Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<

Professional

Both

$312.00

Service Code	HCPCS 11600
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$1,866.00
Rate for Payer: Aetna Commercial	$130.60
Rate for Payer: BCBS Complete	$82.30
Rate for Payer: BCBS Trust/PPO	$1,866.00
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Mclaren Medicaid	$78.38
Rate for Payer: Meridian Medicaid	$82.30
Rate for Payer: Priority Health Choice Medicaid	$78.38
Rate for Payer: Priority Health Cigna Priority Health	$218.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.62
Rate for Payer: Priority Health Narrow Network	$149.62
Rate for Payer: Priority Health SBD	$149.62

PR EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM

Professional

Both

$370.00

Service Code	HCPCS 11601
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$259.00
Rate for Payer: Aetna Commercial	$158.43
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Mclaren Medicaid	$94.79
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$259.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.27
Rate for Payer: Priority Health Narrow Network	$181.27
Rate for Payer: Priority Health SBD	$181.27

PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM

Professional

Both

$402.00

Service Code	HCPCS 11602
Hospital Charge Code	11602
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$281.40
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: BCBS Complete	$108.02
Rate for Payer: BCBS Trust/PPO	$46.61
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Mclaren Medicaid	$102.88
Rate for Payer: Meridian Medicaid	$108.02
Rate for Payer: Priority Health Choice Medicaid	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$281.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$196.89
Rate for Payer: Priority Health Narrow Network	$196.89
Rate for Payer: Priority Health SBD	$196.89

PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM

Facility

$402.00

Service Code	CPT 11602
Hospital Charge Code	11602
Hospital Revenue Code	521
Min. Negotiated Rate	$158.15
Max. Negotiated Rate	$1,076.20
Rate for Payer: Aetna Commercial	$341.70
Rate for Payer: Aetna Medicare	$368.99
Rate for Payer: Aetna New Business (MI Preferred)	$261.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.50
Rate for Payer: Amish Plain Church Group Commercial	$443.50
Rate for Payer: BCBS Complete	$203.80
Rate for Payer: BCBS MAPPO	$354.80
Rate for Payer: BCBS Trust/PPO	$315.91
Rate for Payer: BCN Medicare Advantage	$354.80
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cofinity Commercial	$281.40
Rate for Payer: Cofinity Commercial	$345.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.80
Rate for Payer: Healthscope Commercial	$361.80
Rate for Payer: Mclaren Medicaid	$194.08
Rate for Payer: Mclaren Medicare	$354.80
Rate for Payer: Meridian Medicaid	$203.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.54
Rate for Payer: MI Amish Medical Board Commercial	$408.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$341.70
Rate for Payer: PACE Medicare	$337.06
Rate for Payer: PACE SWMI	$354.80
Rate for Payer: PHP Commercial	$341.70
Rate for Payer: PHP Medicare Advantage	$354.80
Rate for Payer: Priority Health Choice Medicaid	$194.08
Rate for Payer: Priority Health Cigna Priority Health	$281.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,076.20
Rate for Payer: Priority Health Medicare	$354.80
Rate for Payer: Priority Health Narrow Network	$860.96
Rate for Payer: Priority Health SBD	$253.26
Rate for Payer: Railroad Medicare Medicare	$354.80
Rate for Payer: UHC All Payor (Choice/PPO)	$173.96
Rate for Payer: UHC Dual Complete DSNP	$354.80
Rate for Payer: UHC Exchange	$158.15
Rate for Payer: UHC Medicare Advantage	$365.44
Rate for Payer: VA VA	$354.80

PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM

Facility

$402.00

Service Code	CPT 11602
Hospital Charge Code	11602
Hospital Revenue Code	521
Min. Negotiated Rate	$253.26
Max. Negotiated Rate	$361.80
Rate for Payer: Aetna Commercial	$341.70
Rate for Payer: Aetna New Business (MI Preferred)	$261.30
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cofinity Commercial	$281.40
Rate for Payer: Cofinity Commercial	$345.72
Rate for Payer: Healthscope Commercial	$361.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$341.70
Rate for Payer: PHP Commercial	$341.70
Rate for Payer: Priority Health Cigna Priority Health	$281.40
Rate for Payer: Priority Health SBD	$253.26

PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM

Professional

Both

$402.00

Service Code	HCPCS 11602
Min. Negotiated Rate	$46.61
Max. Negotiated Rate	$281.40
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: BCBS Complete	$108.02
Rate for Payer: BCBS Trust/PPO	$46.61
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Mclaren Medicaid	$102.88
Rate for Payer: Meridian Medicaid	$108.02
Rate for Payer: Priority Health Choice Medicaid	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$281.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$196.89
Rate for Payer: Priority Health Narrow Network	$196.89
Rate for Payer: Priority Health SBD	$196.89

PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM

Professional

Both

$458.00

Service Code	HCPCS 11603
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$320.60
Rate for Payer: Aetna Commercial	$205.93
Rate for Payer: BCBS Complete	$129.04
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cash Price	$366.40
Rate for Payer: Mclaren Medicaid	$122.90
Rate for Payer: Meridian Medicaid	$129.04
Rate for Payer: Priority Health Choice Medicaid	$122.90
Rate for Payer: Priority Health Cigna Priority Health	$320.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.93
Rate for Payer: Priority Health Narrow Network	$235.93
Rate for Payer: Priority Health SBD	$235.93

PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM

Facility

$458.00

Service Code	CPT 11603
Hospital Charge Code	11603
Hospital Revenue Code	521
Min. Negotiated Rate	$188.93
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$389.30
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$297.70
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	$366.40
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cofinity Commercial	$393.88
Rate for Payer: Cofinity Commercial	$320.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$412.20
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	$389.30
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$389.30
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	$320.60
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	$288.54
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$207.82
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$188.93
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM

Facility

$458.00

Service Code	CPT 11603
Hospital Charge Code	11603
Hospital Revenue Code	521
Min. Negotiated Rate	$288.54
Max. Negotiated Rate	$412.20
Rate for Payer: Aetna Commercial	$389.30
Rate for Payer: Aetna New Business (MI Preferred)	$297.70
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cofinity Commercial	$320.60
Rate for Payer: Cofinity Commercial	$393.88
Rate for Payer: Healthscope Commercial	$412.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$389.30
Rate for Payer: PHP Commercial	$389.30
Rate for Payer: Priority Health Cigna Priority Health	$320.60
Rate for Payer: Priority Health SBD	$288.54

PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM

Professional

Both

$458.00

Service Code	HCPCS 11603
Hospital Charge Code	11603
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$320.60
Rate for Payer: Aetna Commercial	$205.93
Rate for Payer: BCBS Complete	$129.04
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cash Price	$366.40
Rate for Payer: Mclaren Medicaid	$122.90
Rate for Payer: Meridian Medicaid	$129.04
Rate for Payer: Priority Health Choice Medicaid	$122.90
Rate for Payer: Priority Health Cigna Priority Health	$320.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$235.93
Rate for Payer: Priority Health Narrow Network	$235.93
Rate for Payer: Priority Health SBD	$235.93

PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM

Professional

Both

$511.00

Service Code	HCPCS 11604
Hospital Charge Code	11604
Min. Negotiated Rate	$135.26
Max. Negotiated Rate	$5,686.65
Rate for Payer: Aetna Commercial	$228.37
Rate for Payer: BCBS Complete	$142.02
Rate for Payer: BCBS Trust/PPO	$5,686.65
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Mclaren Medicaid	$135.26
Rate for Payer: Meridian Medicaid	$142.02
Rate for Payer: Priority Health Choice Medicaid	$135.26
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$259.78
Rate for Payer: Priority Health Narrow Network	$259.78
Rate for Payer: Priority Health SBD	$259.78

PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM

Facility

$511.00

Service Code	CPT 11604
Hospital Charge Code	11604
Hospital Revenue Code	521
Min. Negotiated Rate	$207.93
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$434.35
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$332.15
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	$642.39
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cofinity Commercial	$439.46
Rate for Payer: Cofinity Commercial	$357.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$459.90
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	$434.35
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$434.35
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	$357.70
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	$321.93
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$228.72
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$207.93
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM

