Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$81.90

Service Code	NDC 12165010001
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$73.71
Rate for Payer: Aetna Commercial	$69.62
Rate for Payer: Aetna New Business (MI Preferred)	$53.24
Rate for Payer: Cash Price	$65.52
Rate for Payer: Cofinity Commercial	$57.33
Rate for Payer: Cofinity Commercial	$70.43
Rate for Payer: Cofinity Medicare Advantage	$57.33
Rate for Payer: Encore Health Key Benefits Commercial	$65.52
Rate for Payer: Healthscope Commercial	$73.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.62
Rate for Payer: PHP Commercial	$69.62
Rate for Payer: Priority Health Cigna Priority Health	$53.24
Rate for Payer: Priority Health SBD	$51.60

SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK

Facility

$5.16

Service Code	NDC 09900000976
Hospital Charge Code	11359
Hospital Revenue Code	637
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$4.64
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna Medicare	$2.58
Rate for Payer: Aetna New Business (MI Preferred)	$3.35
Rate for Payer: BCBS Complete	$2.06
Rate for Payer: Cash Price	$4.13
Rate for Payer: Cofinity Commercial	$3.61
Rate for Payer: Cofinity Commercial	$4.44
Rate for Payer: Cofinity Medicare Advantage	$3.61
Rate for Payer: Encore Health Key Benefits Commercial	$4.13
Rate for Payer: Healthscope Commercial	$4.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.39
Rate for Payer: PHP Commercial	$4.39
Rate for Payer: Priority Health Cigna Priority Health	$3.35
Rate for Payer: Priority Health SBD	$3.25

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$18.90

Service Code	NDC 67877012405
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$17.01
Rate for Payer: Aetna Commercial	$16.06
Rate for Payer: Aetna Medicare	$9.45
Rate for Payer: Aetna New Business (MI Preferred)	$12.28
Rate for Payer: BCBS Complete	$7.56
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cofinity Commercial	$13.23
Rate for Payer: Cofinity Commercial	$16.25
Rate for Payer: Cofinity Medicare Advantage	$13.23
Rate for Payer: Encore Health Key Benefits Commercial	$15.12
Rate for Payer: Healthscope Commercial	$17.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.06
Rate for Payer: PHP Commercial	$16.06
Rate for Payer: Priority Health Cigna Priority Health	$12.28
Rate for Payer: Priority Health SBD	$11.91

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$15.08

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$12.82
Rate for Payer: Aetna New Business (MI Preferred)	$9.80
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cofinity Commercial	$10.56
Rate for Payer: Cofinity Commercial	$12.97
Rate for Payer: Cofinity Medicare Advantage	$10.56
Rate for Payer: Encore Health Key Benefits Commercial	$12.06
Rate for Payer: Healthscope Commercial	$13.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.82
Rate for Payer: PHP Commercial	$12.82
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$9.50

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$24.15

Service Code	NDC 43598021025
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$20.53
Rate for Payer: Aetna Medicare	$12.08
Rate for Payer: Aetna New Business (MI Preferred)	$15.70
Rate for Payer: BCBS Complete	$9.66
Rate for Payer: Cash Price	$19.32
Rate for Payer: Cofinity Commercial	$16.90
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Cofinity Medicare Advantage	$16.90
Rate for Payer: Encore Health Key Benefits Commercial	$19.32
Rate for Payer: Healthscope Commercial	$21.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.53
Rate for Payer: PHP Commercial	$20.53
Rate for Payer: Priority Health Cigna Priority Health	$15.70
Rate for Payer: Priority Health SBD	$15.21

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$15.08

Service Code	NDC 67877012425
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$13.57
Rate for Payer: Aetna Commercial	$12.82
Rate for Payer: Aetna Medicare	$7.54
Rate for Payer: Aetna New Business (MI Preferred)	$9.80
Rate for Payer: BCBS Complete	$6.03
Rate for Payer: Cash Price	$12.06
Rate for Payer: Cofinity Commercial	$10.56
Rate for Payer: Cofinity Commercial	$12.97
Rate for Payer: Cofinity Medicare Advantage	$10.56
Rate for Payer: Encore Health Key Benefits Commercial	$12.06
Rate for Payer: Healthscope Commercial	$13.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.82
Rate for Payer: PHP Commercial	$12.82
Rate for Payer: Priority Health Cigna Priority Health	$9.80
Rate for Payer: Priority Health SBD	$9.50

