Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM

Facility

$644.00

Service Code	CPT 11406
Hospital Charge Code	11406
Hospital Revenue Code	521
Min. Negotiated Rate	$405.72
Max. Negotiated Rate	$579.60
Rate for Payer: Aetna Commercial	$547.40
Rate for Payer: Aetna New Business (MI Preferred)	$418.60
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cofinity Commercial	$553.84
Rate for Payer: Cofinity Commercial	$450.80
Rate for Payer: Healthscope Commercial	$579.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$547.40
Rate for Payer: PHP Commercial	$547.40
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health SBD	$405.72

PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM

Professional

Both

$644.00

Service Code	HCPCS 11406
Hospital Charge Code	11406
Min. Negotiated Rate	$159.54
Max. Negotiated Rate	$450.80
Rate for Payer: Aetna Commercial	$266.88
Rate for Payer: BCBS Complete	$167.52
Rate for Payer: BCBS Trust/PPO	$201.42
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Mclaren Medicaid	$159.54
Rate for Payer: Meridian Medicaid	$167.52
Rate for Payer: Priority Health Choice Medicaid	$159.54
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$303.76
Rate for Payer: Priority Health Narrow Network	$303.76
Rate for Payer: Priority Health SBD	$303.76

PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM

Facility

$644.00

Service Code	CPT 11406
Hospital Charge Code	11406
Hospital Revenue Code	521
Min. Negotiated Rate	$245.25
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$547.40
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$418.60
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	$1,394.94
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cofinity Commercial	$553.84
Rate for Payer: Cofinity Commercial	$450.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$579.60
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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$547.40
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$547.40
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$405.72
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$269.78
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$245.25
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM

Professional

Both

$644.00

Service Code	HCPCS 11406
Min. Negotiated Rate	$159.54
Max. Negotiated Rate	$450.80
Rate for Payer: Aetna Commercial	$266.88
Rate for Payer: BCBS Complete	$167.52
Rate for Payer: BCBS Trust/PPO	$201.42
Rate for Payer: Cash Price	$515.20
Rate for Payer: Cash Price	$515.20
Rate for Payer: Mclaren Medicaid	$159.54
Rate for Payer: Meridian Medicaid	$167.52
Rate for Payer: Priority Health Choice Medicaid	$159.54
Rate for Payer: Priority Health Cigna Priority Health	$450.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$303.76
Rate for Payer: Priority Health Narrow Network	$303.76
Rate for Payer: Priority Health SBD	$303.76

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM

Professional

Both

$273.00

Service Code	HCPCS 11441
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$191.10
Rate for Payer: Aetna Commercial	$139.29
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCBS Trust/PPO	$185.19
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$163.18
Rate for Payer: Priority Health Narrow Network	$163.18
Rate for Payer: Priority Health SBD	$163.18

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM

Facility

$273.00

Service Code	CPT 11441
Hospital Charge Code	11441
Hospital Revenue Code	521
Min. Negotiated Rate	$131.96
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$232.05
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$177.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$405.67
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cofinity Commercial	$234.78
Rate for Payer: Cofinity Commercial	$191.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$245.70
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.05
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$232.05
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,937.58
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,550.06
Rate for Payer: Priority Health SBD	$171.99
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$145.16
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$131.96
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM

Professional

Both

$273.00

Service Code	HCPCS 11441
Hospital Charge Code	11441
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$191.10
Rate for Payer: Aetna Commercial	$139.29
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCBS Trust/PPO	$185.19
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cash Price	$218.40
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$163.18
Rate for Payer: Priority Health Narrow Network	$163.18
Rate for Payer: Priority Health SBD	$163.18

