical Board Commercial	$1,022.55
Rate for Payer: PACE Medicare	$844.71
Rate for Payer: PACE SWMI	$889.17
Rate for Payer: PHP Medicare Advantage	$889.17
Rate for Payer: Priority Health Choice Medicaid	$476.60
Rate for Payer: Priority Health Medicare	$889.17
Rate for Payer: Railroad Medicare Medicare	$889.17
Rate for Payer: UHC All Payor (Choice/PPO)	$2,502.92
Rate for Payer: UHC Dual Complete DSNP	$889.17
Rate for Payer: UHC Medicare Advantage	$889.17
Rate for Payer: UHCCP Medicaid	$500.60
Rate for Payer: VA VA	$889.17

INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESS OR HEMATOMA

Facility

$7,857.23

Service Code	CPT 23930
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,571.50
Rate for Payer: VA VA	$2,791.30

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED

Facility

$4,448.08

Service Code	CPT 10121
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$889.65
Rate for Payer: VA VA	$1,580.19

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