Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM

Professional

Both

$827.00

Service Code	HCPCS 11606
Min. Negotiated Rate	$175.51
Max. Negotiated Rate	$620.25
Rate for Payer: Aetna Commercial	$341.92
Rate for Payer: Aetna Medicare	$413.50
Rate for Payer: BCBS Complete	$184.29
Rate for Payer: BCN Commercial	$473.08
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Mclaren Medicaid	$175.51
Rate for Payer: Meridian Medicaid	$184.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$620.25
Rate for Payer: Priority Health Choice Medicaid	$175.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$432.99
Rate for Payer: Priority Health Narrow/Tiered Network	$432.99
Rate for Payer: UHC Medicaid	$175.51
Rate for Payer: UHCCP Medicaid	$175.51

PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM

Professional

Both

$827.00

Service Code	HCPCS 11606
Hospital Charge Code	11606
Min. Negotiated Rate	$175.51
Max. Negotiated Rate	$620.25
Rate for Payer: Aetna Commercial	$341.92
Rate for Payer: Aetna Medicare	$413.50
Rate for Payer: BCBS Complete	$184.29
Rate for Payer: BCN Commercial	$473.08
Rate for Payer: Cash Price	$661.60
Rate for Payer: Cash Price	$661.60
Rate for Payer: Mclaren Medicaid	$175.51
Rate for Payer: Meridian Medicaid	$184.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$620.25
Rate for Payer: Priority Health Choice Medicaid	$175.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$432.99
Rate for Payer: Priority Health Narrow/Tiered Network	$432.99
Rate for Payer: UHC Medicaid	$175.51
Rate for Payer: UHCCP Medicaid	$175.51

PR EXCISION MALIGNANT TUMOR MANDIBLE RADICAL

Professional

Both

$2,287.00

Service Code	HCPCS 21045
Min. Negotiated Rate	$676.70
Max. Negotiated Rate	$1,924.37
Rate for Payer: Aetna Commercial	$1,587.89
Rate for Payer: Aetna Medicare	$1,143.50
Rate for Payer: BCBS Complete	$710.53
Rate for Payer: BCN Commercial	$1,800.20
Rate for Payer: Cash Price	$1,829.60
Rate for Payer: Cash Price	$1,829.60
Rate for Payer: Mclaren Medicaid	$676.70
Rate for Payer: Meridian Medicaid	$710.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,715.25
Rate for Payer: Priority Health Choice Medicaid	$676.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,924.37
Rate for Payer: Priority Health Narrow/Tiered Network	$1,924.37
Rate for Payer: UHC Medicaid	$676.70
Rate for Payer: UHCCP Medicaid	$676.70

PR EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA

Professional

Both

$2,837.00

Service Code	HCPCS 21034
Min. Negotiated Rate	$630.05
Max. Negotiated Rate	$2,127.75
Rate for Payer: Aetna Commercial	$1,501.25
Rate for Payer: Aetna Medicare	$1,418.50
Rate for Payer: BCBS Complete	$661.55
Rate for Payer: BCN Commercial	$1,688.66
Rate for Payer: Cash Price	$2,269.60
Rate for Payer: Cash Price	$2,269.60
Rate for Payer: Mclaren Medicaid	$630.05
Rate for Payer: Meridian Medicaid	$661.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,127.75
Rate for Payer: Priority Health Choice Medicaid	$630.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,805.12
Rate for Payer: Priority Health Narrow/Tiered Network	$1,805.12
Rate for Payer: UHC Medicaid	$630.05
Rate for Payer: UHCCP Medicaid	$630.05

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

Professional

Both

$328.00

Service Code	HCPCS 11600
Min. Negotiated Rate	$69.23
Max. Negotiated Rate	$246.00
Rate for Payer: Aetna Commercial	$130.60
Rate for Payer: Aetna Medicare	$164.00
Rate for Payer: BCBS Complete	$72.69
Rate for Payer: BCN Commercial	$183.76
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Mclaren Medicaid	$69.23
Rate for Payer: Meridian Medicaid	$72.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.00
Rate for Payer: Priority Health Choice Medicaid	$69.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$168.19
Rate for Payer: Priority Health Narrow/Tiered Network	$168.19
Rate for Payer: UHC Medicaid	$69.23
Rate for Payer: UHCCP Medicaid	$69.23