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM

Facility

$273.00

Service Code	CPT 11441
Hospital Charge Code	11441
Hospital Revenue Code	521
Min. Negotiated Rate	$171.99
Max. Negotiated Rate	$245.70
Rate for Payer: Aetna Commercial	$232.05
Rate for Payer: Aetna New Business (MI Preferred)	$177.45
Rate for Payer: Cash Price	$218.40
Rate for Payer: Cofinity Commercial	$191.10
Rate for Payer: Cofinity Commercial	$234.78
Rate for Payer: Healthscope Commercial	$245.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$232.05
Rate for Payer: PHP Commercial	$232.05
Rate for Payer: Priority Health Cigna Priority Health	$191.10
Rate for Payer: Priority Health SBD	$171.99

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM

Facility

$346.00

Service Code	CPT 11442
Hospital Charge Code	11442
Hospital Revenue Code	521
Min. Negotiated Rate	$217.98
Max. Negotiated Rate	$311.40
Rate for Payer: Aetna Commercial	$294.10
Rate for Payer: Aetna New Business (MI Preferred)	$224.90
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cofinity Commercial	$242.20
Rate for Payer: Cofinity Commercial	$297.56
Rate for Payer: Healthscope Commercial	$311.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$294.10
Rate for Payer: PHP Commercial	$294.10
Rate for Payer: Priority Health Cigna Priority Health	$242.20
Rate for Payer: Priority Health SBD	$217.98

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM

Professional

Both

$346.00

Service Code	HCPCS 11442
Hospital Charge Code	11442
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$242.20
Rate for Payer: Aetna Commercial	$154.20
Rate for Payer: BCBS Complete	$99.30
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cash Price	$276.80
Rate for Payer: Mclaren Medicaid	$94.57
Rate for Payer: Meridian Medicaid	$99.30
Rate for Payer: Priority Health Choice Medicaid	$94.57
Rate for Payer: Priority Health Cigna Priority Health	$242.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.04
Rate for Payer: Priority Health Narrow Network	$180.04
Rate for Payer: Priority Health SBD	$180.04

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM

Professional

Both

$346.00

Service Code	HCPCS 11442
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$242.20
Rate for Payer: Aetna Commercial	$154.20
Rate for Payer: BCBS Complete	$99.30
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cash Price	$276.80
Rate for Payer: Mclaren Medicaid	$94.57
Rate for Payer: Meridian Medicaid	$99.30
Rate for Payer: Priority Health Choice Medicaid	$94.57
Rate for Payer: Priority Health Cigna Priority Health	$242.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.04
Rate for Payer: Priority Health Narrow Network	$180.04
Rate for Payer: Priority Health SBD	$180.04

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM

Facility

$346.00

Service Code	CPT 11442
Hospital Charge Code	11442
Hospital Revenue Code	521
Min. Negotiated Rate	$145.38
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$294.10
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$224.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$405.67
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cofinity Commercial	$297.56
Rate for Payer: Cofinity Commercial	$242.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$311.40
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$294.10
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$294.10
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$242.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,937.58
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,550.06
Rate for Payer: Priority Health SBD	$217.98
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$159.92
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$145.38
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM

Professional

Both

$440.00

Service Code	HCPCS 11443
Min. Negotiated Rate	$115.02
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$189.95
Rate for Payer: BCBS Complete	$120.77
Rate for Payer: BCBS Trust/PPO	$125.51
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Mclaren Medicaid	$115.02
Rate for Payer: Meridian Medicaid	$120.77
Rate for Payer: Priority Health Choice Medicaid	$115.02
Rate for Payer: Priority Health Cigna Priority Health	$308.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.09
Rate for Payer: Priority Health Narrow Network	$219.09
Rate for Payer: Priority Health SBD	$219.09

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM

Professional

Both

$440.00

Service Code	HCPCS 11443
Hospital Charge Code	11443
Min. Negotiated Rate	$115.02
Max. Negotiated Rate	$308.00
Rate for Payer: Aetna Commercial	$189.95
Rate for Payer: BCBS Complete	$120.77
Rate for Payer: BCBS Trust/PPO	$125.51
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Mclaren Medicaid	$115.02
Rate for Payer: Meridian Medicaid	$120.77
Rate for Payer: Priority Health Choice Medicaid	$115.02
Rate for Payer: Priority Health Cigna Priority Health	$308.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$219.09
Rate for Payer: Priority Health Narrow Network	$219.09
Rate for Payer: Priority Health SBD	$219.09

