Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINED TO SKIN AND SUBCUTANEOUS TISSUES

Facility

$8,903.25

Service Code	CPT 42810
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA, EXTENDING BENEATH SUBCUTANEOUS TISSUES AND/OR INTO PHARYNX

Facility

$16,240.34

Service Code	CPT 42815
Hospital Revenue Code	360
Min. Negotiated Rate	$3,092.41
Max. Negotiated Rate	$16,240.34
Rate for Payer: Aetna Medicare	$6,000.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,211.77
Rate for Payer: Amish Plain Church Group Commercial	$7,211.77
Rate for Payer: BCBS Complete	$3,247.03
Rate for Payer: BCBS MAPPO	$5,769.42
Rate for Payer: BCN Medicare Advantage	$5,769.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,769.42
Rate for Payer: Mclaren Medicaid	$3,092.41
Rate for Payer: Mclaren Medicare	$5,769.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,057.89
Rate for Payer: Meridian Medicaid	$3,247.03
Rate for Payer: MI Amish Medical Board Commercial	$6,634.83
Rate for Payer: PACE Medicare	$5,480.95
Rate for Payer: PACE SWMI	$5,769.42
Rate for Payer: PHP Medicare Advantage	$5,769.42
Rate for Payer: Priority Health Choice Medicaid	$3,092.41
Rate for Payer: Priority Health Medicare	$5,769.42
Rate for Payer: Railroad Medicare Medicare	$5,769.42
Rate for Payer: UHC All Payor (Choice/PPO)	$16,240.34
Rate for Payer: UHC Dual Complete DSNP	$5,769.42
Rate for Payer: UHC Exchange	$11,025.94
Rate for Payer: UHC Medicare Advantage	$5,769.42
Rate for Payer: UHCCP Medicaid	$3,092.41
Rate for Payer: VA VA	$5,769.42

EXCISION DERMOID CYST, NOSE; SIMPLE, SKIN, SUBCUTANEOUS

Facility

$4,066.57

Service Code	CPT 30124
Hospital Revenue Code	360
Min. Negotiated Rate	$774.34
Max. Negotiated Rate	$4,066.57
Rate for Payer: Aetna Medicare	$1,502.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,805.83
Rate for Payer: Amish Plain Church Group Commercial	$1,805.83
Rate for Payer: BCBS Complete	$813.05
Rate for Payer: BCBS MAPPO	$1,444.66
Rate for Payer: BCN Medicare Advantage	$1,444.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,444.66
Rate for Payer: Mclaren Medicaid	$774.34
Rate for Payer: Mclaren Medicare	$1,444.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,516.89
Rate for Payer: Meridian Medicaid	$813.05
Rate for Payer: MI Amish Medical Board Commercial	$1,661.36
Rate for Payer: PACE Medicare	$1,372.43
Rate for Payer: PACE SWMI	$1,444.66
Rate for Payer: PHP Medicare Advantage	$1,444.66
Rate for Payer: Priority Health Choice Medicaid	$774.34
Rate for Payer: Priority Health Medicare	$1,444.66
Rate for Payer: Railroad Medicare Medicare	$1,444.66
Rate for Payer: UHC All Payor (Choice/PPO)	$4,066.57
Rate for Payer: UHC Dual Complete DSNP	$1,444.66
Rate for Payer: UHC Exchange	$2,760.89
Rate for Payer: UHC Medicare Advantage	$1,444.66
Rate for Payer: UHCCP Medicaid	$774.34
Rate for Payer: VA VA	$1,444.66

EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPE OR MATCHED RESECTION)

Facility

$8,907.47

Service Code	CPT 25240
Hospital Revenue Code	360
Min. Negotiated Rate	$1,696.12
Max. Negotiated Rate	$8,907.47
Rate for Payer: Aetna Medicare	$3,290.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,955.50
Rate for Payer: Amish Plain Church Group Commercial	$3,955.50
Rate for Payer: BCBS Complete	$1,780.92
Rate for Payer: BCBS MAPPO	$3,164.40
Rate for Payer: BCN Medicare Advantage	$3,164.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,164.40
Rate for Payer: Mclaren Medicaid	$1,696.12
Rate for Payer: Mclaren Medicare	$3,164.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,322.62
Rate for Payer: Meridian Medicaid	$1,780.92
Rate for Payer: MI Amish Medical Board Commercial	$3,639.06
Rate for Payer: PACE Medicare	$3,006.18
Rate for Payer: PACE SWMI	$3,164.40
Rate for Payer: PHP Medicare Advantage	$3,164.40
Rate for Payer: Priority Health Choice Medicaid	$1,696.12
Rate for Payer: Priority Health Medicare	$3,164.40
Rate for Payer: Railroad Medicare Medicare	$3,164.40
Rate for Payer: UHC All Payor (Choice/PPO)	$8,907.47
Rate for Payer: UHC Dual Complete DSNP	$3,164.40
Rate for Payer: UHC Exchange	$6,047.48
Rate for Payer: UHC Medicare Advantage	$3,164.40
Rate for Payer: UHCCP Medicaid	$1,696.12
Rate for Payer: VA VA	$3,164.40