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$88.20

Service Code	NDC 67877012440
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$24.15

Service Code	NDC 43598021025
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$15.21
Max. Negotiated Rate	$21.74
Rate for Payer: Aetna Commercial	$20.53
Rate for Payer: Aetna New Business (MI Preferred)	$15.70
Rate for Payer: Cash Price	$19.32
Rate for Payer: Cofinity Commercial	$16.90
Rate for Payer: Cofinity Commercial	$20.77
Rate for Payer: Cofinity Medicare Advantage	$16.90
Rate for Payer: Encore Health Key Benefits Commercial	$19.32
Rate for Payer: Healthscope Commercial	$21.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.53
Rate for Payer: PHP Commercial	$20.53
Rate for Payer: Priority Health Cigna Priority Health	$15.70
Rate for Payer: Priority Health SBD	$15.21

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$18.90

Service Code	NDC 67877012405
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$11.91
Max. Negotiated Rate	$17.01
Rate for Payer: Aetna Commercial	$16.06
Rate for Payer: Aetna New Business (MI Preferred)	$12.28
Rate for Payer: Cash Price	$15.12
Rate for Payer: Cofinity Commercial	$13.23
Rate for Payer: Cofinity Commercial	$16.25
Rate for Payer: Cofinity Medicare Advantage	$13.23
Rate for Payer: Encore Health Key Benefits Commercial	$15.12
Rate for Payer: Healthscope Commercial	$17.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.06
Rate for Payer: PHP Commercial	$16.06
Rate for Payer: Priority Health Cigna Priority Health	$12.28
Rate for Payer: Priority Health SBD	$11.91

SILVER SULFADIAZINE 1 % TOPICAL CREAM

Facility

$88.20

Service Code	NDC 67877012440
Hospital Charge Code	7224
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$25.94

Service Code	NDC 19903001022
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$23.35
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna Medicare	$12.97
Rate for Payer: Aetna New Business (MI Preferred)	$16.86
Rate for Payer: BCBS Complete	$10.38
Rate for Payer: Cash Price	$20.75
Rate for Payer: Cofinity Commercial	$18.16
Rate for Payer: Cofinity Commercial	$22.31
Rate for Payer: Cofinity Medicare Advantage	$18.16
Rate for Payer: Encore Health Key Benefits Commercial	$20.75
Rate for Payer: Healthscope Commercial	$23.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.05
Rate for Payer: PHP Commercial	$22.05
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: Priority Health SBD	$16.34

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$24.84

Service Code	NDC 62372063015
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$15.65
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna New Business (MI Preferred)	$16.15
Rate for Payer: Cash Price	$19.87
Rate for Payer: Cofinity Commercial	$17.39
Rate for Payer: Cofinity Commercial	$21.36
Rate for Payer: Cofinity Medicare Advantage	$17.39
Rate for Payer: Encore Health Key Benefits Commercial	$19.87
Rate for Payer: Healthscope Commercial	$22.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.11
Rate for Payer: PHP Commercial	$21.11
Rate for Payer: Priority Health Cigna Priority Health	$16.15
Rate for Payer: Priority Health SBD	$15.65

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$9.05

Service Code	NDC 00536130375
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$8.14
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna New Business (MI Preferred)	$5.88
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$6.34
Rate for Payer: Cofinity Commercial	$7.78
Rate for Payer: Cofinity Medicare Advantage	$6.34
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: PHP Commercial	$7.69
Rate for Payer: Priority Health Cigna Priority Health	$5.88
Rate for Payer: Priority Health SBD	$5.70

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$24.84

Service Code	NDC 62372063015
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$9.94
Max. Negotiated Rate	$22.36
Rate for Payer: Aetna Commercial	$21.11
Rate for Payer: Aetna Medicare	$12.42
Rate for Payer: Aetna New Business (MI Preferred)	$16.15
Rate for Payer: BCBS Complete	$9.94
Rate for Payer: Cash Price	$19.87
Rate for Payer: Cofinity Commercial	$17.39
Rate for Payer: Cofinity Commercial	$21.36
Rate for Payer: Cofinity Medicare Advantage	$17.39
Rate for Payer: Encore Health Key Benefits Commercial	$19.87
Rate for Payer: Healthscope Commercial	$22.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.11
Rate for Payer: PHP Commercial	$21.11
Rate for Payer: Priority Health Cigna Priority Health	$16.15
Rate for Payer: Priority Health SBD	$15.65

