Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL

Professional

Both

$663.00

Service Code	HCPCS 69145
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$2,204.60
Rate for Payer: Aetna Commercial	$284.48
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCBS Trust/PPO	$2,204.60
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health	$464.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$366.79
Rate for Payer: Priority Health Narrow Network	$366.79
Rate for Payer: Priority Health SBD	$366.79

PR EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY

Professional

Both

$586.00

Service Code	HCPCS 54840
Min. Negotiated Rate	$206.61
Max. Negotiated Rate	$2,153.88
Rate for Payer: Aetna Commercial	$412.87
Rate for Payer: BCBS Complete	$216.94
Rate for Payer: BCBS Trust/PPO	$2,153.88
Rate for Payer: Cash Price	$468.80
Rate for Payer: Cash Price	$468.80
Rate for Payer: Mclaren Medicaid	$206.61
Rate for Payer: Meridian Medicaid	$216.94
Rate for Payer: Priority Health Choice Medicaid	$206.61
Rate for Payer: Priority Health Cigna Priority Health	$410.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$517.12
Rate for Payer: Priority Health Narrow Network	$517.12
Rate for Payer: Priority Health SBD	$517.12

PR EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND

Professional

Both

$2,227.00

Service Code	HCPCS 42440
Min. Negotiated Rate	$268.59
Max. Negotiated Rate	$1,558.90
Rate for Payer: Aetna Commercial	$546.03
Rate for Payer: BCBS Complete	$282.02
Rate for Payer: BCBS Trust/PPO	$437.96
Rate for Payer: Cash Price	$1,781.60
Rate for Payer: Cash Price	$1,781.60
Rate for Payer: Mclaren Medicaid	$268.59
Rate for Payer: Meridian Medicaid	$282.02
Rate for Payer: Priority Health Choice Medicaid	$268.59
Rate for Payer: Priority Health Cigna Priority Health	$1,558.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$736.15
Rate for Payer: Priority Health Narrow Network	$736.15
Rate for Payer: Priority Health SBD	$736.15

PR EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA

Professional

Both

$1,015.00

Service Code	HCPCS 30120
Min. Negotiated Rate	$270.08
Max. Negotiated Rate	$710.50
Rate for Payer: Aetna Commercial	$537.29
Rate for Payer: BCBS Complete	$283.58
Rate for Payer: BCBS Trust/PPO	$589.05
Rate for Payer: Cash Price	$812.00
Rate for Payer: Cash Price	$812.00
Rate for Payer: Mclaren Medicaid	$270.08
Rate for Payer: Meridian Medicaid	$283.58
Rate for Payer: Priority Health Choice Medicaid	$270.08
Rate for Payer: Priority Health Cigna Priority Health	$710.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$582.97
Rate for Payer: Priority Health Narrow Network	$582.97
Rate for Payer: Priority Health SBD	$582.97

PR EXCISION SYNOVIAL CYST POPLITEAL SPACE

Professional

Both

$1,608.00

Service Code	HCPCS 27345
Min. Negotiated Rate	$317.37
Max. Negotiated Rate	$1,594.41
Rate for Payer: Aetna Commercial	$645.18
Rate for Payer: BCBS Complete	$333.24
Rate for Payer: BCBS Trust/PPO	$1,594.41
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Mclaren Medicaid	$317.37
Rate for Payer: Meridian Medicaid	$333.24
Rate for Payer: Priority Health Choice Medicaid	$317.37
Rate for Payer: Priority Health Cigna Priority Health	$1,125.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$751.68
Rate for Payer: Priority Health Narrow Network	$751.68
Rate for Payer: Priority Health SBD	$751.68

PR EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH

Professional

Both

$1,247.00

Service Code	HCPCS 26180
Min. Negotiated Rate	$146.34
Max. Negotiated Rate	$872.90
Rate for Payer: Aetna Commercial	$596.15
Rate for Payer: BCBS Complete	$309.53
Rate for Payer: BCBS Trust/PPO	$146.34
Rate for Payer: Cash Price	$997.60
Rate for Payer: Cash Price	$997.60
Rate for Payer: Mclaren Medicaid	$294.79
Rate for Payer: Meridian Medicaid	$309.53
Rate for Payer: Priority Health Choice Medicaid	$294.79
Rate for Payer: Priority Health Cigna Priority Health	$872.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$698.06
Rate for Payer: Priority Health Narrow Network	$698.06
Rate for Payer: Priority Health SBD	$698.06