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

Professional

Both

$388.00

Service Code	HCPCS 11601
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$291.00
Rate for Payer: Aetna Commercial	$158.43
Rate for Payer: Aetna Medicare	$194.00
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCN Commercial	$175.93
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Mclaren Medicaid	$81.79
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.00
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$204.19
Rate for Payer: Priority Health Narrow/Tiered Network	$204.19
Rate for Payer: UHC Medicaid	$81.79
Rate for Payer: UHCCP Medicaid	$81.79

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

Professional

Both

$422.00

Service Code	HCPCS 11602
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: Aetna Medicare	$211.00
Rate for Payer: BCBS Complete	$91.48
Rate for Payer: BCN Commercial	$191.24
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Mclaren Medicaid	$87.12
Rate for Payer: Meridian Medicaid	$91.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: Priority Health Choice Medicaid	$87.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.97
Rate for Payer: Priority Health Narrow/Tiered Network	$221.97
Rate for Payer: UHC Medicaid	$87.12
Rate for Payer: UHCCP Medicaid	$87.12

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

Facility

$422.00

Service Code	CPT 11602
Hospital Charge Code	11602
Hospital Revenue Code	521
Min. Negotiated Rate	$293.71
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna Commercial	$358.70
Rate for Payer: BCBS Trust/PPO	$348.53
Rate for Payer: BCN Commercial	$348.53
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cofinity Commercial	$362.92
Rate for Payer: Encore Health Key Benefits Commercial	$337.60
Rate for Payer: Healthscope Commercial	$379.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$316.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.70
Rate for Payer: Nomi Health Commercial	$346.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: PHP Commercial	$358.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$367.14
Rate for Payer: Priority Health Narrow/Tiered Network	$293.71
Rate for Payer: UHC Core	$352.37
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$316.50

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

Facility

$422.00

Service Code	CPT 11602
Hospital Charge Code	11602
Hospital Revenue Code	521
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna Commercial	$358.70
Rate for Payer: Aetna Medicare	$109.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$131.88
Rate for Payer: Amish Plain Church Group Commercial	$131.88
Rate for Payer: BCBS Complete	$78.11
Rate for Payer: BCBS MAPPO	$105.50
Rate for Payer: BCBS Trust/PPO	$346.93
Rate for Payer: BCN Commercial	$346.93
Rate for Payer: BCN Medicare Advantage	$105.50
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cofinity Commercial	$362.92
Rate for Payer: Encore Health Key Benefits Commercial	$337.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$105.50
Rate for Payer: Healthscope Commercial	$379.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$316.50
Rate for Payer: Mclaren Medicaid	$74.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$110.78
Rate for Payer: Meridian Medicaid	$78.11
Rate for Payer: MI Amish Medical Board Commercial	$121.33
Rate for Payer: Molina Medicare/Medicaid	$116.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.70
Rate for Payer: Nomi Health Commercial	$346.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: PACE Senior Care Partners	$100.22
Rate for Payer: PACE SWMI	$105.50
Rate for Payer: PHP Commercial	$358.70
Rate for Payer: PHP Medicare Advantage	$105.50
Rate for Payer: Priority Health Choice Medicaid	$74.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$367.14
Rate for Payer: Priority Health Medicare	$106.56
Rate for Payer: Priority Health Narrow/Tiered Network	$293.71
Rate for Payer: Railroad Medicare Medicare	$105.50
Rate for Payer: UHC Core	$352.37
Rate for Payer: UHC Exchange	$105.50
Rate for Payer: UHC Medicaid	$74.40
Rate for Payer: UHC Medicare Advantage	$105.50
Rate for Payer: UHCCP Medicaid	$74.40
Rate for Payer: VA VA	$105.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$316.50

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

Professional

Both

$422.00

Service Code	HCPCS 11602
Hospital Charge Code	11602
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$172.05
Rate for Payer: Aetna Medicare	$211.00
Rate for Payer: BCBS Complete	$91.48
Rate for Payer: BCN Commercial	$191.24
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Mclaren Medicaid	$87.12
Rate for Payer: Meridian Medicaid	$91.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: Priority Health Choice Medicaid	$87.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.97
Rate for Payer: Priority Health Narrow/Tiered Network	$221.97
Rate for Payer: UHC Medicaid	$87.12
Rate for Payer: UHCCP Medicaid	$87.12