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$25.94

Service Code	NDC 19903001022
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$23.35
Rate for Payer: Aetna Commercial	$22.05
Rate for Payer: Aetna New Business (MI Preferred)	$16.86
Rate for Payer: Cash Price	$20.75
Rate for Payer: Cofinity Commercial	$18.16
Rate for Payer: Cofinity Commercial	$22.31
Rate for Payer: Cofinity Medicare Advantage	$18.16
Rate for Payer: Encore Health Key Benefits Commercial	$20.75
Rate for Payer: Healthscope Commercial	$23.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.05
Rate for Payer: PHP Commercial	$22.05
Rate for Payer: Priority Health Cigna Priority Health	$16.86
Rate for Payer: Priority Health SBD	$16.34

SIMETHICONE 40 MG/0.6 ML ORAL DROPS,SUSPENSION

Facility

$9.05

Service Code	NDC 00536130375
Hospital Charge Code	7228
Hospital Revenue Code	637
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$8.14
Rate for Payer: Aetna Commercial	$7.69
Rate for Payer: Aetna Medicare	$4.52
Rate for Payer: Aetna New Business (MI Preferred)	$5.88
Rate for Payer: BCBS Complete	$3.62
Rate for Payer: Cash Price	$7.24
Rate for Payer: Cofinity Commercial	$6.34
Rate for Payer: Cofinity Commercial	$7.78
Rate for Payer: Cofinity Medicare Advantage	$6.34
Rate for Payer: Encore Health Key Benefits Commercial	$7.24
Rate for Payer: Healthscope Commercial	$8.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.69
Rate for Payer: PHP Commercial	$7.69
Rate for Payer: Priority Health Cigna Priority Health	$5.88
Rate for Payer: Priority Health SBD	$5.70

SIMETHICONE 80 MG CHEWABLE TABLET

Facility

$72.85

Service Code	NDC 09629513606
Hospital Charge Code	7227
Hospital Revenue Code	637
Min. Negotiated Rate	$45.90
Max. Negotiated Rate	$65.56
Rate for Payer: Aetna Commercial	$61.92
Rate for Payer: Aetna New Business (MI Preferred)	$47.35
Rate for Payer: Cash Price	$58.28
Rate for Payer: Cofinity Commercial	$51.00
Rate for Payer: Cofinity Commercial	$62.65
Rate for Payer: Cofinity Medicare Advantage	$51.00
Rate for Payer: Encore Health Key Benefits Commercial	$58.28
Rate for Payer: Healthscope Commercial	$65.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.92
Rate for Payer: PHP Commercial	$61.92
Rate for Payer: Priority Health Cigna Priority Health	$47.35
Rate for Payer: Priority Health SBD	$45.90

SIMETHICONE 80 MG CHEWABLE TABLET

Facility

$72.85

Service Code	NDC 09629513606
Hospital Charge Code	7227
Hospital Revenue Code	637
Min. Negotiated Rate	$29.14
Max. Negotiated Rate	$65.56
Rate for Payer: Aetna Commercial	$61.92
Rate for Payer: Aetna Medicare	$36.42
Rate for Payer: Aetna New Business (MI Preferred)	$47.35
Rate for Payer: BCBS Complete	$29.14
Rate for Payer: Cash Price	$58.28
Rate for Payer: Cofinity Commercial	$51.00
Rate for Payer: Cofinity Commercial	$62.65
Rate for Payer: Cofinity Medicare Advantage	$51.00
Rate for Payer: Encore Health Key Benefits Commercial	$58.28
Rate for Payer: Healthscope Commercial	$65.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$61.92
Rate for Payer: PHP Commercial	$61.92
Rate for Payer: Priority Health Cigna Priority Health	$47.35
Rate for Payer: Priority Health SBD	$45.90

SIMETHICONE 80 MG CHEWABLE TABLET

Facility

$77.55

Service Code	NDC 70000043401
Hospital Charge Code	7227
Hospital Revenue Code	637
Min. Negotiated Rate	$48.86
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Commercial	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Cofinity Medicare Advantage	$54.28
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health Cigna Priority Health	$50.41
Rate for Payer: Priority Health SBD	$48.86