Professional

Both

$511.00

Service Code	HCPCS 11604
Min. Negotiated Rate	$135.26
Max. Negotiated Rate	$5,686.65
Rate for Payer: Aetna Commercial	$228.37
Rate for Payer: BCBS Complete	$142.02
Rate for Payer: BCBS Trust/PPO	$5,686.65
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cash Price	$408.80
Rate for Payer: Mclaren Medicaid	$135.26
Rate for Payer: Meridian Medicaid	$142.02
Rate for Payer: Priority Health Choice Medicaid	$135.26
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$259.78
Rate for Payer: Priority Health Narrow Network	$259.78
Rate for Payer: Priority Health SBD	$259.78

PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM

Facility

$511.00

Service Code	CPT 11604
Hospital Charge Code	11604
Hospital Revenue Code	521
Min. Negotiated Rate	$321.93
Max. Negotiated Rate	$459.90
Rate for Payer: Aetna Commercial	$434.35
Rate for Payer: Aetna New Business (MI Preferred)	$332.15
Rate for Payer: Cash Price	$408.80
Rate for Payer: Cofinity Commercial	$357.70
Rate for Payer: Cofinity Commercial	$439.46
Rate for Payer: Healthscope Commercial	$459.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$434.35
Rate for Payer: PHP Commercial	$434.35
Rate for Payer: Priority Health Cigna Priority Health	$357.70
Rate for Payer: Priority Health SBD	$321.93

PR EXCISION MAXILLARY TORUS PALATINUS

Professional

Both

$777.00

Service Code	HCPCS 21032
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$543.90
Rate for Payer: Aetna Commercial	$350.61
Rate for Payer: BCBS Complete	$175.57
Rate for Payer: BCBS Trust/PPO	$145.43
Rate for Payer: Cash Price	$621.60
Rate for Payer: Cash Price	$621.60
Rate for Payer: Mclaren Medicaid	$167.21
Rate for Payer: Meridian Medicaid	$175.57
Rate for Payer: Priority Health Choice Medicaid	$167.21
Rate for Payer: Priority Health Cigna Priority Health	$543.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$396.26
Rate for Payer: Priority Health Narrow Network	$396.26
Rate for Payer: Priority Health SBD	$396.26

PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS

Professional

Both

$666.00

Service Code	HCPCS 46230
Min. Negotiated Rate	$111.61
Max. Negotiated Rate	$1,777.73
Rate for Payer: Aetna Commercial	$230.39
Rate for Payer: BCBS Complete	$117.19
Rate for Payer: BCBS Trust/PPO	$1,777.73
Rate for Payer: Cash Price	$532.80
Rate for Payer: Cash Price	$532.80
Rate for Payer: Mclaren Medicaid	$111.61
Rate for Payer: Meridian Medicaid	$117.19
Rate for Payer: Priority Health Choice Medicaid	$111.61
Rate for Payer: Priority Health Cigna Priority Health	$466.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$304.58
Rate for Payer: Priority Health Narrow Network	$304.58
Rate for Payer: Priority Health SBD	$304.58

PR EXCISION NAIL MATRIX PERMANENT REMOVAL

Professional

Both

$474.00

Service Code	HCPCS 11750
Min. Negotiated Rate	$20.33
Max. Negotiated Rate	$331.80
Rate for Payer: Aetna Commercial	$104.27
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCBS Trust/PPO	$20.33
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health	$331.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$122.90
Rate for Payer: Priority Health Narrow Network	$122.90
Rate for Payer: Priority Health SBD	$122.90

PR EXCISION NASAL POLYP EXTENSIVE

Professional

Both

$797.00

Service Code	HCPCS 30115
Min. Negotiated Rate	$300.54
Max. Negotiated Rate	$893.36
Rate for Payer: Aetna Commercial	$587.21
Rate for Payer: BCBS Complete	$315.57
Rate for Payer: BCBS Trust/PPO	$893.36
Rate for Payer: Cash Price	$637.60
Rate for Payer: Cash Price	$637.60
Rate for Payer: Mclaren Medicaid	$300.54
Rate for Payer: Meridian Medicaid	$315.57
Rate for Payer: Priority Health Choice Medicaid	$300.54
Rate for Payer: Priority Health Cigna Priority Health	$557.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$657.53
Rate for Payer: Priority Health Narrow Network	$657.53
Rate for Payer: Priority Health SBD	$657.53

