Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXCISION OF BULBOURETHRAL GLAND

Professional

Both

$1,171.00

Service Code	HCPCS 53250
Min. Negotiated Rate	$234.30
Max. Negotiated Rate	$878.25
Rate for Payer: Aetna Commercial	$505.90
Rate for Payer: Aetna Medicare	$585.50
Rate for Payer: BCBS Complete	$246.01
Rate for Payer: BCN Commercial	$599.07
Rate for Payer: Cash Price	$936.80
Rate for Payer: Cash Price	$936.80
Rate for Payer: Mclaren Medicaid	$234.30
Rate for Payer: Meridian Medicaid	$246.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$878.25
Rate for Payer: Priority Health Choice Medicaid	$234.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$652.59
Rate for Payer: Priority Health Narrow/Tiered Network	$652.59
Rate for Payer: UHC Medicaid	$234.30
Rate for Payer: UHCCP Medicaid	$234.30

PR EXCISION OF PENILE PLAQUE

Professional

Both

$1,222.00

Service Code	HCPCS 54110
Min. Negotiated Rate	$362.53
Max. Negotiated Rate	$1,020.91
Rate for Payer: Aetna Commercial	$802.52
Rate for Payer: Aetna Medicare	$611.00
Rate for Payer: BCBS Complete	$380.66
Rate for Payer: BCN Commercial	$937.20
Rate for Payer: Cash Price	$977.60
Rate for Payer: Cash Price	$977.60
Rate for Payer: Mclaren Medicaid	$362.53
Rate for Payer: Meridian Medicaid	$380.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$916.50
Rate for Payer: Priority Health Choice Medicaid	$362.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,020.91
Rate for Payer: Priority Health Narrow/Tiered Network	$1,020.91
Rate for Payer: UHC Medicaid	$362.53
Rate for Payer: UHCCP Medicaid	$362.53

PR EXCISION OLECRANON BURSA

Professional

Both

$630.00

Service Code	HCPCS 24105
Min. Negotiated Rate	$228.34
Max. Negotiated Rate	$597.80
Rate for Payer: Aetna Commercial	$473.96
Rate for Payer: Aetna Medicare	$315.00
Rate for Payer: BCBS Complete	$239.76
Rate for Payer: BCN Commercial	$559.23
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Mclaren Medicaid	$228.34
Rate for Payer: Meridian Medicaid	$239.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.50
Rate for Payer: Priority Health Choice Medicaid	$228.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$597.80
Rate for Payer: Priority Health Narrow/Tiered Network	$597.80
Rate for Payer: UHC Medicaid	$228.34
Rate for Payer: UHCCP Medicaid	$228.34

PR EXCISION OR FULGURATION SKENES GLANDS

Professional

Both

$414.00

Service Code	HCPCS 53270
Min. Negotiated Rate	$107.99
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$235.70
Rate for Payer: Aetna Medicare	$207.00
Rate for Payer: BCBS Complete	$113.39
Rate for Payer: BCN Commercial	$279.37
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Mclaren Medicaid	$107.99
Rate for Payer: Meridian Medicaid	$113.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.50
Rate for Payer: Priority Health Choice Medicaid	$107.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$304.32
Rate for Payer: Priority Health Narrow/Tiered Network	$304.32
Rate for Payer: UHC Medicaid	$107.99
Rate for Payer: UHCCP Medicaid	$107.99

PR EXCISION PILONIDAL CYST/SINUS COMPLICATED

Professional

Both

$1,189.00

Service Code	HCPCS 11772
Min. Negotiated Rate	$365.72
Max. Negotiated Rate	$891.75
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: Aetna Medicare	$594.50
Rate for Payer: BCBS Complete	$384.01
Rate for Payer: BCN Commercial	$876.45
Rate for Payer: Cash Price	$951.20
Rate for Payer: Cash Price	$951.20
Rate for Payer: Mclaren Medicaid	$365.72
Rate for Payer: Meridian Medicaid	$384.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$891.75
Rate for Payer: Priority Health Choice Medicaid	$365.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$802.18
Rate for Payer: Priority Health Narrow/Tiered Network	$802.18
Rate for Payer: UHC Medicaid	$365.72
Rate for Payer: UHCCP Medicaid	$365.72

PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE

Facility

$1,383.00

Service Code	CPT 11771
Hospital Charge Code	11771
Hospital Revenue Code	960
Min. Negotiated Rate	$962.57
Max. Negotiated Rate	$1,244.70
Rate for Payer: Aetna Commercial	$1,175.55
Rate for Payer: BCBS Trust/PPO	$1,142.22
Rate for Payer: BCN Commercial	$1,142.22
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cofinity Commercial	$1,189.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,106.40
Rate for Payer: Healthscope Commercial	$1,244.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,037.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,175.55
Rate for Payer: Nomi Health Commercial	$1,134.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: PHP Commercial	$1,175.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,203.21
Rate for Payer: Priority Health Narrow/Tiered Network	$962.57
Rate for Payer: UHC Core	$1,154.81
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,037.25

PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE

Professional

Both

$1,383.00

Service Code	HCPCS 11771
Min. Negotiated Rate	$281.80
Max. Negotiated Rate	$1,037.25
Rate for Payer: Aetna Commercial	$483.14
Rate for Payer: Aetna Medicare	$691.50
Rate for Payer: BCBS Complete	$295.89
Rate for Payer: BCN Commercial	$682.23
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Mclaren Medicaid	$281.80
Rate for Payer: Meridian Medicaid	$295.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: Priority Health Choice Medicaid	$281.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$624.42
Rate for Payer: Priority Health Narrow/Tiered Network	$624.42
Rate for Payer: UHC Medicaid	$281.80
Rate for Payer: UHCCP Medicaid	$281.80

PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE

Professional

Both

$1,383.00

Service Code	HCPCS 11771
Hospital Charge Code	11771
Min. Negotiated Rate	$281.80
Max. Negotiated Rate	$1,037.25
Rate for Payer: Aetna Commercial	$483.14
Rate for Payer: Aetna Medicare	$691.50
Rate for Payer: BCBS Complete	$295.89
Rate for Payer: BCN Commercial	$682.23
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Mclaren Medicaid	$281.80
Rate for Payer: Meridian Medicaid	$295.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: Priority Health Choice Medicaid	$281.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$624.42
Rate for Payer: Priority Health Narrow/Tiered Network	$624.42
Rate for Payer: UHC Medicaid	$281.80
Rate for Payer: UHCCP Medicaid	$281.80

PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE

Facility

$1,383.00

Service Code	CPT 11771
Hospital Charge Code	11771
Hospital Revenue Code	960
Min. Negotiated Rate	$243.82
Max. Negotiated Rate	$1,244.70
Rate for Payer: Aetna Commercial	$1,175.55
Rate for Payer: Aetna Medicare	$359.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$432.19
Rate for Payer: Amish Plain Church Group Commercial	$432.19
Rate for Payer: BCBS Complete	$255.99
Rate for Payer: BCBS MAPPO	$345.75
Rate for Payer: BCBS Trust/PPO	$1,136.96
Rate for Payer: BCN Commercial	$1,136.96
Rate for Payer: BCN Medicare Advantage	$345.75
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cofinity Commercial	$1,189.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,106.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$345.75
Rate for Payer: Healthscope Commercial	$1,244.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,037.25
Rate for Payer: Mclaren Medicaid	$243.82
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$363.04
Rate for Payer: Meridian Medicaid	$255.99
Rate for Payer: MI Amish Medical Board Commercial	$397.61
Rate for Payer: Molina Medicare/Medicaid	$380.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,175.55
Rate for Payer: Nomi Health Commercial	$1,134.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: PACE Senior Care Partners	$328.46
Rate for Payer: PACE SWMI	$345.75
Rate for Payer: PHP Commercial	$1,175.55
Rate for Payer: PHP Medicare Advantage	$345.75
Rate for Payer: Priority Health Choice Medicaid	$243.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,203.21
Rate for Payer: Priority Health Medicare	$349.21
Rate for Payer: Priority Health Narrow/Tiered Network	$962.57
Rate for Payer: Railroad Medicare Medicare	$345.75
Rate for Payer: UHC Core	$1,154.81
Rate for Payer: UHC Exchange	$345.75
Rate for Payer: UHC Medicaid	$243.82
Rate for Payer: UHC Medicare Advantage	$345.75
Rate for Payer: UHCCP Medicaid	$243.82
Rate for Payer: VA VA	$345.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,037.25