SIMETHICONE 80 MG CHEWABLE TABLET

Facility

$77.55

Service Code	NDC 70000043401
Hospital Charge Code	7227
Hospital Revenue Code	637
Min. Negotiated Rate	$31.02
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna Medicare	$38.78
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: BCBS Complete	$31.02
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Commercial	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Cofinity Medicare Advantage	$54.28
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health Cigna Priority Health	$50.41
Rate for Payer: Priority Health SBD	$48.86

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS

Facility

$940.00

Service Code	CPT 12011
Hospital Revenue Code	361
Min. Negotiated Rate	$59.88
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Medicare	$202.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$243.35
Rate for Payer: Amish Plain Church Group Commercial	$243.35
Rate for Payer: BCBS Complete	$109.57
Rate for Payer: BCBS MAPPO	$194.68
Rate for Payer: BCBS Trust/PPO	$82.30
Rate for Payer: BCN Commercial	$82.30
Rate for Payer: BCN Medicare Advantage	$194.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$194.68
Rate for Payer: Mclaren Medicaid	$104.35
Rate for Payer: Mclaren Medicare	$194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$204.41
Rate for Payer: Meridian Medicaid	$109.57
Rate for Payer: MI Amish Medical Board Commercial	$223.88
Rate for Payer: Nomi Health Commercial	$584.04
Rate for Payer: PACE Medicare	$184.95
Rate for Payer: PACE SWMI	$194.68
Rate for Payer: PHP Medicare Advantage	$194.68
Rate for Payer: Priority Health Choice Medicaid	$104.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$611.90
Rate for Payer: Priority Health Medicare	$194.68
Rate for Payer: Priority Health Narrow Network	$489.52
Rate for Payer: Railroad Medicare Medicare	$194.68
Rate for Payer: UHC All Payor (Choice/PPO)	$59.88
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$194.68
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$194.68
Rate for Payer: UHCCP Medicaid	$109.60
Rate for Payer: VA VA	$194.68

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM

Facility

$940.00

Service Code	CPT 12013
Hospital Revenue Code	361
Min. Negotiated Rate	$62.94
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Medicare	$202.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$243.35
Rate for Payer: Amish Plain Church Group Commercial	$243.35
Rate for Payer: BCBS Complete	$109.57
Rate for Payer: BCBS MAPPO	$194.68
Rate for Payer: BCBS Trust/PPO	$111.48
Rate for Payer: BCN Commercial	$111.48
Rate for Payer: BCN Medicare Advantage	$194.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$194.68
Rate for Payer: Mclaren Medicaid	$104.35
Rate for Payer: Mclaren Medicare	$194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$204.41
Rate for Payer: Meridian Medicaid	$109.57
Rate for Payer: MI Amish Medical Board Commercial	$223.88
Rate for Payer: Nomi Health Commercial	$584.04
Rate for Payer: PACE Medicare	$184.95
Rate for Payer: PACE SWMI	$194.68
Rate for Payer: PHP Medicare Advantage	$194.68
Rate for Payer: Priority Health Choice Medicaid	$104.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$611.90
Rate for Payer: Priority Health Medicare	$194.68
Rate for Payer: Priority Health Narrow Network	$489.52
Rate for Payer: Railroad Medicare Medicare	$194.68
Rate for Payer: UHC All Payor (Choice/PPO)	$62.94
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$194.68
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$194.68
Rate for Payer: UHCCP Medicaid	$109.60
Rate for Payer: VA VA	$194.68

