Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

IMPACT PEPTIDE 1.5 INTERMITTENT FEED

Facility

$66.60

Service Code	NDC 43900097370
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$24.64
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna American Axle	$43.29
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 Advantage	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$46.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$49.95
Rate for Payer: MI Amish Medical Board Commercial	$53.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.95
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health SBD	$41.96
Rate for Payer: UHC All Payor (Choice/PPO)	$43.29
Rate for Payer: UHC Core	$34.70
Rate for Payer: UHC Exchange	$26.17
Rate for Payer: UMR Bronson Commercial	$24.64
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$49.95

IMPACT PEPTIDE 1.5 INTERMITTENT FEED

Facility

$15.73

Service Code	NDC 43900097399
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna American Axle	$10.22
Rate for Payer: Aetna Commercial	$13.37
Rate for Payer: Aetna Medicare	$7.87
Rate for Payer: Aetna New Business (MI Preferred)	$10.22
Rate for Payer: BCBS Complete	$6.29
Rate for Payer: Cash Price	$12.58
Rate for Payer: Cofinity Advantage	$11.01
Rate for Payer: Cofinity Commercial	$13.53
Rate for Payer: Encore Health Key Benefits Commercial	$12.58
Rate for Payer: Healthscope Commercial	$14.16
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$11.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.80
Rate for Payer: MI Amish Medical Board Commercial	$12.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.80
Rate for Payer: PHP Commercial	$13.37
Rate for Payer: Priority Health SBD	$9.91
Rate for Payer: UHC All Payor (Choice/PPO)	$10.22
Rate for Payer: UHC Core	$8.20
Rate for Payer: UHC Exchange	$6.18
Rate for Payer: UMR Bronson Commercial	$5.82
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.80

IMPACT PEPTIDE 1.5 INTERMITTENT FEED

Facility

$15.73

Service Code	NDC 43900097399
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$6.92
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna American Axle	$10.22
Rate for Payer: Aetna Commercial	$13.37
Rate for Payer: Aetna New Business (MI Preferred)	$10.22
Rate for Payer: Cash Price	$12.58
Rate for Payer: Cofinity Advantage	$11.01
Rate for Payer: Cofinity Commercial	$13.53
Rate for Payer: Encore Health Key Benefits Commercial	$12.58
Rate for Payer: Healthscope Commercial	$14.16
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$11.01
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.80
Rate for Payer: PHP Commercial	$13.37
Rate for Payer: Priority Health SBD	$9.91
Rate for Payer: UMR Bronson Commercial	$6.92
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.80

IMPACT PEPTIDE 1.5 INTERMITTENT FEED

Facility

$66.60

Service Code	NDC 43900097370
Hospital Charge Code	200090
Hospital Revenue Code	637
Min. Negotiated Rate	$29.30
Max. Negotiated Rate	$59.94
Rate for Payer: Aetna American Axle	$43.29
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 Advantage	$46.62
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Encore Health Key Benefits Commercial	$53.28
Rate for Payer: Healthscope Commercial	$59.94
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$46.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$49.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$56.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.95
Rate for Payer: PHP Commercial	$56.61
Rate for Payer: Priority Health SBD	$41.96
Rate for Payer: UMR Bronson Commercial	$29.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$49.95

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$76,039.11

Service Code	APR-DRG 1611
Min. Negotiated Rate	$72,418.20
Max. Negotiated Rate	$76,039.11
Rate for Payer: BCBS Complete	$76,039.11
Rate for Payer: Mclaren Medicaid	$72,418.20
Rate for Payer: Meridian Medicaid	$76,039.11
Rate for Payer: Priority Health Choice Medicaid	$72,418.20
Rate for Payer: UHC Medicaid	$72,418.20
Rate for Payer: UHCCP Medicaid	$72,418.20

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$183,447.37

Service Code	APR-DRG 1614
Min. Negotiated Rate	$174,711.78
Max. Negotiated Rate	$183,447.37
Rate for Payer: BCBS Complete	$183,447.37
Rate for Payer: Mclaren Medicaid	$174,711.78
Rate for Payer: Meridian Medicaid	$183,447.37
Rate for Payer: Priority Health Choice Medicaid	$174,711.78
Rate for Payer: UHC Medicaid	$174,711.78
Rate for Payer: UHCCP Medicaid	$174,711.78

