Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>

Professional

Both

$735.00

Service Code	HCPCS 22903
Min. Negotiated Rate	$273.49
Max. Negotiated Rate	$716.51
Rate for Payer: Aetna Commercial	$589.34
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$287.16
Rate for Payer: BCN Commercial	$670.28
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$273.49
Rate for Payer: Meridian Medicaid	$287.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$273.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$716.51
Rate for Payer: Priority Health Narrow/Tiered Network	$716.51
Rate for Payer: UHC Medicaid	$273.49
Rate for Payer: UHCCP Medicaid	$273.49

PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>

Professional

Both

$735.00

Service Code	HCPCS 22903
Hospital Charge Code	22903
Min. Negotiated Rate	$273.49
Max. Negotiated Rate	$716.51
Rate for Payer: Aetna Commercial	$589.34
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$287.16
Rate for Payer: BCN Commercial	$670.28
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$273.49
Rate for Payer: Meridian Medicaid	$287.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$273.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$716.51
Rate for Payer: Priority Health Narrow/Tiered Network	$716.51
Rate for Payer: UHC Medicaid	$273.49
Rate for Payer: UHCCP Medicaid	$273.49

PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>

Facility

$735.00

Service Code	CPT 22903
Hospital Charge Code	22903
Hospital Revenue Code	960
Min. Negotiated Rate	$511.56
Max. Negotiated Rate	$661.50
Rate for Payer: Aetna Commercial	$624.75
Rate for Payer: BCBS Trust/PPO	$607.04
Rate for Payer: BCN Commercial	$607.04
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cofinity Commercial	$632.10
Rate for Payer: Encore Health Key Benefits Commercial	$588.00
Rate for Payer: Healthscope Commercial	$661.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$551.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$624.75
Rate for Payer: Nomi Health Commercial	$602.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: PHP Commercial	$624.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$639.45
Rate for Payer: Priority Health Narrow/Tiered Network	$511.56
Rate for Payer: UHC Core	$613.73
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$551.25

PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM

Professional

Both

$815.00

Service Code	HCPCS 22902
Min. Negotiated Rate	$211.30
Max. Negotiated Rate	$611.25
Rate for Payer: Aetna Commercial	$444.06
Rate for Payer: Aetna Medicare	$407.50
Rate for Payer: BCBS Complete	$221.87
Rate for Payer: BCN Commercial	$509.93
Rate for Payer: Cash Price	$652.00
Rate for Payer: Cash Price	$652.00
Rate for Payer: Mclaren Medicaid	$211.30
Rate for Payer: Meridian Medicaid	$221.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$611.25
Rate for Payer: Priority Health Choice Medicaid	$211.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$545.11
Rate for Payer: Priority Health Narrow/Tiered Network	$545.11
Rate for Payer: UHC Medicaid	$211.30
Rate for Payer: UHCCP Medicaid	$211.30

PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>

Professional

Both

$1,242.00

Service Code	HCPCS 28041
Min. Negotiated Rate	$268.59
Max. Negotiated Rate	$931.50
Rate for Payer: Aetna Commercial	$597.23
Rate for Payer: Aetna Medicare	$621.00
Rate for Payer: BCBS Complete	$282.02
Rate for Payer: BCN Commercial	$682.23
Rate for Payer: Cash Price	$993.60
Rate for Payer: Cash Price	$993.60
Rate for Payer: Mclaren Medicaid	$268.59
Rate for Payer: Meridian Medicaid	$282.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$931.50
Rate for Payer: Priority Health Choice Medicaid	$268.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$729.29
Rate for Payer: Priority Health Narrow/Tiered Network	$729.29
Rate for Payer: UHC Medicaid	$268.59
Rate for Payer: UHCCP Medicaid	$268.59

PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM

Professional

Both

$907.00

Service Code	HCPCS 28045
Min. Negotiated Rate	$210.02
Max. Negotiated Rate	$680.25
Rate for Payer: Aetna Commercial	$458.34
Rate for Payer: Aetna Medicare	$453.50
Rate for Payer: BCBS Complete	$220.52
Rate for Payer: BCN Commercial	$530.35
Rate for Payer: Cash Price	$725.60
Rate for Payer: Cash Price	$725.60
Rate for Payer: Mclaren Medicaid	$210.02
Rate for Payer: Meridian Medicaid	$220.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$680.25
Rate for Payer: Priority Health Choice Medicaid	$210.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$566.93
Rate for Payer: Priority Health Narrow/Tiered Network	$566.93
Rate for Payer: UHC Medicaid	$210.02
Rate for Payer: UHCCP Medicaid	$210.02

PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

Facility

$1,210.00

Service Code	CPT 25075
Hospital Charge Code	25075
Hospital Revenue Code	361
Min. Negotiated Rate	$213.32
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna Commercial	$1,028.50
Rate for Payer: Aetna Medicare	$314.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$378.12
Rate for Payer: Amish Plain Church Group Commercial	$378.12
Rate for Payer: BCBS Complete	$223.97
Rate for Payer: BCBS MAPPO	$302.50
Rate for Payer: BCBS Trust/PPO	$994.74
Rate for Payer: BCN Commercial	$994.74
Rate for Payer: BCN Medicare Advantage	$302.50
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cofinity Commercial	$1,040.60
Rate for Payer: Encore Health Key Benefits Commercial	$968.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$302.50
Rate for Payer: Healthscope Commercial	$1,089.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$907.50
Rate for Payer: Mclaren Medicaid	$213.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$317.62
Rate for Payer: Meridian Medicaid	$223.97
Rate for Payer: MI Amish Medical Board Commercial	$347.88
Rate for Payer: Molina Medicare/Medicaid	$332.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,028.50
Rate for Payer: Nomi Health Commercial	$992.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: PACE Senior Care Partners	$287.38
Rate for Payer: PACE SWMI	$302.50
Rate for Payer: PHP Commercial	$1,028.50
Rate for Payer: PHP Medicare Advantage	$302.50
Rate for Payer: Priority Health Choice Medicaid	$213.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,052.70
Rate for Payer: Priority Health Medicare	$305.52
Rate for Payer: Priority Health Narrow/Tiered Network	$842.16
Rate for Payer: Railroad Medicare Medicare	$302.50
Rate for Payer: UHC All Payor (Choice/PPO)	$1,064.80
Rate for Payer: UHC Core	$1,010.35
Rate for Payer: UHC Exchange	$302.50
Rate for Payer: UHC Medicaid	$213.32
Rate for Payer: UHC Medicare Advantage	$302.50
Rate for Payer: UHCCP Medicaid	$213.32
Rate for Payer: VA VA	$302.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$907.50

PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

Facility

$1,210.00

Service Code	CPT 25075
Hospital Charge Code	25075
Hospital Revenue Code	361
Min. Negotiated Rate	$842.16
Max. Negotiated Rate	$1,089.00
Rate for Payer: Aetna Commercial	$1,028.50
Rate for Payer: BCBS Trust/PPO	$999.34
Rate for Payer: BCN Commercial	$999.34
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cofinity Commercial	$1,040.60
Rate for Payer: Encore Health Key Benefits Commercial	$968.00
Rate for Payer: Healthscope Commercial	$1,089.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$907.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,028.50
Rate for Payer: Nomi Health Commercial	$992.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: PHP Commercial	$1,028.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,052.70
Rate for Payer: Priority Health Narrow/Tiered Network	$842.16
Rate for Payer: UHC All Payor (Choice/PPO)	$1,064.80
Rate for Payer: UHC Core	$1,010.35
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$907.50

PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

Professional

Both

$1,210.00

Service Code	HCPCS 25075
Hospital Charge Code	25075
Min. Negotiated Rate	$195.53
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$418.59
Rate for Payer: Aetna Medicare	$605.00
Rate for Payer: BCBS Complete	$205.31
Rate for Payer: BCN Commercial	$485.54
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Mclaren Medicaid	$195.53
Rate for Payer: Meridian Medicaid	$205.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: Priority Health Choice Medicaid	$195.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$519.02
Rate for Payer: Priority Health Narrow/Tiered Network	$519.02
Rate for Payer: UHC Medicaid	$195.53
Rate for Payer: UHCCP Medicaid	$195.53

PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM

Professional

Both

$1,210.00

Service Code	HCPCS 25075
Min. Negotiated Rate	$195.53
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$418.59
Rate for Payer: Aetna Medicare	$605.00
Rate for Payer: BCBS Complete	$205.31
Rate for Payer: BCN Commercial	$485.54
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Mclaren Medicaid	$195.53
Rate for Payer: Meridian Medicaid	$205.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: Priority Health Choice Medicaid	$195.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$519.02
Rate for Payer: Priority Health Narrow/Tiered Network	$519.02
Rate for Payer: UHC Medicaid	$195.53
Rate for Payer: UHCCP Medicaid	$195.53

PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>

Professional

Both

$2,457.00

Service Code	HCPCS 27634
Min. Negotiated Rate	$397.46
Max. Negotiated Rate	$1,842.75
Rate for Payer: Aetna Commercial	$906.06
Rate for Payer: Aetna Medicare	$1,228.50
Rate for Payer: BCBS Complete	$417.33
Rate for Payer: BCN Commercial	$1,016.38
Rate for Payer: Cash Price	$1,965.60
Rate for Payer: Cash Price	$1,965.60
Rate for Payer: Mclaren Medicaid	$397.46
Rate for Payer: Meridian Medicaid	$417.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,842.75
Rate for Payer: Priority Health Choice Medicaid	$397.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,086.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,086.48
Rate for Payer: UHC Medicaid	$397.46
Rate for Payer: UHCCP Medicaid	$397.46

PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM

Professional

Both

$1,284.00

Service Code	HCPCS 27619
Min. Negotiated Rate	$278.18
Max. Negotiated Rate	$963.00
Rate for Payer: Aetna Commercial	$613.97
Rate for Payer: Aetna Medicare	$642.00
Rate for Payer: BCBS Complete	$292.09
Rate for Payer: BCN Commercial	$709.63
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Cash Price	$1,027.20
Rate for Payer: Mclaren Medicaid	$278.18
Rate for Payer: Meridian Medicaid	$292.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$963.00
Rate for Payer: Priority Health Choice Medicaid	$278.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$758.57
Rate for Payer: Priority Health Narrow/Tiered Network	$758.57
Rate for Payer: UHC Medicaid	$278.18
Rate for Payer: UHCCP Medicaid	$278.18

PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM

Professional

Both

$1,117.00

Service Code	HCPCS 27618
Min. Negotiated Rate	$190.21
Max. Negotiated Rate	$837.75
Rate for Payer: Aetna Commercial	$403.90
Rate for Payer: Aetna Medicare	$558.50
Rate for Payer: BCBS Complete	$199.72
Rate for Payer: BCN Commercial	$467.11
Rate for Payer: Cash Price	$893.60
Rate for Payer: Cash Price	$893.60
Rate for Payer: Mclaren Medicaid	$190.21
Rate for Payer: Meridian Medicaid	$199.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$837.75
Rate for Payer: Priority Health Choice Medicaid	$190.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$499.32
Rate for Payer: Priority Health Narrow/Tiered Network	$499.32
Rate for Payer: UHC Medicaid	$190.21
Rate for Payer: UHCCP Medicaid	$190.21