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM

Facility

$1,230.33

Service Code	CPT 12005
Hospital Revenue Code	361
Min. Negotiated Rate	$102.95
Max. Negotiated Rate	$1,230.33
Rate for Payer: Aetna Medicare	$407.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$489.31
Rate for Payer: Amish Plain Church Group Commercial	$489.31
Rate for Payer: BCBS Complete	$220.31
Rate for Payer: BCBS MAPPO	$391.45
Rate for Payer: BCBS Trust/PPO	$240.15
Rate for Payer: BCN Commercial	$240.15
Rate for Payer: BCN Medicare Advantage	$391.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$391.45
Rate for Payer: Mclaren Medicaid	$209.82
Rate for Payer: Mclaren Medicare	$391.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$411.02
Rate for Payer: Meridian Medicaid	$220.31
Rate for Payer: MI Amish Medical Board Commercial	$450.17
Rate for Payer: Nomi Health Commercial	$1,174.35
Rate for Payer: PACE Medicare	$371.88
Rate for Payer: PACE SWMI	$391.45
Rate for Payer: PHP Medicare Advantage	$391.45
Rate for Payer: Priority Health Choice Medicaid	$209.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,230.33
Rate for Payer: Priority Health Medicare	$391.45
Rate for Payer: Priority Health Narrow Network	$984.26
Rate for Payer: Railroad Medicare Medicare	$391.45
Rate for Payer: UHC All Payor (Choice/PPO)	$102.95
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$391.45
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$391.45
Rate for Payer: UHCCP Medicaid	$220.39
Rate for Payer: VA VA	$391.45

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM

Facility

$1,230.33

Service Code	CPT 12006
Hospital Revenue Code	360
Min. Negotiated Rate	$125.63
Max. Negotiated Rate	$1,230.33
Rate for Payer: Aetna Medicare	$407.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$489.31
Rate for Payer: Amish Plain Church Group Commercial	$489.31
Rate for Payer: BCBS Complete	$220.31
Rate for Payer: BCBS MAPPO	$391.45
Rate for Payer: BCBS Trust/PPO	$141.35
Rate for Payer: BCN Commercial	$141.35
Rate for Payer: BCN Medicare Advantage	$391.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$391.45
Rate for Payer: Mclaren Medicaid	$209.82
Rate for Payer: Mclaren Medicare	$391.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$411.02
Rate for Payer: Meridian Medicaid	$220.31
Rate for Payer: MI Amish Medical Board Commercial	$450.17
Rate for Payer: Nomi Health Commercial	$1,174.35
Rate for Payer: PACE Medicare	$371.88
Rate for Payer: PACE SWMI	$391.45
Rate for Payer: PHP Medicare Advantage	$391.45
Rate for Payer: Priority Health Choice Medicaid	$209.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,230.33
Rate for Payer: Priority Health Medicare	$391.45
Rate for Payer: Priority Health Narrow Network	$984.26
Rate for Payer: Railroad Medicare Medicare	$391.45
Rate for Payer: UHC All Payor (Choice/PPO)	$125.63
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$391.45
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$391.45
Rate for Payer: UHCCP Medicaid	$220.39
Rate for Payer: VA VA	$391.45

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS

Facility

$940.00

Service Code	CPT 12001
Hospital Revenue Code	361
Min. Negotiated Rate	$48.17
Max. Negotiated Rate	$940.00
Rate for Payer: Aetna Medicare	$202.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$243.35
Rate for Payer: Amish Plain Church Group Commercial	$243.35
Rate for Payer: BCBS Complete	$109.57
Rate for Payer: BCBS MAPPO	$194.68
Rate for Payer: BCBS Trust/PPO	$80.22
Rate for Payer: BCN Commercial	$80.22
Rate for Payer: BCN Medicare Advantage	$194.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$194.68
Rate for Payer: Mclaren Medicaid	$104.35
Rate for Payer: Mclaren Medicare	$194.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$204.41
Rate for Payer: Meridian Medicaid	$109.57
Rate for Payer: MI Amish Medical Board Commercial	$223.88
Rate for Payer: Nomi Health Commercial	$584.04
Rate for Payer: PACE Medicare	$184.95
Rate for Payer: PACE SWMI	$194.68
Rate for Payer: PHP Medicare Advantage	$194.68
Rate for Payer: Priority Health Choice Medicaid	$104.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$611.90
Rate for Payer: Priority Health Medicare	$194.68
Rate for Payer: Priority Health Narrow Network	$489.52
Rate for Payer: Railroad Medicare Medicare	$194.68
Rate for Payer: UHC All Payor (Choice/PPO)	$48.17
Rate for Payer: UHC Core	$878.00
Rate for Payer: UHC Dual Complete DSNP	$194.68
Rate for Payer: UHC Exchange	$940.00
Rate for Payer: UHC Medicare Advantage	$194.68
Rate for Payer: UHCCP Medicaid	$109.60
Rate for Payer: VA VA	$194.68

Know your out-of-pocket cost for care.

All Charges