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$90,222.48

Service Code	APR-DRG 1612
Min. Negotiated Rate	$85,926.17
Max. Negotiated Rate	$90,222.48
Rate for Payer: BCBS Complete	$90,222.48
Rate for Payer: Mclaren Medicaid	$85,926.17
Rate for Payer: Meridian Medicaid	$90,222.48
Rate for Payer: Priority Health Choice Medicaid	$85,926.17
Rate for Payer: UHC Medicaid	$85,926.17
Rate for Payer: UHCCP Medicaid	$85,926.17

IMPLANTABLE HEART ASSIST SYSTEMS

Facility

$99,339.89

Service Code	APR-DRG 1613
Min. Negotiated Rate	$94,609.41
Max. Negotiated Rate	$99,339.89
Rate for Payer: BCBS Complete	$99,339.89
Rate for Payer: Mclaren Medicaid	$94,609.41
Rate for Payer: Meridian Medicaid	$99,339.89
Rate for Payer: Priority Health Choice Medicaid	$94,609.41
Rate for Payer: UHC Medicaid	$94,609.41
Rate for Payer: UHCCP Medicaid	$94,609.41

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

$7,465.51

Service Code	CPT 15777
Hospital Revenue Code	360
Min. Negotiated Rate	$7,465.51
Max. Negotiated Rate	$7,465.51
Rate for Payer: BCBS Trust/PPO	$7,465.51
Rate for Payer: BCN Commercial	$7,465.51

IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING

Facility

$58,077.91

Service Code	CPT 62362
Hospital Revenue Code	360
Min. Negotiated Rate	$9,392.58
Max. Negotiated Rate	$58,077.91
Rate for Payer: Aetna Medicare	$18,677.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,448.80
Rate for Payer: Amish Plain Church Group Commercial	$22,448.80
Rate for Payer: BCBS Complete	$9,863.10
Rate for Payer: BCBS MAPPO	$17,959.04
Rate for Payer: BCBS Trust/PPO	$28,322.25
Rate for Payer: BCN Commercial	$28,322.25
Rate for Payer: BCN Medicare Advantage	$17,959.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,959.04
Rate for Payer: Mclaren Medicaid	$17,959.04
Rate for Payer: Mclaren Medicare	$17,959.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,856.99
Rate for Payer: Meridian Medicaid	$18,856.99
Rate for Payer: MI Amish Medical Board Commercial	$20,652.90
Rate for Payer: Molina Medicare/Medicaid	$19,754.94
Rate for Payer: Nomi Health Commercial	$53,877.12
Rate for Payer: PACE Medicare	$17,061.09
Rate for Payer: PACE SWMI	$17,959.04
Rate for Payer: PHP Medicare Advantage	$17,959.04
Rate for Payer: Priority Health Choice Medicaid	$9,392.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$58,077.91
Rate for Payer: Priority Health Medicare	$17,959.04
Rate for Payer: Priority Health Tiered Network	$46,462.33
Rate for Payer: Railroad Medicare Medicare	$17,959.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$17,959.04
Rate for Payer: UHC Medicaid	$9,392.58
Rate for Payer: UHCCP Medicaid	$9,392.58
Rate for Payer: VA VA	$17,959.04

IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH MAGNETIC TRANSCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR, WITHIN THE MASTOID AND/OR RESULTING IN REMOVAL OF LESS THAN 100 SQ MM SURFACE AREA OF BONE DEEP TO THE OUTER CRANIAL CORTEX