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM

Facility

$440.00

Service Code	CPT 11443
Hospital Charge Code	11443
Hospital Revenue Code	521
Min. Negotiated Rate	$176.82
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$374.00
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$286.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$937.37
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cofinity Commercial	$378.40
Rate for Payer: Cofinity Commercial	$308.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$396.00
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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$374.00
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$374.00
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$308.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$277.20
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$194.50
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$176.82
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM

Facility

$440.00

Service Code	CPT 11443
Hospital Charge Code	11443
Hospital Revenue Code	521
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna Commercial	$374.00
Rate for Payer: Aetna New Business (MI Preferred)	$286.00
Rate for Payer: Cash Price	$352.00
Rate for Payer: Cofinity Commercial	$308.00
Rate for Payer: Cofinity Commercial	$378.40
Rate for Payer: Healthscope Commercial	$396.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$374.00
Rate for Payer: PHP Commercial	$374.00
Rate for Payer: Priority Health Cigna Priority Health	$308.00
Rate for Payer: Priority Health SBD	$277.20

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM

Facility

$566.00

Service Code	CPT 11444
Hospital Charge Code	11444
Hospital Revenue Code	521
Min. Negotiated Rate	$356.58
Max. Negotiated Rate	$509.40
Rate for Payer: Aetna Commercial	$481.10
Rate for Payer: Aetna New Business (MI Preferred)	$367.90
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cofinity Commercial	$396.20
Rate for Payer: Cofinity Commercial	$486.76
Rate for Payer: Healthscope Commercial	$509.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$481.10
Rate for Payer: PHP Commercial	$481.10
Rate for Payer: Priority Health Cigna Priority Health	$396.20
Rate for Payer: Priority Health SBD	$356.58

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM

Facility

$566.00

Service Code	CPT 11444
Hospital Charge Code	11444
Hospital Revenue Code	521
Min. Negotiated Rate	$222.33
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$481.10
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$367.90
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	$527.99
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cofinity Commercial	$396.20
Rate for Payer: Cofinity Commercial	$486.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$509.40
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: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$481.10
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$481.10
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$396.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$356.58
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$244.56
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$222.33
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM

Professional

Both

$566.00

Service Code	HCPCS 11444
Hospital Charge Code	11444
Min. Negotiated Rate	$144.63
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$242.15
Rate for Payer: BCBS Complete	$151.86
Rate for Payer: BCBS Trust/PPO	$540.00
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cash Price	$452.80
Rate for Payer: Mclaren Medicaid	$144.63
Rate for Payer: Meridian Medicaid	$151.86
Rate for Payer: Priority Health Choice Medicaid	$144.63
Rate for Payer: Priority Health Cigna Priority Health	$396.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.22
Rate for Payer: Priority Health Narrow Network	$276.22
Rate for Payer: Priority Health SBD	$276.22

PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM

Professional

Both

$566.00

Service Code	HCPCS 11444
Min. Negotiated Rate	$144.63
Max. Negotiated Rate	$540.00
Rate for Payer: Aetna Commercial	$242.15
Rate for Payer: BCBS Complete	$151.86
Rate for Payer: BCBS Trust/PPO	$540.00
Rate for Payer: Cash Price	$452.80
Rate for Payer: Cash Price	$452.80
Rate for Payer: Mclaren Medicaid	$144.63
Rate for Payer: Meridian Medicaid	$151.86
Rate for Payer: Priority Health Choice Medicaid	$144.63
Rate for Payer: Priority Health Cigna Priority Health	$396.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$276.22
Rate for Payer: Priority Health Narrow Network	$276.22
Rate for Payer: Priority Health SBD	$276.22

