Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV

Professional

Both

$2,452.00

Service Code	HCPCS 64790
Min. Negotiated Rate	$512.69
Max. Negotiated Rate	$1,839.00
Rate for Payer: Aetna Commercial	$1,074.60
Rate for Payer: Aetna Medicare	$1,226.00
Rate for Payer: BCBS Complete	$538.32
Rate for Payer: BCN Commercial	$1,299.73
Rate for Payer: Cash Price	$1,961.60
Rate for Payer: Cash Price	$1,961.60
Rate for Payer: Mclaren Medicaid	$512.69
Rate for Payer: Meridian Medicaid	$538.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,839.00
Rate for Payer: Priority Health Choice Medicaid	$512.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,509.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,509.61
Rate for Payer: UHC Medicaid	$512.69
Rate for Payer: UHCCP Medicaid	$512.69

PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE

Professional

Both

$1,255.00

Service Code	HCPCS 64774
Min. Negotiated Rate	$262.63
Max. Negotiated Rate	$941.25
Rate for Payer: Aetna Commercial	$520.46
Rate for Payer: Aetna Medicare	$627.50
Rate for Payer: BCBS Complete	$275.76
Rate for Payer: BCN Commercial	$654.35
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Mclaren Medicaid	$262.63
Rate for Payer: Meridian Medicaid	$275.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$941.25
Rate for Payer: Priority Health Choice Medicaid	$262.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$760.01
Rate for Payer: Priority Health Narrow/Tiered Network	$760.01
Rate for Payer: UHC Medicaid	$262.63
Rate for Payer: UHCCP Medicaid	$262.63

PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT

Professional

Both

$1,297.00

Service Code	HCPCS 64776
Min. Negotiated Rate	$238.77
Max. Negotiated Rate	$972.75
Rate for Payer: Aetna Commercial	$501.13
Rate for Payer: Aetna Medicare	$648.50
Rate for Payer: BCBS Complete	$250.71
Rate for Payer: BCN Commercial	$613.51
Rate for Payer: Cash Price	$1,037.60
Rate for Payer: Cash Price	$1,037.60
Rate for Payer: Mclaren Medicaid	$238.77
Rate for Payer: Meridian Medicaid	$250.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$972.75
Rate for Payer: Priority Health Choice Medicaid	$238.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$712.59
Rate for Payer: Priority Health Narrow/Tiered Network	$712.59
Rate for Payer: UHC Medicaid	$238.77
Rate for Payer: UHCCP Medicaid	$238.77

PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT

Professional

Both

$458.00

Service Code	HCPCS 64783
Min. Negotiated Rate	$118.22
Max. Negotiated Rate	$371.91
Rate for Payer: Aetna Commercial	$279.67
Rate for Payer: Aetna Medicare	$229.00
Rate for Payer: BCBS Complete	$124.13
Rate for Payer: BCN Commercial	$320.20
Rate for Payer: Cash Price	$366.40
Rate for Payer: Cash Price	$366.40
Rate for Payer: Mclaren Medicaid	$118.22
Rate for Payer: Meridian Medicaid	$124.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$343.50
Rate for Payer: Priority Health Choice Medicaid	$118.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$371.91
Rate for Payer: Priority Health Narrow/Tiered Network	$371.91
Rate for Payer: UHC Medicaid	$118.22
Rate for Payer: UHCCP Medicaid	$118.22

PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE

Professional

Both

$1,745.00

Service Code	HCPCS 64782
Min. Negotiated Rate	$278.18
Max. Negotiated Rate	$1,308.75
Rate for Payer: Aetna Commercial	$586.40
Rate for Payer: Aetna Medicare	$872.50
Rate for Payer: BCBS Complete	$292.09
Rate for Payer: BCN Commercial	$698.67
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Cash Price	$1,396.00
Rate for Payer: Mclaren Medicaid	$278.18
Rate for Payer: Meridian Medicaid	$292.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,308.75
Rate for Payer: Priority Health Choice Medicaid	$278.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$811.49
Rate for Payer: Priority Health Narrow/Tiered Network	$811.49
Rate for Payer: UHC Medicaid	$278.18
Rate for Payer: UHCCP Medicaid	$278.18

PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC

Professional

Both

$2,564.00

Service Code	HCPCS 64784
Min. Negotiated Rate	$429.20
Max. Negotiated Rate	$1,923.00
Rate for Payer: Aetna Commercial	$937.29
Rate for Payer: Aetna Medicare	$1,282.00
Rate for Payer: BCBS Complete	$450.66
Rate for Payer: BCN Commercial	$1,104.52
Rate for Payer: Cash Price	$2,051.20
Rate for Payer: Cash Price	$2,051.20
Rate for Payer: Mclaren Medicaid	$429.20
Rate for Payer: Meridian Medicaid	$450.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,923.00
Rate for Payer: Priority Health Choice Medicaid	$429.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,282.89
Rate for Payer: Priority Health Narrow/Tiered Network	$1,282.89
Rate for Payer: UHC Medicaid	$429.20
Rate for Payer: UHCCP Medicaid	$429.20

PR EXC PRESAC/SACROCOCCYGEAL TUMOR

Professional

Both

$4,120.00

Service Code	HCPCS 49215
Min. Negotiated Rate	$1,277.57
Max. Negotiated Rate	$4,028.25
Rate for Payer: Aetna Commercial	$2,988.87
Rate for Payer: Aetna Medicare	$2,060.00
Rate for Payer: BCBS Complete	$1,341.45
Rate for Payer: BCN Commercial	$3,306.09
Rate for Payer: Cash Price	$3,296.00
Rate for Payer: Cash Price	$3,296.00
Rate for Payer: Mclaren Medicaid	$1,277.57
Rate for Payer: Meridian Medicaid	$1,341.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,090.00
Rate for Payer: Priority Health Choice Medicaid	$1,277.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,028.25
Rate for Payer: Priority Health Narrow/Tiered Network	$4,028.25
Rate for Payer: UHC Medicaid	$1,277.57
Rate for Payer: UHCCP Medicaid	$1,277.57

PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR

Professional

Both

$1,841.00

Service Code	HCPCS 42415
Min. Negotiated Rate	$586.82
Max. Negotiated Rate	$1,941.01
Rate for Payer: Aetna Commercial	$1,398.85
Rate for Payer: Aetna Medicare	$920.50
Rate for Payer: BCBS Complete	$616.16
Rate for Payer: BCN Commercial	$1,593.04
Rate for Payer: Cash Price	$1,472.80
Rate for Payer: Cash Price	$1,472.80
Rate for Payer: Mclaren Medicaid	$586.82
Rate for Payer: Meridian Medicaid	$616.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,380.75
Rate for Payer: Priority Health Choice Medicaid	$586.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,941.01
Rate for Payer: Priority Health Narrow/Tiered Network	$1,941.01
Rate for Payer: UHC Medicaid	$586.82
Rate for Payer: UHCCP Medicaid	$586.82

PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ

Professional

Both

$1,220.00

Service Code	HCPCS 42410
Min. Negotiated Rate	$355.28
Max. Negotiated Rate	$1,157.09
Rate for Payer: Aetna Commercial	$830.54
Rate for Payer: Aetna Medicare	$610.00
Rate for Payer: BCBS Complete	$373.04
Rate for Payer: BCN Commercial	$949.65
Rate for Payer: Cash Price	$976.00
Rate for Payer: Cash Price	$976.00
Rate for Payer: Mclaren Medicaid	$355.28
Rate for Payer: Meridian Medicaid	$373.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.00
Rate for Payer: Priority Health Choice Medicaid	$355.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,157.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,157.09
Rate for Payer: UHC Medicaid	$355.28
Rate for Payer: UHCCP Medicaid	$355.28

PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR

Professional

Both

$2,093.00

Service Code	HCPCS 42420
Min. Negotiated Rate	$654.12
Max. Negotiated Rate	$2,172.18
Rate for Payer: Aetna Commercial	$1,570.77
Rate for Payer: Aetna Medicare	$1,046.50
Rate for Payer: BCBS Complete	$686.83
Rate for Payer: BCN Commercial	$1,782.77
Rate for Payer: Cash Price	$1,674.40
Rate for Payer: Cash Price	$1,674.40
Rate for Payer: Mclaren Medicaid	$654.12
Rate for Payer: Meridian Medicaid	$686.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,569.75
Rate for Payer: Priority Health Choice Medicaid	$654.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,172.18
Rate for Payer: Priority Health Narrow/Tiered Network	$2,172.18
Rate for Payer: UHC Medicaid	$654.12
Rate for Payer: UHCCP Medicaid	$654.12

PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH

Professional

Both

$2,784.00

Service Code	HCPCS 45135
Min. Negotiated Rate	$762.75
Max. Negotiated Rate	$2,355.43
Rate for Payer: Aetna Commercial	$1,721.13
Rate for Payer: Aetna Medicare	$1,392.00
Rate for Payer: BCBS Complete	$800.89
Rate for Payer: BCN Commercial	$1,933.16
Rate for Payer: Cash Price	$2,227.20
Rate for Payer: Cash Price	$2,227.20
Rate for Payer: Mclaren Medicaid	$762.75
Rate for Payer: Meridian Medicaid	$800.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,088.00
Rate for Payer: Priority Health Choice Medicaid	$762.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,355.43
Rate for Payer: Priority Health Narrow/Tiered Network	$2,355.43
Rate for Payer: UHC Medicaid	$762.75
Rate for Payer: UHCCP Medicaid	$762.75

PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH

Professional

Both

$2,912.00

Service Code	HCPCS 45130
Min. Negotiated Rate	$640.70
Max. Negotiated Rate	$2,184.00
Rate for Payer: Aetna Commercial	$1,446.17
Rate for Payer: Aetna Medicare	$1,456.00
Rate for Payer: BCBS Complete	$672.74
Rate for Payer: BCN Commercial	$1,618.93
Rate for Payer: Cash Price	$2,329.60
Rate for Payer: Cash Price	$2,329.60
Rate for Payer: Mclaren Medicaid	$640.70
Rate for Payer: Meridian Medicaid	$672.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,184.00
Rate for Payer: Priority Health Choice Medicaid	$640.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,972.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,972.56
Rate for Payer: UHC Medicaid	$640.70
Rate for Payer: UHCCP Medicaid	$640.70

PR EXC RCT TUM INCL MUSCULARIS PROPRIA

Professional

Both

$1,939.00

Service Code	HCPCS 45172
Min. Negotiated Rate	$506.94
Max. Negotiated Rate	$1,509.01
Rate for Payer: Aetna Commercial	$1,102.79
Rate for Payer: Aetna Medicare	$969.50
Rate for Payer: BCBS Complete	$532.29
Rate for Payer: BCN Commercial	$1,238.48
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Mclaren Medicaid	$506.94
Rate for Payer: Meridian Medicaid	$532.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,454.25
Rate for Payer: Priority Health Choice Medicaid	$506.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,509.01
Rate for Payer: Priority Health Narrow/Tiered Network	$1,509.01
Rate for Payer: UHC Medicaid	$506.94
Rate for Payer: UHCCP Medicaid	$506.94

PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA

Professional

Both

$1,411.00

Service Code	HCPCS 45171
Min. Negotiated Rate	$390.22
Max. Negotiated Rate	$1,135.24
Rate for Payer: Aetna Commercial	$825.89
Rate for Payer: Aetna Medicare	$705.50
Rate for Payer: BCBS Complete	$409.73
Rate for Payer: BCN Commercial	$931.72
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Mclaren Medicaid	$390.22
Rate for Payer: Meridian Medicaid	$409.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,058.25
Rate for Payer: Priority Health Choice Medicaid	$390.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,135.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,135.24
Rate for Payer: UHC Medicaid	$390.22
Rate for Payer: UHCCP Medicaid	$390.22

PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL

Professional

Both

$2,155.00

Service Code	HCPCS 45160
Min. Negotiated Rate	$622.60
Max. Negotiated Rate	$1,887.02
Rate for Payer: Aetna Commercial	$1,385.01
Rate for Payer: Aetna Medicare	$1,077.50
Rate for Payer: BCBS Complete	$653.73
Rate for Payer: BCN Commercial	$1,548.72
Rate for Payer: Cash Price	$1,724.00
Rate for Payer: Cash Price	$1,724.00
Rate for Payer: Mclaren Medicaid	$622.60
Rate for Payer: Meridian Medicaid	$653.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,616.25
Rate for Payer: Priority Health Choice Medicaid	$622.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,887.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,887.02
Rate for Payer: UHC Medicaid	$622.60
Rate for Payer: UHCCP Medicaid	$622.60

PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR

Professional

Both

$1,595.00

Service Code	HCPCS 15936
Min. Negotiated Rate	$534.42
Max. Negotiated Rate	$1,340.57
Rate for Payer: Aetna Commercial	$982.56
Rate for Payer: Aetna Medicare	$797.50
Rate for Payer: BCBS Complete	$561.14
Rate for Payer: BCN Commercial	$1,340.57
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Mclaren Medicaid	$534.42
Rate for Payer: Meridian Medicaid	$561.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,196.25
Rate for Payer: Priority Health Choice Medicaid	$534.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,226.97
Rate for Payer: Priority Health Narrow/Tiered Network	$1,226.97
Rate for Payer: UHC Medicaid	$534.42
Rate for Payer: UHCCP Medicaid	$534.42

PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC

Professional

Both

$2,170.00

Service Code	HCPCS 15937
Min. Negotiated Rate	$586.39
Max. Negotiated Rate	$1,627.50
Rate for Payer: Aetna Commercial	$1,133.75
Rate for Payer: Aetna Medicare	$1,085.00
Rate for Payer: BCBS Complete	$615.71
Rate for Payer: BCN Commercial	$1,479.50
Rate for Payer: Cash Price	$1,736.00
Rate for Payer: Cash Price	$1,736.00
Rate for Payer: Mclaren Medicaid	$586.39
Rate for Payer: Meridian Medicaid	$615.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,627.50
Rate for Payer: Priority Health Choice Medicaid	$586.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,354.12
Rate for Payer: Priority Health Narrow/Tiered Network	$1,354.12
Rate for Payer: UHC Medicaid	$586.39
Rate for Payer: UHCCP Medicaid	$586.39

PR EXC SUBLINGUAL SALIVARY CYST RANULA

Professional

Both

$750.00

Service Code	HCPCS 42408
Min. Negotiated Rate	$206.82
Max. Negotiated Rate	$644.38
Rate for Payer: Aetna Commercial	$459.09
Rate for Payer: Aetna Medicare	$375.00
Rate for Payer: BCBS Complete	$217.16
Rate for Payer: BCN Commercial	$528.85
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Mclaren Medicaid	$206.82
Rate for Payer: Meridian Medicaid	$217.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$562.50
Rate for Payer: Priority Health Choice Medicaid	$206.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$644.38
Rate for Payer: Priority Health Narrow/Tiered Network	$644.38
Rate for Payer: UHC Medicaid	$206.82
Rate for Payer: UHCCP Medicaid	$206.82

PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA

Professional

Both

$1,856.00

Service Code	HCPCS 25109
Min. Negotiated Rate	$322.70
Max. Negotiated Rate	$1,392.00
Rate for Payer: Aetna Commercial	$711.43
Rate for Payer: Aetna Medicare	$928.00
Rate for Payer: BCBS Complete	$338.83
Rate for Payer: BCN Commercial	$826.65
Rate for Payer: Cash Price	$1,484.80
Rate for Payer: Cash Price	$1,484.80
Rate for Payer: Mclaren Medicaid	$322.70
Rate for Payer: Meridian Medicaid	$338.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,392.00
Rate for Payer: Priority Health Choice Medicaid	$322.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$883.66
Rate for Payer: Priority Health Narrow/Tiered Network	$883.66
Rate for Payer: UHC Medicaid	$322.70
Rate for Payer: UHCCP Medicaid	$322.70

PR EXC THROMBOSED HEMORRHOID XTRNL

Professional

Both

$366.00

Service Code	HCPCS 46320
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Commercial	$150.24
Rate for Payer: Aetna Medicare	$183.00
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCN Commercial	$171.30
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cash Price	$292.80
Rate for Payer: Mclaren Medicaid	$69.01
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$274.50
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$208.72
Rate for Payer: Priority Health Narrow/Tiered Network	$208.72
Rate for Payer: UHC Medicaid	$69.01
Rate for Payer: UHCCP Medicaid	$69.01

PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR

Professional

Both

$1,235.00

Service Code	HCPCS 15950
Min. Negotiated Rate	$375.31
Max. Negotiated Rate	$964.59
Rate for Payer: Aetna Commercial	$662.98
Rate for Payer: Aetna Medicare	$617.50
Rate for Payer: BCBS Complete	$394.08
Rate for Payer: BCN Commercial	$964.59
Rate for Payer: Cash Price	$988.00
Rate for Payer: Cash Price	$988.00
Rate for Payer: Mclaren Medicaid	$375.31
Rate for Payer: Meridian Medicaid	$394.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$926.25
Rate for Payer: Priority Health Choice Medicaid	$375.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$882.85
Rate for Payer: Priority Health Narrow/Tiered Network	$882.85
Rate for Payer: UHC Medicaid	$375.31
Rate for Payer: UHCCP Medicaid	$375.31

PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN

Professional

Both

$2,055.00

Service Code	HCPCS 15956
Min. Negotiated Rate	$697.15
Max. Negotiated Rate	$1,754.88
Rate for Payer: Aetna Commercial	$1,266.84
Rate for Payer: Aetna Medicare	$1,027.50
Rate for Payer: BCBS Complete	$732.01
Rate for Payer: BCN Commercial	$1,754.88
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Mclaren Medicaid	$697.15
Rate for Payer: Meridian Medicaid	$732.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,541.25
Rate for Payer: Priority Health Choice Medicaid	$697.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,606.17
Rate for Payer: Priority Health Narrow/Tiered Network	$1,606.17
Rate for Payer: UHC Medicaid	$697.15
Rate for Payer: UHCCP Medicaid	$697.15

PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>

Professional

Both

$2,295.00

Service Code	HCPCS 25073
Min. Negotiated Rate	$323.97
Max. Negotiated Rate	$1,721.25
Rate for Payer: Aetna Commercial	$712.93
Rate for Payer: Aetna Medicare	$1,147.50
Rate for Payer: BCBS Complete	$340.17
Rate for Payer: BCN Commercial	$822.16
Rate for Payer: Cash Price	$1,836.00
Rate for Payer: Cash Price	$1,836.00
Rate for Payer: Mclaren Medicaid	$323.97
Rate for Payer: Meridian Medicaid	$340.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,721.25
Rate for Payer: Priority Health Choice Medicaid	$323.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$878.87
Rate for Payer: Priority Health Narrow/Tiered Network	$878.87
Rate for Payer: UHC Medicaid	$323.97
Rate for Payer: UHCCP Medicaid	$323.97

PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>

Professional

Both

$1,270.00

Service Code	HCPCS 21552
Min. Negotiated Rate	$273.71
Max. Negotiated Rate	$952.50
Rate for Payer: Aetna Commercial	$597.45
Rate for Payer: Aetna Medicare	$635.00
Rate for Payer: BCBS Complete	$287.40
Rate for Payer: BCN Commercial	$680.24
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Cash Price	$1,016.00
Rate for Payer: Mclaren Medicaid	$273.71
Rate for Payer: Meridian Medicaid	$287.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$952.50
Rate for Payer: Priority Health Choice Medicaid	$273.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$727.15
Rate for Payer: Priority Health Narrow/Tiered Network	$727.15
Rate for Payer: UHC Medicaid	$273.71
Rate for Payer: UHCCP Medicaid	$273.71

PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>

Facility

$1,221.00

Service Code	CPT 21933
Hospital Charge Code	21933
Hospital Revenue Code	960
Min. Negotiated Rate	$849.82
Max. Negotiated Rate	$1,098.90
Rate for Payer: Aetna Commercial	$1,037.85
Rate for Payer: BCBS Trust/PPO	$1,008.42
Rate for Payer: BCN Commercial	$1,008.42
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cofinity Commercial	$1,050.06
Rate for Payer: Encore Health Key Benefits Commercial	$976.80
Rate for Payer: Healthscope Commercial	$1,098.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$915.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,037.85
Rate for Payer: Nomi Health Commercial	$1,001.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: PHP Commercial	$1,037.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,062.27
Rate for Payer: Priority Health Narrow/Tiered Network	$849.82
Rate for Payer: UHC Core	$1,019.53
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$915.75

Know your out-of-pocket cost for care.

All Charges