Facility

$41,369.85

Service Code	CPT 69716
Hospital Revenue Code	360
Min. Negotiated Rate	$6,690.48
Max. Negotiated Rate	$41,369.85
Rate for Payer: Aetna Medicare	$13,304.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,990.64
Rate for Payer: Amish Plain Church Group Commercial	$15,990.64
Rate for Payer: BCBS Complete	$7,025.65
Rate for Payer: BCBS MAPPO	$12,792.51
Rate for Payer: BCBS Trust/PPO	$15,603.42
Rate for Payer: BCN Commercial	$15,603.42
Rate for Payer: BCN Medicare Advantage	$12,792.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,792.51
Rate for Payer: Mclaren Medicaid	$12,792.51
Rate for Payer: Mclaren Medicare	$12,792.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,432.14
Rate for Payer: Meridian Medicaid	$13,432.14
Rate for Payer: MI Amish Medical Board Commercial	$14,711.39
Rate for Payer: Molina Medicare/Medicaid	$14,071.76
Rate for Payer: Nomi Health Commercial	$38,377.53
Rate for Payer: PACE Medicare	$12,152.88
Rate for Payer: PACE SWMI	$12,792.51
Rate for Payer: PHP Medicare Advantage	$12,792.51
Rate for Payer: Priority Health Choice Medicaid	$6,690.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$41,369.85
Rate for Payer: Priority Health Medicare	$12,792.51
Rate for Payer: Priority Health Tiered Network	$33,095.88
Rate for Payer: Railroad Medicare Medicare	$12,792.51
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,792.51
Rate for Payer: UHC Medicaid	$6,690.48
Rate for Payer: UHCCP Medicaid	$6,690.48
Rate for Payer: VA VA	$12,792.51

IMPLANTATION, OSSEOINTEGRATED IMPLANT, SKULL; WITH PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR

Facility

$41,369.85

Service Code	CPT 69714
Hospital Revenue Code	360
Min. Negotiated Rate	$6,690.48
Max. Negotiated Rate	$41,369.85
Rate for Payer: Aetna Medicare	$13,304.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,990.64
Rate for Payer: Amish Plain Church Group Commercial	$15,990.64
Rate for Payer: BCBS Complete	$7,025.65
Rate for Payer: BCBS MAPPO	$12,792.51
Rate for Payer: BCBS Trust/PPO	$10,296.47
Rate for Payer: BCN Commercial	$10,296.47
Rate for Payer: BCN Medicare Advantage	$12,792.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,792.51
Rate for Payer: Mclaren Medicaid	$12,792.51
Rate for Payer: Mclaren Medicare	$12,792.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,432.14
Rate for Payer: Meridian Medicaid	$13,432.14
Rate for Payer: MI Amish Medical Board Commercial	$14,711.39
Rate for Payer: Molina Medicare/Medicaid	$14,071.76
Rate for Payer: Nomi Health Commercial	$38,377.53
Rate for Payer: PACE Medicare	$12,152.88
Rate for Payer: PACE SWMI	$12,792.51
Rate for Payer: PHP Medicare Advantage	$12,792.51
Rate for Payer: Priority Health Choice Medicaid	$6,690.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$41,369.85
Rate for Payer: Priority Health Medicare	$12,792.51
Rate for Payer: Priority Health Tiered Network	$33,095.88
Rate for Payer: Railroad Medicare Medicare	$12,792.51
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,792.51
Rate for Payer: UHC Medicaid	$6,690.48
Rate for Payer: UHCCP Medicaid	$6,690.48
Rate for Payer: VA VA	$12,792.51

IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY

Facility

$28,278.25

Service Code	CPT 62350
Hospital Revenue Code	360
Min. Negotiated Rate	$4,573.26
Max. Negotiated Rate	$28,278.25
Rate for Payer: Aetna Medicare	$9,094.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,930.36
Rate for Payer: Amish Plain Church Group Commercial	$10,930.36
Rate for Payer: BCBS Complete	$4,802.36
Rate for Payer: BCBS MAPPO	$8,744.29
Rate for Payer: BCBS Trust/PPO	$4,733.45
Rate for Payer: BCN Commercial	$4,733.45
Rate for Payer: BCN Medicare Advantage	$8,744.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,744.29
Rate for Payer: Mclaren Medicaid	$8,744.29
Rate for Payer: Mclaren Medicare	$8,744.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,181.50
Rate for Payer: Meridian Medicaid	$9,181.50
Rate for Payer: MI Amish Medical Board Commercial	$10,055.93
Rate for Payer: Molina Medicare/Medicaid	$9,618.72
Rate for Payer: Nomi Health Commercial	$26,232.87
Rate for Payer: PACE Medicare	$8,307.08
Rate for Payer: PACE SWMI	$8,744.29
Rate for Payer: PHP Medicare Advantage	$8,744.29
Rate for Payer: Priority Health Choice Medicaid	$4,573.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,278.25
Rate for Payer: Priority Health Medicare	$8,744.29
Rate for Payer: Priority Health Tiered Network	$22,622.60
Rate for Payer: Railroad Medicare Medicare	$8,744.29
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,744.29
Rate for Payer: UHC Medicaid	$4,573.26
Rate for Payer: UHCCP Medicaid	$4,573.26
Rate for Payer: VA VA	$8,744.29