PR EXCISION PILONIDAL CYST/SINUS SIMPLE

Professional

Both

$536.00

Service Code	HCPCS 11770
Hospital Charge Code	11770
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$402.00
Rate for Payer: Aetna Commercial	$202.59
Rate for Payer: Aetna Medicare	$268.00
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$278.87
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cash Price	$428.80
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$255.24
Rate for Payer: Priority Health Narrow/Tiered Network	$255.24
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

PR EXCISION PILONIDAL CYST/SINUS SIMPLE

Facility

$536.00

Service Code	CPT 11770
Hospital Charge Code	11770
Hospital Revenue Code	960
Min. Negotiated Rate	$373.06
Max. Negotiated Rate	$482.40
Rate for Payer: Aetna Commercial	$455.60
Rate for Payer: BCBS Trust/PPO	$442.68
Rate for Payer: BCN Commercial	$442.68
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cofinity Commercial	$460.96
Rate for Payer: Encore Health Key Benefits Commercial	$428.80
Rate for Payer: Healthscope Commercial	$482.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$402.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.60
Rate for Payer: Nomi Health Commercial	$439.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00
Rate for Payer: PHP Commercial	$455.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$466.32
Rate for Payer: Priority Health Narrow/Tiered Network	$373.06
Rate for Payer: UHC Core	$447.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$402.00

PR EXCISION PILONIDAL CYST/SINUS SIMPLE

Facility

$536.00

Service Code	CPT 11770
Hospital Charge Code	11770
Hospital Revenue Code	960
Min. Negotiated Rate	$94.50
Max. Negotiated Rate	$482.40
Rate for Payer: Aetna Commercial	$455.60
Rate for Payer: Aetna Medicare	$139.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$167.50
Rate for Payer: Amish Plain Church Group Commercial	$167.50
Rate for Payer: BCBS Complete	$99.21
Rate for Payer: BCBS MAPPO	$134.00
Rate for Payer: BCBS Trust/PPO	$440.65
Rate for Payer: BCN Commercial	$440.65
Rate for Payer: BCN Medicare Advantage	$134.00
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cofinity Commercial	$460.96
Rate for Payer: Encore Health Key Benefits Commercial	$428.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$134.00
Rate for Payer: Healthscope Commercial	$482.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$402.00
Rate for Payer: Mclaren Medicaid	$94.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.70
Rate for Payer: Meridian Medicaid	$99.21
Rate for Payer: MI Amish Medical Board Commercial	$154.10
Rate for Payer: Molina Medicare/Medicaid	$147.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$455.60
Rate for Payer: Nomi Health Commercial	$439.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00
Rate for Payer: PACE Senior Care Partners	$127.30
Rate for Payer: PACE SWMI	$134.00
Rate for Payer: PHP Commercial	$455.60
Rate for Payer: PHP Medicare Advantage	$134.00
Rate for Payer: Priority Health Choice Medicaid	$94.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$466.32
Rate for Payer: Priority Health Medicare	$135.34
Rate for Payer: Priority Health Narrow/Tiered Network	$373.06
Rate for Payer: Railroad Medicare Medicare	$134.00
Rate for Payer: UHC Core	$447.56
Rate for Payer: UHC Exchange	$134.00
Rate for Payer: UHC Medicaid	$94.50
Rate for Payer: UHC Medicare Advantage	$134.00
Rate for Payer: UHCCP Medicaid	$94.50
Rate for Payer: VA VA	$134.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$402.00