PR EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH

Professional

Both

$1,092.00

Service Code	HCPCS 26170
Min. Negotiated Rate	$77.66
Max. Negotiated Rate	$764.40
Rate for Payer: Aetna Commercial	$541.73
Rate for Payer: BCBS Complete	$280.91
Rate for Payer: BCBS Trust/PPO	$77.66
Rate for Payer: Cash Price	$873.60
Rate for Payer: Cash Price	$873.60
Rate for Payer: Mclaren Medicaid	$267.53
Rate for Payer: Meridian Medicaid	$280.91
Rate for Payer: Priority Health Choice Medicaid	$267.53
Rate for Payer: Priority Health Cigna Priority Health	$764.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$634.23
Rate for Payer: Priority Health Narrow Network	$634.23
Rate for Payer: Priority Health SBD	$634.23

PR EXCISION THYROGLOSSAL DUCT CYST/SINUS

Professional

Both

$2,033.00

Service Code	HCPCS 60280
Min. Negotiated Rate	$293.51
Max. Negotiated Rate	$3,383.23
Rate for Payer: Aetna Commercial	$571.08
Rate for Payer: BCBS Complete	$308.19
Rate for Payer: BCBS Trust/PPO	$3,383.23
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Cash Price	$1,626.40
Rate for Payer: Mclaren Medicaid	$293.51
Rate for Payer: Meridian Medicaid	$308.19
Rate for Payer: Priority Health Choice Medicaid	$293.51
Rate for Payer: Priority Health Cigna Priority Health	$1,423.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.79
Rate for Payer: Priority Health Narrow Network	$646.79
Rate for Payer: Priority Health SBD	$646.79

PR EXCISION THYROGLOSSAL DUCT CYST/SINUS RECURRENT

Professional

Both

$2,154.00

Service Code	HCPCS 60281
Min. Negotiated Rate	$384.04
Max. Negotiated Rate	$3,474.63
Rate for Payer: Aetna Commercial	$753.00
Rate for Payer: BCBS Complete	$403.24
Rate for Payer: BCBS Trust/PPO	$3,474.63
Rate for Payer: Cash Price	$1,723.20
Rate for Payer: Cash Price	$1,723.20
Rate for Payer: Mclaren Medicaid	$384.04
Rate for Payer: Meridian Medicaid	$403.24
Rate for Payer: Priority Health Choice Medicaid	$384.04
Rate for Payer: Priority Health Cigna Priority Health	$1,507.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$848.82
Rate for Payer: Priority Health Narrow Network	$848.82
Rate for Payer: Priority Health SBD	$848.82

PR EXCISION TONSIL TAGS

Professional

Both

$373.00

Service Code	HCPCS 42860
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$890.19
Rate for Payer: Aetna Commercial	$249.27
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCBS Trust/PPO	$890.19
Rate for Payer: Cash Price	$298.40
Rate for Payer: Cash Price	$298.40
Rate for Payer: Mclaren Medicaid	$126.31
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health	$261.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$344.55
Rate for Payer: Priority Health Narrow Network	$344.55
Rate for Payer: Priority Health SBD	$344.55

PR EXCISION TRACHEAL TUMOR/CARCINOMA CERVICAL

Professional

Both

$3,871.00

Service Code	HCPCS 31785
Min. Negotiated Rate	$686.29
Max. Negotiated Rate	$2,709.70
Rate for Payer: Aetna Commercial	$1,372.02
Rate for Payer: BCBS Complete	$720.60
Rate for Payer: BCBS Trust/PPO	$1,040.22
Rate for Payer: Cash Price	$3,096.80
Rate for Payer: Cash Price	$3,096.80
Rate for Payer: Mclaren Medicaid	$686.29
Rate for Payer: Meridian Medicaid	$720.60
Rate for Payer: Priority Health Choice Medicaid	$686.29
Rate for Payer: Priority Health Cigna Priority Health	$2,709.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,487.77
Rate for Payer: Priority Health Narrow Network	$1,487.77
Rate for Payer: Priority Health SBD	$1,487.77