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY

Facility

$17,903.47

Service Code	CPT 15830
Hospital Revenue Code	360
Min. Negotiated Rate	$3,409.09
Max. Negotiated Rate	$17,903.47
Rate for Payer: Aetna Medicare	$6,614.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,950.31
Rate for Payer: Amish Plain Church Group Commercial	$7,950.31
Rate for Payer: BCBS Complete	$3,579.55
Rate for Payer: BCBS MAPPO	$6,360.25
Rate for Payer: BCN Medicare Advantage	$6,360.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,360.25
Rate for Payer: Mclaren Medicaid	$3,409.09
Rate for Payer: Mclaren Medicare	$6,360.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,678.26
Rate for Payer: Meridian Medicaid	$3,579.55
Rate for Payer: MI Amish Medical Board Commercial	$7,314.29
Rate for Payer: PACE Medicare	$6,042.24
Rate for Payer: PACE SWMI	$6,360.25
Rate for Payer: PHP Medicare Advantage	$6,360.25
Rate for Payer: Priority Health Choice Medicaid	$3,409.09
Rate for Payer: Priority Health Medicare	$6,360.25
Rate for Payer: Railroad Medicare Medicare	$6,360.25
Rate for Payer: UHC All Payor (Choice/PPO)	$17,903.47
Rate for Payer: UHC Dual Complete DSNP	$6,360.25
Rate for Payer: UHC Exchange	$12,155.07
Rate for Payer: UHC Medicare Advantage	$6,360.25
Rate for Payer: UHCCP Medicaid	$3,409.09
Rate for Payer: VA VA	$6,360.25

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ARM

Facility

$7,857.23

Service Code	CPT 15836
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); OTHER AREA

Facility

$7,857.23

Service Code	CPT 15839
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); THIGH

Facility

$7,857.23

Service Code	CPT 15832
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR

Facility

$7,857.23

Service Code	CPT 69110
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

EXCISION INFERIOR TURBINATE, PARTIAL OR COMPLETE, ANY METHOD

Facility

$8,903.25

Service Code	CPT 30130
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH

Facility

$4,393.64

Service Code	CPT 28080
Hospital Revenue Code	360
Min. Negotiated Rate	$836.62
Max. Negotiated Rate	$4,393.64
Rate for Payer: Aetna Medicare	$1,623.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,951.06
Rate for Payer: Amish Plain Church Group Commercial	$1,951.06
Rate for Payer: BCBS Complete	$878.45
Rate for Payer: BCBS MAPPO	$1,560.85
Rate for Payer: BCN Medicare Advantage	$1,560.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,560.85
Rate for Payer: Mclaren Medicaid	$836.62
Rate for Payer: Mclaren Medicare	$1,560.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,638.89
Rate for Payer: Meridian Medicaid	$878.45
Rate for Payer: MI Amish Medical Board Commercial	$1,794.98
Rate for Payer: PACE Medicare	$1,482.81
Rate for Payer: PACE SWMI	$1,560.85
Rate for Payer: PHP Medicare Advantage	$1,560.85
Rate for Payer: Priority Health Choice Medicaid	$836.62
Rate for Payer: Priority Health Medicare	$1,560.85
Rate for Payer: Railroad Medicare Medicare	$1,560.85
Rate for Payer: UHC All Payor (Choice/PPO)	$4,393.64
Rate for Payer: UHC Dual Complete DSNP	$1,560.85
Rate for Payer: UHC Exchange	$2,982.94
Rate for Payer: UHC Medicare Advantage	$1,560.85
Rate for Payer: UHCCP Medicaid	$836.62
Rate for Payer: VA VA	$1,560.85

EXCISION, LESION OF FLOOR OF MOUTH

Facility

$8,903.25

Service Code	CPT 41116
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE

Facility

$8,903.25

Service Code	CPT 42104
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARY CLOSURE

Facility

$8,903.25

Service Code	CPT 42106
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Exchange	$6,044.62
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,695.31
Rate for Payer: VA VA	$3,162.90

EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST

Facility

$4,393.64

Service Code	CPT 25110
Hospital Revenue Code	360
Min. Negotiated Rate	$836.62
Max. Negotiated Rate	$4,393.64
Rate for Payer: Aetna Medicare	$1,623.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,951.06
Rate for Payer: Amish Plain Church Group Commercial	$1,951.06
Rate for Payer: BCBS Complete	$878.45
Rate for Payer: BCBS MAPPO	$1,560.85
Rate for Payer: BCN Medicare Advantage	$1,560.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,560.85
Rate for Payer: Mclaren Medicaid	$836.62
Rate for Payer: Mclaren Medicare	$1,560.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,638.89
Rate for Payer: Meridian Medicaid	$878.45
Rate for Payer: MI Amish Medical Board Commercial	$1,794.98
Rate for Payer: PACE Medicare	$1,482.81
Rate for Payer: PACE SWMI	$1,560.85
Rate for Payer: PHP Medicare Advantage	$1,560.85
Rate for Payer: Priority Health Choice Medicaid	$836.62
Rate for Payer: Priority Health Medicare	$1,560.85
Rate for Payer: Railroad Medicare Medicare	$1,560.85
Rate for Payer: UHC All Payor (Choice/PPO)	$4,393.64
Rate for Payer: UHC Dual Complete DSNP	$1,560.85
Rate for Payer: UHC Exchange	$2,982.94
Rate for Payer: UHC Medicare Advantage	$1,560.85
Rate for Payer: UHCCP Medicaid	$836.62
Rate for Payer: VA VA	$1,560.85