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

Facility

$481.00

Service Code	CPT 11603
Hospital Charge Code	11603
Hospital Revenue Code	521
Min. Negotiated Rate	$334.78
Max. Negotiated Rate	$432.90
Rate for Payer: Aetna Commercial	$408.85
Rate for Payer: BCBS Trust/PPO	$397.26
Rate for Payer: BCN Commercial	$397.26
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cofinity Commercial	$413.66
Rate for Payer: Encore Health Key Benefits Commercial	$384.80
Rate for Payer: Healthscope Commercial	$432.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$360.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$408.85
Rate for Payer: Nomi Health Commercial	$394.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.75
Rate for Payer: PHP Commercial	$408.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$418.47
Rate for Payer: Priority Health Narrow/Tiered Network	$334.78
Rate for Payer: UHC Core	$401.63
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$360.75

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

Facility

$481.00

Service Code	CPT 11603
Hospital Charge Code	11603
Hospital Revenue Code	521
Min. Negotiated Rate	$84.80
Max. Negotiated Rate	$432.90
Rate for Payer: Aetna Commercial	$408.85
Rate for Payer: Aetna Medicare	$125.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$150.31
Rate for Payer: Amish Plain Church Group Commercial	$150.31
Rate for Payer: BCBS Complete	$89.03
Rate for Payer: BCBS MAPPO	$120.25
Rate for Payer: BCBS Trust/PPO	$395.43
Rate for Payer: BCN Commercial	$395.43
Rate for Payer: BCN Medicare Advantage	$120.25
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cofinity Commercial	$413.66
Rate for Payer: Encore Health Key Benefits Commercial	$384.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$120.25
Rate for Payer: Healthscope Commercial	$432.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$360.75
Rate for Payer: Mclaren Medicaid	$84.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$126.26
Rate for Payer: Meridian Medicaid	$89.03
Rate for Payer: MI Amish Medical Board Commercial	$138.29
Rate for Payer: Molina Medicare/Medicaid	$132.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$408.85
Rate for Payer: Nomi Health Commercial	$394.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.75
Rate for Payer: PACE Senior Care Partners	$114.24
Rate for Payer: PACE SWMI	$120.25
Rate for Payer: PHP Commercial	$408.85
Rate for Payer: PHP Medicare Advantage	$120.25
Rate for Payer: Priority Health Choice Medicaid	$84.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$418.47
Rate for Payer: Priority Health Medicare	$121.45
Rate for Payer: Priority Health Narrow/Tiered Network	$334.78
Rate for Payer: Railroad Medicare Medicare	$120.25
Rate for Payer: UHC Core	$401.63
Rate for Payer: UHC Exchange	$120.25
Rate for Payer: UHC Medicaid	$84.80
Rate for Payer: UHC Medicare Advantage	$120.25
Rate for Payer: UHCCP Medicaid	$84.80
Rate for Payer: VA VA	$120.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$360.75

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

Professional

Both

$481.00

Service Code	HCPCS 11603
Hospital Charge Code	11603
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$360.75
Rate for Payer: Aetna Commercial	$205.93
Rate for Payer: Aetna Medicare	$240.50
Rate for Payer: BCBS Complete	$109.37
Rate for Payer: BCN Commercial	$289.82
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cash Price	$384.80
Rate for Payer: Mclaren Medicaid	$104.16
Rate for Payer: Meridian Medicaid	$109.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.75
Rate for Payer: Priority Health Choice Medicaid	$104.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$265.27
Rate for Payer: Priority Health Narrow/Tiered Network	$265.27
Rate for Payer: UHC Medicaid	$104.16
Rate for Payer: UHCCP Medicaid	$104.16

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

Professional

Both

$481.00

Service Code	HCPCS 11603
Min. Negotiated Rate	$104.16
Max. Negotiated Rate	$360.75
Rate for Payer: Aetna Commercial	$205.93
Rate for Payer: Aetna Medicare	$240.50
Rate for Payer: BCBS Complete	$109.37
Rate for Payer: BCN Commercial	$289.82
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cash Price	$384.80
Rate for Payer: Mclaren Medicaid	$104.16
Rate for Payer: Meridian Medicaid	$109.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.75
Rate for Payer: Priority Health Choice Medicaid	$104.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$265.27
Rate for Payer: Priority Health Narrow/Tiered Network	$265.27
Rate for Payer: UHC Medicaid	$104.16
Rate for Payer: UHCCP Medicaid	$104.16

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

Professional

Both

$537.00

Service Code	HCPCS 11604
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$402.75
Rate for Payer: Aetna Commercial	$228.37
Rate for Payer: Aetna Medicare	$268.50
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$319.21
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$292.15
Rate for Payer: Priority Health Narrow/Tiered Network	$292.15
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