PR EXCISION PILONIDAL CYST/SINUS SIMPLE

Professional

Both

$536.00

Service Code	HCPCS 11770
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$402.00
Rate for Payer: Aetna Commercial	$202.59
Rate for Payer: Aetna Medicare	$268.00
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$278.87
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cash Price	$428.80
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$255.24
Rate for Payer: Priority Health Narrow/Tiered Network	$255.24
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

PR EXCISION PREPATELLAR BURSA

Professional

Both

$1,340.00

Service Code	HCPCS 27340
Min. Negotiated Rate	$235.79
Max. Negotiated Rate	$1,005.00
Rate for Payer: Aetna Commercial	$495.88
Rate for Payer: Aetna Medicare	$670.00
Rate for Payer: BCBS Complete	$247.58
Rate for Payer: BCN Commercial	$580.15
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Mclaren Medicaid	$235.79
Rate for Payer: Meridian Medicaid	$247.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,005.00
Rate for Payer: Priority Health Choice Medicaid	$235.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$620.17
Rate for Payer: Priority Health Narrow/Tiered Network	$620.17
Rate for Payer: UHC Medicaid	$235.79
Rate for Payer: UHCCP Medicaid	$235.79

PR EXCISION RADIAL HEAD

Professional

Both

$1,294.00

Service Code	HCPCS 24130
Min. Negotiated Rate	$309.49
Max. Negotiated Rate	$970.50
Rate for Payer: Aetna Commercial	$679.15
Rate for Payer: Aetna Medicare	$647.00
Rate for Payer: BCBS Complete	$324.96
Rate for Payer: BCN Commercial	$790.79
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Mclaren Medicaid	$309.49
Rate for Payer: Meridian Medicaid	$324.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: Priority Health Choice Medicaid	$309.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$845.33
Rate for Payer: Priority Health Narrow/Tiered Network	$845.33
Rate for Payer: UHC Medicaid	$309.49
Rate for Payer: UHCCP Medicaid	$309.49

PR EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN

Professional

Both

$1,187.00

Service Code	HCPCS 67961
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$890.25
Rate for Payer: Aetna Commercial	$587.78
Rate for Payer: Aetna Medicare	$593.50
Rate for Payer: BCBS Complete	$261.45
Rate for Payer: BCN Commercial	$674.27
Rate for Payer: Cash Price	$949.60
Rate for Payer: Cash Price	$949.60
Rate for Payer: Mclaren Medicaid	$249.00
Rate for Payer: Meridian Medicaid	$261.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$890.25
Rate for Payer: Priority Health Choice Medicaid	$249.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$789.79
Rate for Payer: Priority Health Narrow/Tiered Network	$789.79
Rate for Payer: UHC Medicaid	$249.00
Rate for Payer: UHCCP Medicaid	$249.00

PR EXCISION RIB PARTIAL

Professional

Both

$1,674.00

Service Code	HCPCS 21600
Min. Negotiated Rate	$362.10
Max. Negotiated Rate	$1,255.50
Rate for Payer: Aetna Commercial	$740.10
Rate for Payer: Aetna Medicare	$837.00
Rate for Payer: BCBS Complete	$380.20
Rate for Payer: BCN Commercial	$870.97
Rate for Payer: Cash Price	$1,339.20
Rate for Payer: Cash Price	$1,339.20
Rate for Payer: Mclaren Medicaid	$362.10
Rate for Payer: Meridian Medicaid	$380.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,255.50
Rate for Payer: Priority Health Choice Medicaid	$362.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$931.04
Rate for Payer: Priority Health Narrow/Tiered Network	$931.04
Rate for Payer: UHC Medicaid	$362.10
Rate for Payer: UHCCP Medicaid	$362.10