PR EXC BARTHOLINS GLAND/CYST

Professional

Both

$911.00

Service Code	HCPCS 56740
Min. Negotiated Rate	$202.78
Max. Negotiated Rate	$1,879.16
Rate for Payer: Aetna Commercial	$372.87
Rate for Payer: BCBS Complete	$212.92
Rate for Payer: BCBS Trust/PPO	$1,879.16
Rate for Payer: Cash Price	$728.80
Rate for Payer: Cash Price	$728.80
Rate for Payer: Mclaren Medicaid	$202.78
Rate for Payer: Meridian Medicaid	$212.92
Rate for Payer: Priority Health Choice Medicaid	$202.78
Rate for Payer: Priority Health Cigna Priority Health	$637.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$448.81
Rate for Payer: Priority Health Narrow Network	$448.81
Rate for Payer: Priority Health SBD	$448.81

PR EXC BENIGN TUM CRANIAL BONE W/O OPTIC NRV DCMPRN

Professional

Both

$7,827.00

Service Code	HCPCS 61563
Min. Negotiated Rate	$382.49
Max. Negotiated Rate	$5,478.90
Rate for Payer: Aetna Commercial	$2,563.18
Rate for Payer: BCBS Complete	$1,350.63
Rate for Payer: BCBS Trust/PPO	$382.49
Rate for Payer: Cash Price	$6,261.60
Rate for Payer: Cash Price	$6,261.60
Rate for Payer: Mclaren Medicaid	$1,286.31
Rate for Payer: Meridian Medicaid	$1,350.63
Rate for Payer: Priority Health Choice Medicaid	$1,286.31
Rate for Payer: Priority Health Cigna Priority Health	$5,478.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,388.85
Rate for Payer: Priority Health Narrow Network	$3,388.85
Rate for Payer: Priority Health SBD	$3,388.85

PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT

Professional

Both

$2,266.00

Service Code	HCPCS 21048
Min. Negotiated Rate	$635.38
Max. Negotiated Rate	$3,701.02
Rate for Payer: Aetna Commercial	$1,361.18
Rate for Payer: BCBS Complete	$667.15
Rate for Payer: BCBS Trust/PPO	$3,701.02
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Mclaren Medicaid	$635.38
Rate for Payer: Meridian Medicaid	$667.15
Rate for Payer: Priority Health Choice Medicaid	$635.38
Rate for Payer: Priority Health Cigna Priority Health	$1,586.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,517.66
Rate for Payer: Priority Health Narrow Network	$1,517.66
Rate for Payer: Priority Health SBD	$1,517.66

PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG

Professional

Both

$1,004.00

Service Code	HCPCS 21030
Min. Negotiated Rate	$230.89
Max. Negotiated Rate	$998.90
Rate for Payer: Aetna Commercial	$488.49
Rate for Payer: BCBS Complete	$242.43
Rate for Payer: BCBS Trust/PPO	$998.90
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Mclaren Medicaid	$230.89
Rate for Payer: Meridian Medicaid	$242.43
Rate for Payer: Priority Health Choice Medicaid	$230.89
Rate for Payer: Priority Health Cigna Priority Health	$702.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$549.98
Rate for Payer: Priority Health Narrow Network	$549.98
Rate for Payer: Priority Health SBD	$549.98

PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX

Professional

Both

$1,623.00

Service Code	HCPCS 42815
Min. Negotiated Rate	$278.41
Max. Negotiated Rate	$1,136.10
Rate for Payer: Aetna Commercial	$718.44
Rate for Payer: BCBS Complete	$364.33
Rate for Payer: BCBS Trust/PPO	$278.41
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Mclaren Medicaid	$346.98
Rate for Payer: Meridian Medicaid	$364.33
Rate for Payer: Priority Health Choice Medicaid	$346.98
Rate for Payer: Priority Health Cigna Priority Health	$1,136.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$958.39
Rate for Payer: Priority Health Narrow Network	$958.39
Rate for Payer: Priority Health SBD	$958.39

Know your out-of-pocket cost for care.

All Charges