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.5 CM OR LESS

Facility

$1,931.58

Service Code	CPT 11640
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Exchange	$1,311.40
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$367.80
Rate for Payer: VA VA	$686.20

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$1,931.58

Service Code	CPT 11641
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Exchange	$1,311.40
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$367.80
Rate for Payer: VA VA	$686.20

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$1,931.58

Service Code	CPT 11642
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Exchange	$1,311.40
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$367.80
Rate for Payer: VA VA	$686.20

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$4,448.08

Service Code	CPT 11643
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Exchange	$3,019.90
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$846.98
Rate for Payer: VA VA	$1,580.19

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER 3.1 TO 4.0 CM

Facility

$4,448.08

Service Code	CPT 11644
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Exchange	$3,019.90
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$846.98
Rate for Payer: VA VA	$1,580.19

EXCISION, MALIGNANT LESION INCLUDING MARGINS, FACE, EARS, EYELIDS, NOSE, LIPS; EXCISED DIAMETER OVER 4.0 CM

Facility

$7,857.23

Service Code	CPT 11646
Hospital Revenue Code	360
Min. Negotiated Rate	$1,496.14
Max. Negotiated Rate	$7,857.23
Rate for Payer: Aetna Medicare	$2,902.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,489.12
Rate for Payer: Amish Plain Church Group Commercial	$3,489.12
Rate for Payer: BCBS Complete	$1,570.94
Rate for Payer: BCBS MAPPO	$2,791.30
Rate for Payer: BCN Medicare Advantage	$2,791.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,791.30
Rate for Payer: Mclaren Medicaid	$1,496.14
Rate for Payer: Mclaren Medicare	$2,791.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,930.86
Rate for Payer: Meridian Medicaid	$1,570.94
Rate for Payer: MI Amish Medical Board Commercial	$3,209.99
Rate for Payer: PACE Medicare	$2,651.74
Rate for Payer: PACE SWMI	$2,791.30
Rate for Payer: PHP Medicare Advantage	$2,791.30
Rate for Payer: Priority Health Choice Medicaid	$1,496.14
Rate for Payer: Priority Health Medicare	$2,791.30
Rate for Payer: Railroad Medicare Medicare	$2,791.30
Rate for Payer: UHC All Payor (Choice/PPO)	$7,857.23
Rate for Payer: UHC Dual Complete DSNP	$2,791.30
Rate for Payer: UHC Exchange	$5,334.45
Rate for Payer: UHC Medicare Advantage	$2,791.30
Rate for Payer: UHCCP Medicaid	$1,496.14
Rate for Payer: VA VA	$2,791.30

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS

Facility

$4,448.08

Service Code	CPT 11620
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Exchange	$3,019.90
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$846.98
Rate for Payer: VA VA	$1,580.19

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$1,931.58

Service Code	CPT 11621
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Exchange	$1,311.40
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$367.80
Rate for Payer: VA VA	$686.20

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$1,931.58

Service Code	CPT 11622
Hospital Revenue Code	360
Min. Negotiated Rate	$367.80
Max. Negotiated Rate	$1,931.58
Rate for Payer: Aetna Medicare	$713.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$857.75
Rate for Payer: Amish Plain Church Group Commercial	$857.75
Rate for Payer: BCBS Complete	$386.19
Rate for Payer: BCBS MAPPO	$686.20
Rate for Payer: BCN Medicare Advantage	$686.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$686.20
Rate for Payer: Mclaren Medicaid	$367.80
Rate for Payer: Mclaren Medicare	$686.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$720.51
Rate for Payer: Meridian Medicaid	$386.19
Rate for Payer: MI Amish Medical Board Commercial	$789.13
Rate for Payer: PACE Medicare	$651.89
Rate for Payer: PACE SWMI	$686.20
Rate for Payer: PHP Medicare Advantage	$686.20
Rate for Payer: Priority Health Choice Medicaid	$367.80
Rate for Payer: Priority Health Medicare	$686.20
Rate for Payer: Railroad Medicare Medicare	$686.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,931.58
Rate for Payer: UHC Dual Complete DSNP	$686.20
Rate for Payer: UHC Exchange	$1,311.40
Rate for Payer: UHC Medicare Advantage	$686.20
Rate for Payer: UHCCP Medicaid	$367.80
Rate for Payer: VA VA	$686.20

EXCISION, MALIGNANT LESION INCLUDING MARGINS, SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$4,448.08

Service Code	CPT 11623
Hospital Revenue Code	360
Min. Negotiated Rate	$846.98
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Exchange	$3,019.90
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$846.98
Rate for Payer: VA VA	$1,580.19

Know your out-of-pocket cost for care.

All Charges