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

Facility

$537.00

Service Code	CPT 11604
Hospital Charge Code	11604
Hospital Revenue Code	521
Min. Negotiated Rate	$94.67
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna Commercial	$456.45
Rate for Payer: Aetna Medicare	$139.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$167.81
Rate for Payer: Amish Plain Church Group Commercial	$167.81
Rate for Payer: BCBS Complete	$99.40
Rate for Payer: BCBS MAPPO	$134.25
Rate for Payer: BCBS Trust/PPO	$441.47
Rate for Payer: BCN Commercial	$441.47
Rate for Payer: BCN Medicare Advantage	$134.25
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cofinity Commercial	$461.82
Rate for Payer: Encore Health Key Benefits Commercial	$429.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$134.25
Rate for Payer: Healthscope Commercial	$483.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$402.75
Rate for Payer: Mclaren Medicaid	$94.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.96
Rate for Payer: Meridian Medicaid	$99.40
Rate for Payer: MI Amish Medical Board Commercial	$154.39
Rate for Payer: Molina Medicare/Medicaid	$147.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$456.45
Rate for Payer: Nomi Health Commercial	$440.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: PACE Senior Care Partners	$127.54
Rate for Payer: PACE SWMI	$134.25
Rate for Payer: PHP Commercial	$456.45
Rate for Payer: PHP Medicare Advantage	$134.25
Rate for Payer: Priority Health Choice Medicaid	$94.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$467.19
Rate for Payer: Priority Health Medicare	$135.59
Rate for Payer: Priority Health Narrow/Tiered Network	$373.75
Rate for Payer: Railroad Medicare Medicare	$134.25
Rate for Payer: UHC Core	$448.39
Rate for Payer: UHC Exchange	$134.25
Rate for Payer: UHC Medicaid	$94.67
Rate for Payer: UHC Medicare Advantage	$134.25
Rate for Payer: UHCCP Medicaid	$94.67
Rate for Payer: VA VA	$134.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$402.75

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

Facility

$537.00

Service Code	CPT 11604
Hospital Charge Code	11604
Hospital Revenue Code	521
Min. Negotiated Rate	$373.75
Max. Negotiated Rate	$483.30
Rate for Payer: Aetna Commercial	$456.45
Rate for Payer: BCBS Trust/PPO	$443.51
Rate for Payer: BCN Commercial	$443.51
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cofinity Commercial	$461.82
Rate for Payer: Encore Health Key Benefits Commercial	$429.60
Rate for Payer: Healthscope Commercial	$483.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$402.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$456.45
Rate for Payer: Nomi Health Commercial	$440.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: PHP Commercial	$456.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$467.19
Rate for Payer: Priority Health Narrow/Tiered Network	$373.75
Rate for Payer: UHC Core	$448.39
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$402.75

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

Professional

Both

$537.00

Service Code	HCPCS 11604
Hospital Charge Code	11604
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$402.75
Rate for Payer: Aetna Commercial	$228.37
Rate for Payer: Aetna Medicare	$268.50
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$319.21
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$292.15
Rate for Payer: Priority Health Narrow/Tiered Network	$292.15
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

PR EXCISION MAXILLARY TORUS PALATINUS

Professional

Both

$817.00

Service Code	HCPCS 21032
Min. Negotiated Rate	$155.70
Max. Negotiated Rate	$612.75
Rate for Payer: Aetna Commercial	$350.61
Rate for Payer: Aetna Medicare	$408.50
Rate for Payer: BCBS Complete	$163.49
Rate for Payer: BCN Commercial	$397.38
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Mclaren Medicaid	$155.70
Rate for Payer: Meridian Medicaid	$163.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$612.75
Rate for Payer: Priority Health Choice Medicaid	$155.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$424.81
Rate for Payer: Priority Health Narrow/Tiered Network	$424.81
Rate for Payer: UHC Medicaid	$155.70
Rate for Payer: UHCCP Medicaid	$155.70

PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS

Professional

Both

$699.00

Service Code	HCPCS 46230
Min. Negotiated Rate	$106.07
Max. Negotiated Rate	$524.25
Rate for Payer: Aetna Commercial	$230.39
Rate for Payer: Aetna Medicare	$349.50
Rate for Payer: BCBS Complete	$111.37
Rate for Payer: BCN Commercial	$263.44
Rate for Payer: Cash Price	$559.20
Rate for Payer: Cash Price	$559.20
Rate for Payer: Mclaren Medicaid	$106.07
Rate for Payer: Meridian Medicaid	$111.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$524.25
Rate for Payer: Priority Health Choice Medicaid	$106.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$320.97
Rate for Payer: Priority Health Narrow/Tiered Network	$320.97
Rate for Payer: UHC Medicaid	$106.07
Rate for Payer: UHCCP Medicaid	$106.07