PR EXCISION TROCHANTERIC BURSA/CALCIFICATION

Professional

Both

$1,645.00

Service Code	HCPCS 27062
Min. Negotiated Rate	$296.07
Max. Negotiated Rate	$4,466.25
Rate for Payer: Aetna Commercial	$606.20
Rate for Payer: BCBS Complete	$310.87
Rate for Payer: BCBS Trust/PPO	$4,466.25
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Cash Price	$1,316.00
Rate for Payer: Mclaren Medicaid	$296.07
Rate for Payer: Meridian Medicaid	$310.87
Rate for Payer: Priority Health Choice Medicaid	$296.07
Rate for Payer: Priority Health Cigna Priority Health	$1,151.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$703.17
Rate for Payer: Priority Health Narrow Network	$703.17
Rate for Payer: Priority Health SBD	$703.17

PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Professional

Both

$730.00

Service Code	HCPCS 21931
Min. Negotiated Rate	$303.31
Max. Negotiated Rate	$9,087.30
Rate for Payer: Aetna Commercial	$629.51
Rate for Payer: BCBS Complete	$318.48
Rate for Payer: BCBS Trust/PPO	$9,087.30
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Mclaren Medicaid	$303.31
Rate for Payer: Meridian Medicaid	$318.48
Rate for Payer: Priority Health Choice Medicaid	$303.31
Rate for Payer: Priority Health Cigna Priority Health	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$720.53
Rate for Payer: Priority Health Narrow Network	$720.53
Rate for Payer: Priority Health SBD	$720.53

PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Professional

Both

$730.00

Service Code	HCPCS 21931
Hospital Charge Code	21931
Min. Negotiated Rate	$303.31
Max. Negotiated Rate	$9,087.30
Rate for Payer: Aetna Commercial	$629.51
Rate for Payer: BCBS Complete	$318.48
Rate for Payer: BCBS Trust/PPO	$9,087.30
Rate for Payer: Cash Price	$584.00
Rate for Payer: Cash Price	$584.00
Rate for Payer: Mclaren Medicaid	$303.31
Rate for Payer: Meridian Medicaid	$318.48
Rate for Payer: Priority Health Choice Medicaid	$303.31
Rate for Payer: Priority Health Cigna Priority Health	$511.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$720.53
Rate for Payer: Priority Health Narrow Network	$720.53
Rate for Payer: Priority Health SBD	$720.53

PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Facility

$730.00

Service Code	CPT 21931
Hospital Charge Code	21931
Hospital Revenue Code	521
Min. Negotiated Rate	$459.90
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	$1,372.70
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	$511.00
Rate for Payer: Cofinity Commercial	$627.80
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)	$512.91
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$466.28
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/>

Facility

$730.00

Service Code	CPT 21931
Hospital Charge Code	21931
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 TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>

Facility

$896.00

Service Code	CPT 28039
Hospital Charge Code	28039
Min. Negotiated Rate	$564.48
Max. Negotiated Rate	$806.40
Rate for Payer: Aetna Commercial	$761.60
Rate for Payer: Aetna New Business (MI Preferred)	$582.40
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cofinity Commercial	$627.20
Rate for Payer: Cofinity Commercial	$770.56
Rate for Payer: Healthscope Commercial	$806.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$761.60
Rate for Payer: PHP Commercial	$761.60
Rate for Payer: Priority Health Cigna Priority Health	$627.20
Rate for Payer: Priority Health SBD	$564.48

PR EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>

Facility

$896.00

Service Code	CPT 28039
Hospital Charge Code	28039
Min. Negotiated Rate	$334.97
Max. Negotiated Rate	$7,382.58
Rate for Payer: Aetna Commercial	$761.60
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$582.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,368.02
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cofinity Commercial	$627.20
Rate for Payer: Cofinity Commercial	$770.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$806.40
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$761.60
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$761.60
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Cigna Priority Health	$627.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,382.58
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health Narrow Network	$5,906.06
Rate for Payer: Priority Health SBD	$564.48
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$368.47
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$334.97
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