PR EXCISION NASAL POLYP SIMPLE

Professional

Both

$487.00

Service Code	HCPCS 30110
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$937.20
Rate for Payer: Aetna Commercial	$164.52
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCBS Trust/PPO	$937.20
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
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	$340.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.29
Rate for Payer: Priority Health Narrow Network	$184.29
Rate for Payer: Priority Health SBD	$184.29

PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT

Professional

Both

$326.00

Service Code	HCPCS 64778
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$303.50
Rate for Payer: Aetna Commercial	$235.17
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCBS Trust/PPO	$291.09
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health	$228.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$303.50
Rate for Payer: Priority Health Narrow Network	$303.50
Rate for Payer: Priority Health SBD	$303.50

PR EXCISION NEUROMA SCIATIC NERVE

Professional

Both

$3,478.00

Service Code	HCPCS 64786
Min. Negotiated Rate	$154.26
Max. Negotiated Rate	$2,434.60
Rate for Payer: Aetna Commercial	$1,308.54
Rate for Payer: BCBS Complete	$676.55
Rate for Payer: BCBS Trust/PPO	$154.26
Rate for Payer: Cash Price	$2,782.40
Rate for Payer: Cash Price	$2,782.40
Rate for Payer: Mclaren Medicaid	$644.33
Rate for Payer: Meridian Medicaid	$676.55
Rate for Payer: Priority Health Choice Medicaid	$644.33
Rate for Payer: Priority Health Cigna Priority Health	$2,434.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,703.77
Rate for Payer: Priority Health Narrow Network	$1,703.77
Rate for Payer: Priority Health SBD	$1,703.77

PR EXCISION OF BULBOURETHRAL GLAND

Professional

Both

$1,115.00

Service Code	HCPCS 53250
Min. Negotiated Rate	$253.90
Max. Negotiated Rate	$780.50
Rate for Payer: Aetna Commercial	$505.90
Rate for Payer: BCBS Complete	$266.60
Rate for Payer: BCBS Trust/PPO	$419.47
Rate for Payer: Cash Price	$892.00
Rate for Payer: Cash Price	$892.00
Rate for Payer: Mclaren Medicaid	$253.90
Rate for Payer: Meridian Medicaid	$266.60
Rate for Payer: Priority Health Choice Medicaid	$253.90
Rate for Payer: Priority Health Cigna Priority Health	$780.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$634.91
Rate for Payer: Priority Health Narrow Network	$634.91
Rate for Payer: Priority Health SBD	$634.91

PR EXCISION OF PENILE PLAQUE

Professional

Both

$1,163.00

Service Code	HCPCS 54110
Min. Negotiated Rate	$398.31
Max. Negotiated Rate	$2,843.84
Rate for Payer: Aetna Commercial	$802.52
Rate for Payer: BCBS Complete	$418.23
Rate for Payer: BCBS Trust/PPO	$2,843.84
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cash Price	$930.40
Rate for Payer: Mclaren Medicaid	$398.31
Rate for Payer: Meridian Medicaid	$418.23
Rate for Payer: Priority Health Choice Medicaid	$398.31
Rate for Payer: Priority Health Cigna Priority Health	$814.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$996.42
Rate for Payer: Priority Health Narrow Network	$996.42
Rate for Payer: Priority Health SBD	$996.42

PR EXCISION OLECRANON BURSA

Professional

Both

$600.00

Service Code	HCPCS 24105
Min. Negotiated Rate	$206.04
Max. Negotiated Rate	$559.67
Rate for Payer: Aetna Commercial	$473.96
Rate for Payer: BCBS Complete	$248.70
Rate for Payer: BCBS Trust/PPO	$206.04
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Mclaren Medicaid	$236.86
Rate for Payer: Meridian Medicaid	$248.70
Rate for Payer: Priority Health Choice Medicaid	$236.86
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$559.67
Rate for Payer: Priority Health Narrow Network	$559.67
Rate for Payer: Priority Health SBD	$559.67

PR EXCISION OLECRANON BURSA

Facility

$600.00

Service Code	CPT 24105
Hospital Charge Code	24105
Min. Negotiated Rate	$364.12
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$510.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$390.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,641.73
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cofinity Commercial	$420.00
Rate for Payer: Cofinity Commercial	$516.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$540.00
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$510.00
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$510.00
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$378.00
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$400.53
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$364.12
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

Know your out-of-pocket cost for care.

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