PR EXCISION NAIL&NAIL MATRIX PRTL/COMPL PERM RMVL

Professional

Both

$497.00

Service Code	HCPCS 11750
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$372.75
Rate for Payer: Aetna Commercial	$104.27
Rate for Payer: Aetna Medicare	$248.50
Rate for Payer: BCBS Complete	$63.07
Rate for Payer: BCN Commercial	$120.56
Rate for Payer: Cash Price	$397.60
Rate for Payer: Cash Price	$397.60
Rate for Payer: Mclaren Medicaid	$60.07
Rate for Payer: Meridian Medicaid	$63.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$372.75
Rate for Payer: Priority Health Choice Medicaid	$60.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.92
Rate for Payer: Priority Health Narrow/Tiered Network	$139.92
Rate for Payer: UHC Medicaid	$60.07
Rate for Payer: UHCCP Medicaid	$60.07

PR EXCISION NASAL POLYP EXTENSIVE

Professional

Both

$837.00

Service Code	HCPCS 30115
Min. Negotiated Rate	$276.47
Max. Negotiated Rate	$697.67
Rate for Payer: Aetna Commercial	$587.21
Rate for Payer: Aetna Medicare	$418.50
Rate for Payer: BCBS Complete	$290.29
Rate for Payer: BCN Commercial	$697.67
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Mclaren Medicaid	$276.47
Rate for Payer: Meridian Medicaid	$290.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$627.75
Rate for Payer: Priority Health Choice Medicaid	$276.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$656.99
Rate for Payer: Priority Health Narrow/Tiered Network	$656.99
Rate for Payer: UHC Medicaid	$276.47
Rate for Payer: UHCCP Medicaid	$276.47

PR EXCISION NASAL POLYP SIMPLE

Professional

Both

$512.00

Service Code	HCPCS 30110
Min. Negotiated Rate	$76.47
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna Commercial	$164.52
Rate for Payer: Aetna Medicare	$256.00
Rate for Payer: BCBS Complete	$80.29
Rate for Payer: BCN Commercial	$201.68
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cash Price	$409.60
Rate for Payer: Mclaren Medicaid	$76.47
Rate for Payer: Meridian Medicaid	$80.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$384.00
Rate for Payer: Priority Health Choice Medicaid	$76.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$189.92
Rate for Payer: Priority Health Narrow/Tiered Network	$189.92
Rate for Payer: UHC Medicaid	$76.47
Rate for Payer: UHCCP Medicaid	$76.47

PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT

Professional

Both

$343.00

Service Code	HCPCS 64778
Min. Negotiated Rate	$98.83
Max. Negotiated Rate	$311.17
Rate for Payer: Aetna Commercial	$235.17
Rate for Payer: Aetna Medicare	$171.50
Rate for Payer: BCBS Complete	$103.77
Rate for Payer: BCN Commercial	$267.91
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cash Price	$274.40
Rate for Payer: Mclaren Medicaid	$98.83
Rate for Payer: Meridian Medicaid	$103.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$257.25
Rate for Payer: Priority Health Choice Medicaid	$98.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$311.17
Rate for Payer: Priority Health Narrow/Tiered Network	$311.17
Rate for Payer: UHC Medicaid	$98.83
Rate for Payer: UHCCP Medicaid	$98.83

PR EXCISION NEUROMA SCIATIC NERVE

Professional

Both

$3,654.00

Service Code	HCPCS 64786
Min. Negotiated Rate	$606.62
Max. Negotiated Rate	$2,740.50
Rate for Payer: Aetna Commercial	$1,308.54
Rate for Payer: Aetna Medicare	$1,827.00
Rate for Payer: BCBS Complete	$636.95
Rate for Payer: BCN Commercial	$1,514.86
Rate for Payer: Cash Price	$2,923.20
Rate for Payer: Cash Price	$2,923.20
Rate for Payer: Mclaren Medicaid	$606.62
Rate for Payer: Meridian Medicaid	$636.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,740.50
Rate for Payer: Priority Health Choice Medicaid	$606.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,759.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,759.48
Rate for Payer: UHC Medicaid	$606.62
Rate for Payer: UHCCP Medicaid	$606.62

Know your out-of-pocket cost for care.

All Charges