PR EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>

Professional

Both

$896.00

Service Code	HCPCS 28039
Hospital Charge Code	28039
Min. Negotiated Rate	$217.90
Max. Negotiated Rate	$897.58
Rate for Payer: Aetna Commercial	$461.09
Rate for Payer: BCBS Complete	$228.80
Rate for Payer: BCBS Trust/PPO	$897.58
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cash Price	$716.80
Rate for Payer: Mclaren Medicaid	$217.90
Rate for Payer: Meridian Medicaid	$228.80
Rate for Payer: Priority Health Choice Medicaid	$217.90
Rate for Payer: Priority Health Cigna Priority Health	$627.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$520.35
Rate for Payer: Priority Health Narrow Network	$520.35
Rate for Payer: Priority Health SBD	$520.35

PR EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>

Professional

Both

$896.00

Service Code	HCPCS 28039
Min. Negotiated Rate	$217.90
Max. Negotiated Rate	$897.58
Rate for Payer: Aetna Commercial	$461.09
Rate for Payer: BCBS Complete	$228.80
Rate for Payer: BCBS Trust/PPO	$897.58
Rate for Payer: Cash Price	$716.80
Rate for Payer: Cash Price	$716.80
Rate for Payer: Mclaren Medicaid	$217.90
Rate for Payer: Meridian Medicaid	$228.80
Rate for Payer: Priority Health Choice Medicaid	$217.90
Rate for Payer: Priority Health Cigna Priority Health	$627.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$520.35
Rate for Payer: Priority Health Narrow Network	$520.35
Rate for Payer: Priority Health SBD	$520.35

PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>

Facility

$639.00

Service Code	CPT 21012
Hospital Charge Code	21012
Min. Negotiated Rate	$336.94
Max. Negotiated Rate	$4,496.47
Rate for Payer: Aetna Commercial	$543.15
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$415.35
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	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$549.54
Rate for Payer: Cofinity Commercial	$447.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$575.10
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	$543.15
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$543.15
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	$447.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,496.47
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,597.18
Rate for Payer: Priority Health SBD	$402.57
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$370.63
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$336.94
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>

Facility

$639.00

Service Code	CPT 21012
Hospital Charge Code	21012
Min. Negotiated Rate	$402.57
Max. Negotiated Rate	$575.10
Rate for Payer: Aetna Commercial	$543.15
Rate for Payer: Aetna New Business (MI Preferred)	$415.35
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cofinity Commercial	$447.30
Rate for Payer: Cofinity Commercial	$549.54
Rate for Payer: Healthscope Commercial	$575.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.15
Rate for Payer: PHP Commercial	$543.15
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health SBD	$402.57

PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>

Professional

Both

$639.00

Service Code	HCPCS 21012
Hospital Charge Code	21012
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$934.38
Rate for Payer: Aetna Commercial	$448.00
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCBS Trust/PPO	$934.38
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Mclaren Medicaid	$219.18
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$520.86
Rate for Payer: Priority Health Narrow Network	$520.86
Rate for Payer: Priority Health SBD	$520.86

PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/>

Professional

Both

$639.00

Service Code	HCPCS 21012
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$934.38
Rate for Payer: Aetna Commercial	$448.00
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCBS Trust/PPO	$934.38
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Mclaren Medicaid	$219.18
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health	$447.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$520.86
Rate for Payer: Priority Health Narrow Network	$520.86
Rate for Payer: Priority Health SBD	$520.86

PR EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM

Facility

$542.00

Service Code	CPT 21011
Hospital Charge Code	21011
Min. Negotiated Rate	$341.46
Max. Negotiated Rate	$487.80
Rate for Payer: Aetna Commercial	$460.70
Rate for Payer: Aetna New Business (MI Preferred)	$352.30
Rate for Payer: Cash Price	$433.60
Rate for Payer: Cofinity Commercial	$379.40
Rate for Payer: Cofinity Commercial	$466.12
Rate for Payer: Healthscope Commercial	$487.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$460.70
Rate for Payer: PHP Commercial	$460.70
Rate for Payer: Priority Health Cigna Priority Health	$379.40
Rate for Payer: Priority Health SBD	$341.46

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