INBORN AND OTHER DISORDERS OF METABOLISM

Facility

$47,350.23

Service Code	MSDRG 642
Min. Negotiated Rate	$11,861.27
Max. Negotiated Rate	$47,350.23
Rate for Payer: Aetna Medicare	$12,984.97
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,606.94
Rate for Payer: Amish Plain Church Group Commercial	$15,606.94
Rate for Payer: BCBS MAPPO	$12,485.55
Rate for Payer: BCBS Trust/PPO	$47,350.23
Rate for Payer: BCN Commercial	$47,350.23
Rate for Payer: BCN Medicare Advantage	$12,485.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,485.55
Rate for Payer: Mclaren Medicare	$12,485.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,109.83
Rate for Payer: MI Amish Medical Board Commercial	$14,358.38
Rate for Payer: Molina Medicare/Medicaid	$13,734.10
Rate for Payer: Nomi Health Commercial	$18,345.09
Rate for Payer: PACE Medicare	$11,861.27
Rate for Payer: PACE SWMI	$12,485.55
Rate for Payer: PHP Medicare Advantage	$12,485.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$22,927.30
Rate for Payer: Priority Health Medicare	$12,485.55
Rate for Payer: Priority Health Tiered Network	$18,341.83
Rate for Payer: Railroad Medicare Medicare	$12,485.55
Rate for Payer: UHC All Payor (Choice/PPO)	$23,180.23
Rate for Payer: UHC Core	$19,393.18
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,485.55
Rate for Payer: UHC Exchange	$15,837.93
Rate for Payer: VA VA	$12,485.55

INBORN ERRORS OF METABOLISM

Facility

$30,185.14

Service Code	APR-DRG 4234
Min. Negotiated Rate	$28,747.75
Max. Negotiated Rate	$30,185.14
Rate for Payer: BCBS Complete	$30,185.14
Rate for Payer: Mclaren Medicaid	$28,747.75
Rate for Payer: Meridian Medicaid	$30,185.14
Rate for Payer: Priority Health Choice Medicaid	$28,747.75
Rate for Payer: UHC Medicaid	$28,747.75
Rate for Payer: UHCCP Medicaid	$28,747.75

INBORN ERRORS OF METABOLISM

Facility

$8,195.50

Service Code	APR-DRG 4232
Min. Negotiated Rate	$7,805.23
Max. Negotiated Rate	$8,195.50
Rate for Payer: BCBS Complete	$8,195.50
Rate for Payer: Mclaren Medicaid	$7,805.23
Rate for Payer: Meridian Medicaid	$8,195.50
Rate for Payer: Priority Health Choice Medicaid	$7,805.23
Rate for Payer: UHC Medicaid	$7,805.23
Rate for Payer: UHCCP Medicaid	$7,805.23

INBORN ERRORS OF METABOLISM

Facility

$3,545.99

Service Code	APR-DRG 4231
Min. Negotiated Rate	$3,377.14
Max. Negotiated Rate	$3,545.99
Rate for Payer: BCBS Complete	$3,545.99
Rate for Payer: Mclaren Medicaid	$3,377.14
Rate for Payer: Meridian Medicaid	$3,545.99
Rate for Payer: Priority Health Choice Medicaid	$3,377.14
Rate for Payer: UHC Medicaid	$3,377.14
Rate for Payer: UHCCP Medicaid	$3,377.14

