Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXCISION LESION TONGUE W/O CLOSURE

Professional

Both

$374.00

Service Code	HCPCS 41110
Min. Negotiated Rate	$83.71
Max. Negotiated Rate	$569.51
Rate for Payer: Aetna Commercial	$170.28
Rate for Payer: BCBS Complete	$87.90
Rate for Payer: BCBS Trust/PPO	$569.51
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Mclaren Medicaid	$83.71
Rate for Payer: Meridian Medicaid	$87.90
Rate for Payer: Priority Health Choice Medicaid	$83.71
Rate for Payer: Priority Health Cigna Priority Health	$261.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$229.90
Rate for Payer: Priority Health Narrow Network	$229.90
Rate for Payer: Priority Health SBD	$229.90

PR EXCISION LINGUAL FRENUM FRENECTOMY

Professional

Both

$438.00

Service Code	HCPCS 41115
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$967.85
Rate for Payer: Aetna Commercial	$191.54
Rate for Payer: BCBS Complete	$98.86
Rate for Payer: BCBS Trust/PPO	$967.85
Rate for Payer: Cash Price	$350.40
Rate for Payer: Cash Price	$350.40
Rate for Payer: Mclaren Medicaid	$94.15
Rate for Payer: Meridian Medicaid	$98.86
Rate for Payer: Priority Health Choice Medicaid	$94.15
Rate for Payer: Priority Health Cigna Priority Health	$306.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$258.70
Rate for Payer: Priority Health Narrow Network	$258.70
Rate for Payer: Priority Health SBD	$258.70

PR EXCISION LOCAL LESION EPIDIDYMIS

Professional

Both

$605.00

Service Code	HCPCS 54830
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$1,910.86
Rate for Payer: Aetna Commercial	$476.03
Rate for Payer: BCBS Complete	$251.16
Rate for Payer: BCBS Trust/PPO	$1,910.86
Rate for Payer: Cash Price	$484.00
Rate for Payer: Cash Price	$484.00
Rate for Payer: Mclaren Medicaid	$239.20
Rate for Payer: Meridian Medicaid	$251.16
Rate for Payer: Priority Health Choice Medicaid	$239.20
Rate for Payer: Priority Health Cigna Priority Health	$423.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$597.09
Rate for Payer: Priority Health Narrow Network	$597.09
Rate for Payer: Priority Health SBD	$597.09

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<

Professional

Both

$326.00

Service Code	HCPCS 11640
Hospital Charge Code	11640
Min. Negotiated Rate	$81.15
Max. Negotiated Rate	$977.96
Rate for Payer: Aetna Commercial	$134.58
Rate for Payer: BCBS Complete	$85.21
Rate for Payer: BCBS Trust/PPO	$977.96
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Mclaren Medicaid	$81.15
Rate for Payer: Meridian Medicaid	$85.21
Rate for Payer: Priority Health Choice Medicaid	$81.15
Rate for Payer: Priority Health Cigna Priority Health	$228.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.56
Rate for Payer: Priority Health Narrow Network	$154.56
Rate for Payer: Priority Health SBD	$154.56

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<

Facility

$326.00

Service Code	CPT 11640
Hospital Charge Code	11640
Hospital Revenue Code	521
Min. Negotiated Rate	$205.38
Max. Negotiated Rate	$293.40
Rate for Payer: Aetna Commercial	$277.10
Rate for Payer: Aetna New Business (MI Preferred)	$211.90
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cofinity Commercial	$228.20
Rate for Payer: Cofinity Commercial	$280.36
Rate for Payer: Healthscope Commercial	$293.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$277.10
Rate for Payer: PHP Commercial	$277.10
Rate for Payer: Priority Health Cigna Priority Health	$228.20
Rate for Payer: Priority Health SBD	$205.38

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<

Professional

Both

$326.00

Service Code	HCPCS 11640
Min. Negotiated Rate	$81.15
Max. Negotiated Rate	$977.96
Rate for Payer: Aetna Commercial	$134.58
Rate for Payer: BCBS Complete	$85.21
Rate for Payer: BCBS Trust/PPO	$977.96
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Mclaren Medicaid	$81.15
Rate for Payer: Meridian Medicaid	$85.21
Rate for Payer: Priority Health Choice Medicaid	$81.15
Rate for Payer: Priority Health Cigna Priority Health	$228.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$154.56
Rate for Payer: Priority Health Narrow Network	$154.56
Rate for Payer: Priority Health SBD	$154.56