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

Facility

$830.00

Service Code	CPT 21555
Hospital Charge Code	21555
Hospital Revenue Code	960
Min. Negotiated Rate	$577.68
Max. Negotiated Rate	$747.00
Rate for Payer: Aetna Commercial	$705.50
Rate for Payer: BCBS Trust/PPO	$685.50
Rate for Payer: BCN Commercial	$685.50
Rate for Payer: Cash Price	$664.00
Rate for Payer: Cofinity Commercial	$713.80
Rate for Payer: Encore Health Key Benefits Commercial	$664.00
Rate for Payer: Healthscope Commercial	$747.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$622.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$705.50
Rate for Payer: Nomi Health Commercial	$680.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$622.50
Rate for Payer: PHP Commercial	$705.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$722.10
Rate for Payer: Priority Health Narrow/Tiered Network	$577.68
Rate for Payer: UHC Core	$693.05
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$622.50

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

Professional

Both

$830.00

Service Code	HCPCS 21555
Hospital Charge Code	21555
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$622.50
Rate for Payer: Aetna Commercial	$404.86
Rate for Payer: Aetna Medicare	$415.00
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCN Commercial	$469.10
Rate for Payer: Cash Price	$664.00
Rate for Payer: Cash Price	$664.00
Rate for Payer: Mclaren Medicaid	$189.78
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$622.50
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$501.45
Rate for Payer: Priority Health Narrow/Tiered Network	$501.45
Rate for Payer: UHC Medicaid	$189.78
Rate for Payer: UHCCP Medicaid	$189.78

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

Professional

Both

$830.00

Service Code	HCPCS 21555
Min. Negotiated Rate	$189.78
Max. Negotiated Rate	$622.50
Rate for Payer: Aetna Commercial	$404.86
Rate for Payer: Aetna Medicare	$415.00
Rate for Payer: BCBS Complete	$199.27
Rate for Payer: BCN Commercial	$469.10
Rate for Payer: Cash Price	$664.00
Rate for Payer: Cash Price	$664.00
Rate for Payer: Mclaren Medicaid	$189.78
Rate for Payer: Meridian Medicaid	$199.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$622.50
Rate for Payer: Priority Health Choice Medicaid	$189.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$501.45
Rate for Payer: Priority Health Narrow/Tiered Network	$501.45
Rate for Payer: UHC Medicaid	$189.78
Rate for Payer: UHCCP Medicaid	$189.78

PR EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM

Facility

$830.00

Service Code	CPT 21555
Hospital Charge Code	21555
Hospital Revenue Code	960
Min. Negotiated Rate	$146.33
Max. Negotiated Rate	$747.00
Rate for Payer: Aetna Commercial	$705.50
Rate for Payer: Aetna Medicare	$215.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$259.38
Rate for Payer: Amish Plain Church Group Commercial	$259.38
Rate for Payer: BCBS Complete	$153.63
Rate for Payer: BCBS MAPPO	$207.50
Rate for Payer: BCBS Trust/PPO	$682.34
Rate for Payer: BCN Commercial	$682.34
Rate for Payer: BCN Medicare Advantage	$207.50
Rate for Payer: Cash Price	$664.00
Rate for Payer: Cofinity Commercial	$713.80
Rate for Payer: Encore Health Key Benefits Commercial	$664.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$207.50
Rate for Payer: Healthscope Commercial	$747.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$622.50
Rate for Payer: Mclaren Medicaid	$146.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$217.88
Rate for Payer: Meridian Medicaid	$153.63
Rate for Payer: MI Amish Medical Board Commercial	$238.62
Rate for Payer: Molina Medicare/Medicaid	$228.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$705.50
Rate for Payer: Nomi Health Commercial	$680.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$622.50
Rate for Payer: PACE Senior Care Partners	$197.12
Rate for Payer: PACE SWMI	$207.50
Rate for Payer: PHP Commercial	$705.50
Rate for Payer: PHP Medicare Advantage	$207.50
Rate for Payer: Priority Health Choice Medicaid	$146.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$722.10
Rate for Payer: Priority Health Medicare	$209.57
Rate for Payer: Priority Health Narrow/Tiered Network	$577.68
Rate for Payer: Railroad Medicare Medicare	$207.50
Rate for Payer: UHC Core	$693.05
Rate for Payer: UHC Exchange	$207.50
Rate for Payer: UHC Medicaid	$146.33
Rate for Payer: UHC Medicare Advantage	$207.50
Rate for Payer: UHCCP Medicaid	$146.33
Rate for Payer: VA VA	$207.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$622.50

PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>

Professional

Both

$2,208.00

Service Code	HCPCS 21554
Hospital Charge Code	21554
Min. Negotiated Rate	$434.09
Max. Negotiated Rate	$1,656.00
Rate for Payer: Aetna Commercial	$976.70
Rate for Payer: Aetna Medicare	$1,104.00
Rate for Payer: BCBS Complete	$455.79
Rate for Payer: BCN Commercial	$1,107.51
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Mclaren Medicaid	$434.09
Rate for Payer: Meridian Medicaid	$455.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,656.00
Rate for Payer: Priority Health Choice Medicaid	$434.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,183.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,183.90
Rate for Payer: UHC Medicaid	$434.09
Rate for Payer: UHCCP Medicaid	$434.09

PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>

Professional

Both

$2,208.00

Service Code	HCPCS 21554
Min. Negotiated Rate	$434.09
Max. Negotiated Rate	$1,656.00
Rate for Payer: Aetna Commercial	$976.70
Rate for Payer: Aetna Medicare	$1,104.00
Rate for Payer: BCBS Complete	$455.79
Rate for Payer: BCN Commercial	$1,107.51
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Mclaren Medicaid	$434.09
Rate for Payer: Meridian Medicaid	$455.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,656.00
Rate for Payer: Priority Health Choice Medicaid	$434.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,183.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,183.90
Rate for Payer: UHC Medicaid	$434.09
Rate for Payer: UHCCP Medicaid	$434.09

PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>

Facility

$2,208.00

Service Code	CPT 21554
Hospital Charge Code	21554
Hospital Revenue Code	960
Min. Negotiated Rate	$1,536.77
Max. Negotiated Rate	$1,987.20
Rate for Payer: Aetna Commercial	$1,876.80
Rate for Payer: BCBS Trust/PPO	$1,823.59
Rate for Payer: BCN Commercial	$1,823.59
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Cofinity Commercial	$1,898.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,766.40
Rate for Payer: Healthscope Commercial	$1,987.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,656.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,876.80
Rate for Payer: Nomi Health Commercial	$1,810.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,656.00
Rate for Payer: PHP Commercial	$1,876.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,920.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,536.77
Rate for Payer: UHC Core	$1,843.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,656.00

PR EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/>

Facility

$2,208.00

Service Code	CPT 21554
Hospital Charge Code	21554
Hospital Revenue Code	960
Min. Negotiated Rate	$389.27
Max. Negotiated Rate	$1,987.20
Rate for Payer: Aetna Commercial	$1,876.80
Rate for Payer: Aetna Medicare	$574.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$690.00
Rate for Payer: Amish Plain Church Group Commercial	$690.00
Rate for Payer: BCBS Complete	$408.70
Rate for Payer: BCBS MAPPO	$552.00
Rate for Payer: BCBS Trust/PPO	$1,815.20
Rate for Payer: BCN Commercial	$1,815.20
Rate for Payer: BCN Medicare Advantage	$552.00
Rate for Payer: Cash Price	$1,766.40
Rate for Payer: Cofinity Commercial	$1,898.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,766.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$552.00
Rate for Payer: Healthscope Commercial	$1,987.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,656.00
Rate for Payer: Mclaren Medicaid	$389.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$579.60
Rate for Payer: Meridian Medicaid	$408.70
Rate for Payer: MI Amish Medical Board Commercial	$634.80
Rate for Payer: Molina Medicare/Medicaid	$607.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,876.80
Rate for Payer: Nomi Health Commercial	$1,810.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,656.00
Rate for Payer: PACE Senior Care Partners	$524.40
Rate for Payer: PACE SWMI	$552.00
Rate for Payer: PHP Commercial	$1,876.80
Rate for Payer: PHP Medicare Advantage	$552.00
Rate for Payer: Priority Health Choice Medicaid	$389.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,920.96
Rate for Payer: Priority Health Medicare	$557.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,536.77
Rate for Payer: Railroad Medicare Medicare	$552.00
Rate for Payer: UHC Core	$1,843.68
Rate for Payer: UHC Exchange	$552.00
Rate for Payer: UHC Medicaid	$389.27
Rate for Payer: UHC Medicare Advantage	$552.00
Rate for Payer: UHCCP Medicaid	$389.27
Rate for Payer: VA VA	$552.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,656.00

PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM

Professional

Both

$1,307.00

Service Code	HCPCS 27048
Min. Negotiated Rate	$374.24
Max. Negotiated Rate	$999.17
Rate for Payer: Aetna Commercial	$818.66
Rate for Payer: Aetna Medicare	$653.50
Rate for Payer: BCBS Complete	$392.95
Rate for Payer: BCN Commercial	$934.71
Rate for Payer: Cash Price	$1,045.60
Rate for Payer: Cash Price	$1,045.60
Rate for Payer: Mclaren Medicaid	$374.24
Rate for Payer: Meridian Medicaid	$392.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$980.25
Rate for Payer: Priority Health Choice Medicaid	$374.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$999.17
Rate for Payer: Priority Health Narrow/Tiered Network	$999.17
Rate for Payer: UHC Medicaid	$374.24
Rate for Payer: UHCCP Medicaid	$374.24

PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>

Professional

Both

$1,441.00

Service Code	HCPCS 27045
Min. Negotiated Rate	$441.12
Max. Negotiated Rate	$1,189.75
Rate for Payer: Aetna Commercial	$985.74
Rate for Payer: Aetna Medicare	$720.50
Rate for Payer: BCBS Complete	$463.18
Rate for Payer: BCN Commercial	$1,112.99
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Mclaren Medicaid	$441.12
Rate for Payer: Meridian Medicaid	$463.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,080.75
Rate for Payer: Priority Health Choice Medicaid	$441.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,189.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,189.75
Rate for Payer: UHC Medicaid	$441.12
Rate for Payer: UHCCP Medicaid	$441.12

PR EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM

Professional

Both

$828.00

Service Code	HCPCS 27047
Min. Negotiated Rate	$224.29
Max. Negotiated Rate	$621.00
Rate for Payer: Aetna Commercial	$478.89
Rate for Payer: Aetna Medicare	$414.00
Rate for Payer: BCBS Complete	$235.50
Rate for Payer: BCN Commercial	$550.77
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Mclaren Medicaid	$224.29
Rate for Payer: Meridian Medicaid	$235.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.00
Rate for Payer: Priority Health Choice Medicaid	$224.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$588.75
Rate for Payer: Priority Health Narrow/Tiered Network	$588.75
Rate for Payer: UHC Medicaid	$224.29
Rate for Payer: UHCCP Medicaid	$224.29

PR EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>

Professional

Both

$1,635.00

Service Code	HCPCS 23073
Min. Negotiated Rate	$420.04
Max. Negotiated Rate	$1,226.25
Rate for Payer: Aetna Commercial	$933.13
Rate for Payer: Aetna Medicare	$817.50
Rate for Payer: BCBS Complete	$441.04
Rate for Payer: BCN Commercial	$1,059.21
Rate for Payer: Cash Price	$1,308.00
Rate for Payer: Cash Price	$1,308.00
Rate for Payer: Mclaren Medicaid	$420.04
Rate for Payer: Meridian Medicaid	$441.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,226.25
Rate for Payer: Priority Health Choice Medicaid	$420.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,132.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,132.26
Rate for Payer: UHC Medicaid	$420.04
Rate for Payer: UHCCP Medicaid	$420.04

Know your out-of-pocket cost for care.

All Charges