INBORN ERRORS OF METABOLISM

Facility

$11,547.79

Service Code	APR-DRG 4233
Min. Negotiated Rate	$10,997.89
Max. Negotiated Rate	$11,547.79
Rate for Payer: BCBS Complete	$11,547.79
Rate for Payer: Mclaren Medicaid	$10,997.89
Rate for Payer: Meridian Medicaid	$11,547.79
Rate for Payer: Priority Health Choice Medicaid	$10,997.89
Rate for Payer: UHC Medicaid	$10,997.89
Rate for Payer: UHCCP Medicaid	$10,997.89

INCISIONAL BIOPSY OF EYELID SKIN INCLUDING LID MARGIN

Facility

$1,022.76

Service Code	CPT 67810
Hospital Revenue Code	360
Min. Negotiated Rate	$165.40
Max. Negotiated Rate	$1,022.76
Rate for Payer: Aetna Medicare	$328.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$395.32
Rate for Payer: Amish Plain Church Group Commercial	$395.32
Rate for Payer: BCBS Complete	$173.69
Rate for Payer: BCBS MAPPO	$316.26
Rate for Payer: BCBS Trust/PPO	$203.07
Rate for Payer: BCN Commercial	$203.07
Rate for Payer: BCN Medicare Advantage	$316.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$316.26
Rate for Payer: Mclaren Medicaid	$316.26
Rate for Payer: Mclaren Medicare	$316.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$332.07
Rate for Payer: Meridian Medicaid	$332.07
Rate for Payer: MI Amish Medical Board Commercial	$363.70
Rate for Payer: Molina Medicare/Medicaid	$347.89
Rate for Payer: Nomi Health Commercial	$948.78
Rate for Payer: PACE Medicare	$300.45
Rate for Payer: PACE SWMI	$316.26
Rate for Payer: PHP Medicare Advantage	$316.26
Rate for Payer: Priority Health Choice Medicaid	$165.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,022.76
Rate for Payer: Priority Health Medicare	$316.26
Rate for Payer: Priority Health Tiered Network	$818.21
Rate for Payer: Railroad Medicare Medicare	$316.26
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$316.26
Rate for Payer: UHC Medicaid	$165.40
Rate for Payer: UHCCP Medicaid	$165.40
Rate for Payer: VA VA	$316.26

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

Facility

$2,381.49

Service Code	CPT 11106
Hospital Revenue Code	360
Min. Negotiated Rate	$175.46
Max. Negotiated Rate	$2,381.49
Rate for Payer: Aetna Medicare	$765.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$920.51
Rate for Payer: Amish Plain Church Group Commercial	$920.51
Rate for Payer: BCBS Complete	$404.44
Rate for Payer: BCBS MAPPO	$736.41
Rate for Payer: BCBS Trust/PPO	$175.46
Rate for Payer: BCN Commercial	$175.46
Rate for Payer: BCN Medicare Advantage	$736.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$736.41
Rate for Payer: Mclaren Medicaid	$736.41
Rate for Payer: Mclaren Medicare	$736.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$773.23
Rate for Payer: Meridian Medicaid	$773.23
Rate for Payer: MI Amish Medical Board Commercial	$846.87
Rate for Payer: Molina Medicare/Medicaid	$810.05
Rate for Payer: Nomi Health Commercial	$2,209.23
Rate for Payer: PACE Medicare	$699.59
Rate for Payer: PACE SWMI	$736.41
Rate for Payer: PHP Medicare Advantage	$736.41
Rate for Payer: Priority Health Choice Medicaid	$385.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,381.49
Rate for Payer: Priority Health Medicare	$736.41
Rate for Payer: Priority Health Tiered Network	$1,905.19
Rate for Payer: Railroad Medicare Medicare	$736.41
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$736.41
Rate for Payer: UHC Medicaid	$385.14
Rate for Payer: UHCCP Medicaid	$385.14
Rate for Payer: VA VA	$736.41

INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; MULTIPLE AREAS

Facility

$10,543.31

Service Code	CPT 28003
Hospital Revenue Code	360
Min. Negotiated Rate	$1,705.10
Max. Negotiated Rate	$10,543.31
Rate for Payer: Aetna Medicare	$3,390.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,075.29
Rate for Payer: Amish Plain Church Group Commercial	$4,075.29
Rate for Payer: BCBS Complete	$1,790.52
Rate for Payer: BCBS MAPPO	$3,260.23
Rate for Payer: BCBS Trust/PPO	$2,675.66
Rate for Payer: BCN Commercial	$2,675.66
Rate for Payer: BCN Medicare Advantage	$3,260.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,260.23
Rate for Payer: Mclaren Medicaid	$3,260.23
Rate for Payer: Mclaren Medicare	$3,260.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,423.24
Rate for Payer: Meridian Medicaid	$3,423.24
Rate for Payer: MI Amish Medical Board Commercial	$3,749.26
Rate for Payer: Molina Medicare/Medicaid	$3,586.25
Rate for Payer: Nomi Health Commercial	$9,780.69
Rate for Payer: PACE Medicare	$3,097.22
Rate for Payer: PACE SWMI	$3,260.23
Rate for Payer: PHP Medicare Advantage	$3,260.23
Rate for Payer: Priority Health Choice Medicaid	$1,705.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,543.31
Rate for Payer: Priority Health Medicare	$3,260.23
Rate for Payer: Priority Health Tiered Network	$8,434.65
Rate for Payer: Railroad Medicare Medicare	$3,260.23
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,260.23
Rate for Payer: UHC Medicaid	$1,705.10
Rate for Payer: UHCCP Medicaid	$1,705.10
Rate for Payer: VA VA	$3,260.23

INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUND INFECTION

Facility

$9,359.82

Service Code	CPT 10180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,513.70
Max. Negotiated Rate	$9,359.82
Rate for Payer: Aetna Medicare	$3,010.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,617.84
Rate for Payer: Amish Plain Church Group Commercial	$3,617.84
Rate for Payer: BCBS Complete	$1,589.53
Rate for Payer: BCBS MAPPO	$2,894.27
Rate for Payer: BCBS Trust/PPO	$3,210.08
Rate for Payer: BCN Commercial	$3,210.08
Rate for Payer: BCN Medicare Advantage	$2,894.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,894.27
Rate for Payer: Mclaren Medicaid	$2,894.27
Rate for Payer: Mclaren Medicare	$2,894.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,038.98
Rate for Payer: Meridian Medicaid	$3,038.98
Rate for Payer: MI Amish Medical Board Commercial	$3,328.41
Rate for Payer: Molina Medicare/Medicaid	$3,183.70
Rate for Payer: Nomi Health Commercial	$8,682.81
Rate for Payer: PACE Medicare	$2,749.56
Rate for Payer: PACE SWMI	$2,894.27
Rate for Payer: PHP Medicare Advantage	$2,894.27
Rate for Payer: Priority Health Choice Medicaid	$1,513.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$9,359.82
Rate for Payer: Priority Health Medicare	$2,894.27
Rate for Payer: Priority Health Tiered Network	$7,487.86
Rate for Payer: Railroad Medicare Medicare	$2,894.27
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,894.27
Rate for Payer: UHC Medicaid	$1,513.70
Rate for Payer: UHCCP Medicaid	$1,513.70
Rate for Payer: VA VA	$2,894.27

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

Facility

$9,359.82

Service Code	CPT 27301
Hospital Revenue Code	360
Min. Negotiated Rate	$1,513.70
Max. Negotiated Rate	$9,359.82
Rate for Payer: Aetna Medicare	$3,010.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,617.84
Rate for Payer: Amish Plain Church Group Commercial	$3,617.84
Rate for Payer: BCBS Complete	$1,589.53
Rate for Payer: BCBS MAPPO	$2,894.27
Rate for Payer: BCBS Trust/PPO	$1,940.82
Rate for Payer: BCN Commercial	$1,940.82
Rate for Payer: BCN Medicare Advantage	$2,894.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,894.27
Rate for Payer: Mclaren Medicaid	$2,894.27
Rate for Payer: Mclaren Medicare	$2,894.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,038.98
Rate for Payer: Meridian Medicaid	$3,038.98
Rate for Payer: MI Amish Medical Board Commercial	$3,328.41
Rate for Payer: Molina Medicare/Medicaid	$3,183.70
Rate for Payer: Nomi Health Commercial	$8,682.81
Rate for Payer: PACE Medicare	$2,749.56
Rate for Payer: PACE SWMI	$2,894.27
Rate for Payer: PHP Medicare Advantage	$2,894.27
Rate for Payer: Priority Health Choice Medicaid	$1,513.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$9,359.82
Rate for Payer: Priority Health Medicare	$2,894.27
Rate for Payer: Priority Health Tiered Network	$7,487.86
Rate for Payer: Railroad Medicare Medicare	$2,894.27
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,894.27
Rate for Payer: UHC Medicaid	$1,513.70
Rate for Payer: UHCCP Medicaid	$1,513.70
Rate for Payer: VA VA	$2,894.27