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<

Facility

$326.00

Service Code	CPT 11640
Hospital Charge Code	11640
Hospital Revenue Code	521
Min. Negotiated Rate	$99.78
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$277.10
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$211.90
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	$99.78
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cofinity Commercial	$228.20
Rate for Payer: Cofinity Commercial	$280.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$293.40
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	$277.10
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$277.10
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	$228.20
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	$205.38
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$137.24
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$124.76
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM

Facility

$386.00

Service Code	CPT 11641
Hospital Charge Code	11641
Hospital Revenue Code	521
Min. Negotiated Rate	$112.74
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$328.10
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$250.90
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	$112.74
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cofinity Commercial	$270.20
Rate for Payer: Cofinity Commercial	$331.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$347.40
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	$328.10
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$328.10
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	$270.20
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	$243.18
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$167.85
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$152.59
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM

Professional

Both

$386.00

Service Code	HCPCS 11641
Hospital Charge Code	11641
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$1,307.96
Rate for Payer: Aetna Commercial	$165.44
Rate for Payer: BCBS Complete	$104.22
Rate for Payer: BCBS Trust/PPO	$1,307.96
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Mclaren Medicaid	$99.26
Rate for Payer: Meridian Medicaid	$104.22
Rate for Payer: Priority Health Choice Medicaid	$99.26
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.90
Rate for Payer: Priority Health Narrow Network	$189.90
Rate for Payer: Priority Health SBD	$189.90

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM

Professional

Both

$386.00

Service Code	HCPCS 11641
Min. Negotiated Rate	$99.26
Max. Negotiated Rate	$1,307.96
Rate for Payer: Aetna Commercial	$165.44
Rate for Payer: BCBS Complete	$104.22
Rate for Payer: BCBS Trust/PPO	$1,307.96
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Mclaren Medicaid	$99.26
Rate for Payer: Meridian Medicaid	$104.22
Rate for Payer: Priority Health Choice Medicaid	$99.26
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.90
Rate for Payer: Priority Health Narrow Network	$189.90
Rate for Payer: Priority Health SBD	$189.90

PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM

Facility

$386.00

Service Code	CPT 11641
Hospital Charge Code	11641
Hospital Revenue Code	521
Min. Negotiated Rate	$243.18
Max. Negotiated Rate	$347.40
Rate for Payer: Aetna Commercial	$328.10
Rate for Payer: Aetna New Business (MI Preferred)	$250.90
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cofinity Commercial	$270.20
Rate for Payer: Cofinity Commercial	$331.96
Rate for Payer: Healthscope Commercial	$347.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$328.10
Rate for Payer: PHP Commercial	$328.10
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health SBD	$243.18

PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM

Facility

$584.00

Service Code	CPT 11642
Hospital Charge Code	11642
Hospital Revenue Code	521
Min. Negotiated Rate	$367.92
Max. Negotiated Rate	$525.60
Rate for Payer: Aetna Commercial	$496.40
Rate for Payer: Aetna New Business (MI Preferred)	$379.60
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cofinity Commercial	$408.80
Rate for Payer: Cofinity Commercial	$502.24
Rate for Payer: Healthscope Commercial	$525.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$496.40
Rate for Payer: PHP Commercial	$496.40
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health SBD	$367.92

PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM

Professional

Both

$584.00

Service Code	HCPCS 11642
Hospital Charge Code	11642
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$194.03
Rate for Payer: BCBS Complete	$121.89
Rate for Payer: BCBS Trust/PPO	$712.50
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Mclaren Medicaid	$116.09
Rate for Payer: Meridian Medicaid	$121.89
Rate for Payer: Priority Health Choice Medicaid	$116.09
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.55
Rate for Payer: Priority Health Narrow Network	$221.55
Rate for Payer: Priority Health SBD	$221.55

PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM

Facility

$584.00

Service Code	CPT 11642
Hospital Charge Code	11642
Hospital Revenue Code	521
Min. Negotiated Rate	$178.46
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$496.40
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$379.60
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	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cofinity Commercial	$502.24
Rate for Payer: Cofinity Commercial	$408.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$525.60
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	$496.40
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$496.40
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	$408.80
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	$367.92
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$196.31
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$178.46
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM

Professional

Both

$584.00

Service Code	HCPCS 11642
Min. Negotiated Rate	$116.09
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$194.03
Rate for Payer: BCBS Complete	$121.89
Rate for Payer: BCBS Trust/PPO	$712.50
Rate for Payer: Cash Price	$467.20
Rate for Payer: Cash Price	$467.20
Rate for Payer: Mclaren Medicaid	$116.09
Rate for Payer: Meridian Medicaid	$121.89
Rate for Payer: Priority Health Choice Medicaid	$116.09
Rate for Payer: Priority Health Cigna Priority Health	$408.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.55
Rate for Payer: Priority Health Narrow Network	$221.55
Rate for Payer: Priority Health SBD	$221.55

PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM

Facility

$730.00

Service Code	CPT 11643
Hospital Charge Code	11643
Hospital Revenue Code	521
Min. Negotiated Rate	$222.33
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$620.50
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$474.50
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	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cofinity Commercial	$627.80
Rate for Payer: Cofinity Commercial	$511.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$657.00
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	$620.50
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$620.50
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	$511.00
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	$459.90
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 EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM

Professional

Both

$730.00

Service Code	HCPCS 11643
Hospital Charge Code	11643
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$511.00
Rate for Payer: Aetna Commercial	$243.96
Rate for Payer: BCBS Complete	$151.86
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
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	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$277.04
Rate for Payer: Priority Health Narrow Network	$277.04
Rate for Payer: Priority Health SBD	$277.04

PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM

Facility

$730.00

Service Code	CPT 11643
Hospital Charge Code	11643
Hospital Revenue Code	521
Min. Negotiated Rate	$459.90
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna Commercial	$620.50
Rate for Payer: Aetna New Business (MI Preferred)	$474.50
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cofinity Commercial	$511.00
Rate for Payer: Cofinity Commercial	$627.80
Rate for Payer: Healthscope Commercial	$657.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$620.50
Rate for Payer: PHP Commercial	$620.50
Rate for Payer: Priority Health Cigna Priority Health	$511.00
Rate for Payer: Priority Health SBD	$459.90

PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM

Professional

Both

$730.00

Service Code	HCPCS 11643
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$511.00
Rate for Payer: Aetna Commercial	$243.96
Rate for Payer: BCBS Complete	$151.86
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
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	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$277.04
Rate for Payer: Priority Health Narrow Network	$277.04
Rate for Payer: Priority Health SBD	$277.04

PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM

Professional

Both

$904.00

Service Code	HCPCS 11644
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$655.87
Rate for Payer: Aetna Commercial	$303.84
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCBS Trust/PPO	$655.87
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cash Price	$723.20
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health	$632.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.63
Rate for Payer: Priority Health Narrow Network	$343.63
Rate for Payer: Priority Health SBD	$343.63

PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM

Facility

$904.00

Service Code	CPT 11644
Hospital Charge Code	11644
Hospital Revenue Code	521
Min. Negotiated Rate	$275.38
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$768.40
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$587.60
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	$596.92
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cofinity Commercial	$777.44
Rate for Payer: Cofinity Commercial	$632.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$813.60
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	$768.40
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$768.40
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	$632.80
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	$569.52
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$302.92
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$275.38
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM

Professional

Both

$904.00

Service Code	HCPCS 11644
Hospital Charge Code	11644
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$655.87
Rate for Payer: Aetna Commercial	$303.84
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCBS Trust/PPO	$655.87
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cash Price	$723.20
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health	$632.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$343.63
Rate for Payer: Priority Health Narrow Network	$343.63
Rate for Payer: Priority Health SBD	$343.63

PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM

Facility

$904.00

Service Code	CPT 11644
Hospital Charge Code	11644
Hospital Revenue Code	521
Min. Negotiated Rate	$569.52
Max. Negotiated Rate	$813.60
Rate for Payer: Aetna Commercial	$768.40
Rate for Payer: Aetna New Business (MI Preferred)	$587.60
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cofinity Commercial	$632.80
Rate for Payer: Cofinity Commercial	$777.44
Rate for Payer: Healthscope Commercial	$813.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$768.40
Rate for Payer: PHP Commercial	$768.40
Rate for Payer: Priority Health Cigna Priority Health	$632.80
Rate for Payer: Priority Health SBD	$569.52

PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM

Professional

Both

$904.00

Service Code	HCPCS 11646
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$632.80
Rate for Payer: Aetna Commercial	$422.43
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cash Price	$723.20
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health	$632.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$475.57
Rate for Payer: Priority Health Narrow Network	$475.57
Rate for Payer: Priority Health SBD	$475.57

PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM

Professional

Both

$904.00

Service Code	HCPCS 11646
Hospital Charge Code	11646
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$632.80
Rate for Payer: Aetna Commercial	$422.43
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$723.20
Rate for Payer: Cash Price	$723.20
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health	$632.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$475.57
Rate for Payer: Priority Health Narrow Network	$475.57
Rate for Payer: Priority Health SBD	$475.57

Know your out-of-pocket cost for care.

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