PR EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE

Professional

Both

$1,209.00

Service Code	HCPCS 15931
Min. Negotiated Rate	$429.41
Max. Negotiated Rate	$1,066.68
Rate for Payer: Aetna Commercial	$766.63
Rate for Payer: Aetna Medicare	$604.50
Rate for Payer: BCBS Complete	$450.88
Rate for Payer: BCN Commercial	$1,066.68
Rate for Payer: Cash Price	$967.20
Rate for Payer: Cash Price	$967.20
Rate for Payer: Mclaren Medicaid	$429.41
Rate for Payer: Meridian Medicaid	$450.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$906.75
Rate for Payer: Priority Health Choice Medicaid	$429.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$976.28
Rate for Payer: Priority Health Narrow/Tiered Network	$976.28
Rate for Payer: UHC Medicaid	$429.41
Rate for Payer: UHCCP Medicaid	$429.41

PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS

Professional

Both

$453.00

Service Code	HCPCS 46220
Hospital Charge Code	46220
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$339.75
Rate for Payer: Aetna Commercial	$159.56
Rate for Payer: Aetna Medicare	$226.50
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCN Commercial	$184.25
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cash Price	$362.40
Rate for Payer: Mclaren Medicaid	$76.25
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.75
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$224.50
Rate for Payer: Priority Health Narrow/Tiered Network	$224.50
Rate for Payer: UHC Medicaid	$76.25
Rate for Payer: UHCCP Medicaid	$76.25

PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS

Professional

Both

$453.00

Service Code	HCPCS 46220
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$339.75
Rate for Payer: Aetna Commercial	$159.56
Rate for Payer: Aetna Medicare	$226.50
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCN Commercial	$184.25
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cash Price	$362.40
Rate for Payer: Mclaren Medicaid	$76.25
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.75
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$224.50
Rate for Payer: Priority Health Narrow/Tiered Network	$224.50
Rate for Payer: UHC Medicaid	$76.25
Rate for Payer: UHCCP Medicaid	$76.25

PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS

Facility

$453.00

Service Code	CPT 46220
Hospital Charge Code	46220
Hospital Revenue Code	960
Min. Negotiated Rate	$315.29
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna Commercial	$385.05
Rate for Payer: BCBS Trust/PPO	$374.13
Rate for Payer: BCN Commercial	$374.13
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cofinity Commercial	$389.58
Rate for Payer: Encore Health Key Benefits Commercial	$362.40
Rate for Payer: Healthscope Commercial	$407.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$339.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.05
Rate for Payer: Nomi Health Commercial	$371.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.75
Rate for Payer: PHP Commercial	$385.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$394.11
Rate for Payer: Priority Health Narrow/Tiered Network	$315.29
Rate for Payer: UHC Core	$378.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$339.75

PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS

Facility

$453.00

Service Code	CPT 46220
Hospital Charge Code	46220
Hospital Revenue Code	960
Min. Negotiated Rate	$79.86
Max. Negotiated Rate	$407.70
Rate for Payer: Aetna Commercial	$385.05
Rate for Payer: Aetna Medicare	$117.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$141.56
Rate for Payer: Amish Plain Church Group Commercial	$141.56
Rate for Payer: BCBS Complete	$83.85
Rate for Payer: BCBS MAPPO	$113.25
Rate for Payer: BCBS Trust/PPO	$372.41
Rate for Payer: BCN Commercial	$372.41
Rate for Payer: BCN Medicare Advantage	$113.25
Rate for Payer: Cash Price	$362.40
Rate for Payer: Cofinity Commercial	$389.58
Rate for Payer: Encore Health Key Benefits Commercial	$362.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$113.25
Rate for Payer: Healthscope Commercial	$407.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$339.75
Rate for Payer: Mclaren Medicaid	$79.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$118.91
Rate for Payer: Meridian Medicaid	$83.85
Rate for Payer: MI Amish Medical Board Commercial	$130.24
Rate for Payer: Molina Medicare/Medicaid	$124.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.05
Rate for Payer: Nomi Health Commercial	$371.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.75
Rate for Payer: PACE Senior Care Partners	$107.59
Rate for Payer: PACE SWMI	$113.25
Rate for Payer: PHP Commercial	$385.05
Rate for Payer: PHP Medicare Advantage	$113.25
Rate for Payer: Priority Health Choice Medicaid	$79.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$394.11
Rate for Payer: Priority Health Medicare	$114.38
Rate for Payer: Priority Health Narrow/Tiered Network	$315.29
Rate for Payer: Railroad Medicare Medicare	$113.25
Rate for Payer: UHC Core	$378.25
Rate for Payer: UHC Exchange	$113.25
Rate for Payer: UHC Medicaid	$79.86
Rate for Payer: UHC Medicare Advantage	$113.25
Rate for Payer: UHCCP Medicaid	$79.86
Rate for Payer: VA VA	$113.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$339.75

PR EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL

Professional

Both

$696.00

Service Code	HCPCS 69145
Min. Negotiated Rate	$151.23
Max. Negotiated Rate	$522.00
Rate for Payer: Aetna Commercial	$284.48
Rate for Payer: Aetna Medicare	$348.00
Rate for Payer: BCBS Complete	$158.79
Rate for Payer: BCN Commercial	$386.44
Rate for Payer: Cash Price	$556.80
Rate for Payer: Cash Price	$556.80
Rate for Payer: Mclaren Medicaid	$151.23
Rate for Payer: Meridian Medicaid	$158.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$522.00
Rate for Payer: Priority Health Choice Medicaid	$151.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$381.84
Rate for Payer: Priority Health Narrow/Tiered Network	$381.84
Rate for Payer: UHC Medicaid	$151.23
Rate for Payer: UHCCP Medicaid	$151.23

PR EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY

Professional

Both

$616.00

Service Code	HCPCS 54840
Min. Negotiated Rate	$190.42
Max. Negotiated Rate	$529.44
Rate for Payer: Aetna Commercial	$412.87
Rate for Payer: Aetna Medicare	$308.00
Rate for Payer: BCBS Complete	$199.94
Rate for Payer: BCN Commercial	$486.03
Rate for Payer: Cash Price	$492.80
Rate for Payer: Cash Price	$492.80
Rate for Payer: Mclaren Medicaid	$190.42
Rate for Payer: Meridian Medicaid	$199.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$462.00
Rate for Payer: Priority Health Choice Medicaid	$190.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$529.44
Rate for Payer: Priority Health Narrow/Tiered Network	$529.44
Rate for Payer: UHC Medicaid	$190.42
Rate for Payer: UHCCP Medicaid	$190.42

PR EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND

Professional

Both

$2,340.00

Service Code	HCPCS 42440
Min. Negotiated Rate	$236.22
Max. Negotiated Rate	$1,755.00
Rate for Payer: Aetna Commercial	$546.03
Rate for Payer: Aetna Medicare	$1,170.00
Rate for Payer: BCBS Complete	$248.03
Rate for Payer: BCN Commercial	$628.95
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Cash Price	$1,872.00
Rate for Payer: Mclaren Medicaid	$236.22
Rate for Payer: Meridian Medicaid	$248.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,755.00
Rate for Payer: Priority Health Choice Medicaid	$236.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$766.34
Rate for Payer: Priority Health Narrow/Tiered Network	$766.34
Rate for Payer: UHC Medicaid	$236.22
Rate for Payer: UHCCP Medicaid	$236.22

Know your out-of-pocket cost for care.

All Charges