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

Facility

$9,359.82

Service Code	CPT 21501
Hospital Revenue Code	360
Min. Negotiated Rate	$1,513.70
Max. Negotiated Rate	$9,359.82
Rate for Payer: Aetna Medicare	$3,010.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,617.84
Rate for Payer: Amish Plain Church Group Commercial	$3,617.84
Rate for Payer: BCBS Complete	$1,589.53
Rate for Payer: BCBS MAPPO	$2,894.27
Rate for Payer: BCBS Trust/PPO	$3,500.30
Rate for Payer: BCN Commercial	$3,500.30
Rate for Payer: BCN Medicare Advantage	$2,894.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,894.27
Rate for Payer: Mclaren Medicaid	$2,894.27
Rate for Payer: Mclaren Medicare	$2,894.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,038.98
Rate for Payer: Meridian Medicaid	$3,038.98
Rate for Payer: MI Amish Medical Board Commercial	$3,328.41
Rate for Payer: Molina Medicare/Medicaid	$3,183.70
Rate for Payer: Nomi Health Commercial	$8,682.81
Rate for Payer: PACE Medicare	$2,749.56
Rate for Payer: PACE SWMI	$2,894.27
Rate for Payer: PHP Medicare Advantage	$2,894.27
Rate for Payer: Priority Health Choice Medicaid	$1,513.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$9,359.82
Rate for Payer: Priority Health Medicare	$2,894.27
Rate for Payer: Priority Health Tiered Network	$7,487.86
Rate for Payer: Railroad Medicare Medicare	$2,894.27
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,894.27
Rate for Payer: UHC Medicaid	$1,513.70
Rate for Payer: UHCCP Medicaid	$1,513.70
Rate for Payer: VA VA	$2,894.27

INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS OR HEMATOMA

Facility

$10,543.31

Service Code	CPT 25028
Hospital Revenue Code	360
Min. Negotiated Rate	$1,705.10
Max. Negotiated Rate	$10,543.31
Rate for Payer: Aetna Medicare	$3,390.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,075.29
Rate for Payer: Amish Plain Church Group Commercial	$4,075.29
Rate for Payer: BCBS Complete	$1,790.52
Rate for Payer: BCBS MAPPO	$3,260.23
Rate for Payer: BCBS Trust/PPO	$2,293.43
Rate for Payer: BCN Commercial	$2,293.43
Rate for Payer: BCN Medicare Advantage	$3,260.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,260.23
Rate for Payer: Mclaren Medicaid	$3,260.23
Rate for Payer: Mclaren Medicare	$3,260.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,423.24
Rate for Payer: Meridian Medicaid	$3,423.24
Rate for Payer: MI Amish Medical Board Commercial	$3,749.26
Rate for Payer: Molina Medicare/Medicaid	$3,586.25
Rate for Payer: Nomi Health Commercial	$9,780.69
Rate for Payer: PACE Medicare	$3,097.22
Rate for Payer: PACE SWMI	$3,260.23
Rate for Payer: PHP Medicare Advantage	$3,260.23
Rate for Payer: Priority Health Choice Medicaid	$1,705.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,543.31
Rate for Payer: Priority Health Medicare	$3,260.23
Rate for Payer: Priority Health Tiered Network	$8,434.65
Rate for Payer: Railroad Medicare Medicare	$3,260.23
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,260.23
Rate for Payer: UHC Medicaid	$1,705.10
Rate for Payer: UHCCP Medicaid	$1,705.10
Rate for Payer: VA VA	$3,260.23

Know your out-of-pocket cost for care.

All Charges