Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR OF RADIUS OR ULNA (EXCLUDING HEAD OR NECK OF RADIUS AND OLECRANON PROCESS);

Facility

$8,907.47

Service Code	CPT 25120
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, PHALANGES OF FOOT

Facility

$4,393.64

Service Code	CPT 28108
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS;

Facility

$8,907.47

Service Code	CPT 28100
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS OR CALCANEUS; WITH ALLOGRAFT

Facility

$19,611.80

Service Code	CPT 28103
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Exchange	$13,314.90
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,734.39
Rate for Payer: VA VA	$6,967.14

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSAL OR METATARSAL, EXCEPT TALUS OR CALCANEUS;

Facility

$8,907.47

Service Code	CPT 28104
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA;

Facility

$8,907.47

Service Code	CPT 27635
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 OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA OR FIBULA; WITH ALLOGRAFT

Facility

$19,611.80

Service Code	CPT 27638
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Exchange	$13,314.90
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,734.39
Rate for Payer: VA VA	$6,967.14

EXCISION OR DESTRUCTION (EG, LASER), INTRANASAL LESION; INTERNAL APPROACH

Facility

$8,903.25

Service Code	CPT 30117
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 OR DESTRUCTION LINGUAL TONSIL, ANY METHOD (SEPARATE PROCEDURE)

Facility

$16,240.34

Service Code	CPT 42870
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 OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD

Facility

$8,903.25

Service Code	CPT 42808
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 OR FULGURATION; SKENE'S GLANDS

Facility

$9,468.51

Service Code	CPT 53270
Hospital Revenue Code	360
Min. Negotiated Rate	$1,802.95
Max. Negotiated Rate	$9,468.51
Rate for Payer: Aetna Medicare	$3,498.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,204.64
Rate for Payer: Amish Plain Church Group Commercial	$4,204.64
Rate for Payer: BCBS Complete	$1,893.10
Rate for Payer: BCBS MAPPO	$3,363.71
Rate for Payer: BCN Medicare Advantage	$3,363.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,363.71
Rate for Payer: Mclaren Medicaid	$1,802.95
Rate for Payer: Mclaren Medicare	$3,363.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,531.90
Rate for Payer: Meridian Medicaid	$1,893.10
Rate for Payer: MI Amish Medical Board Commercial	$3,868.27
Rate for Payer: PACE Medicare	$3,195.52
Rate for Payer: PACE SWMI	$3,363.71
Rate for Payer: PHP Medicare Advantage	$3,363.71
Rate for Payer: Priority Health Choice Medicaid	$1,802.95
Rate for Payer: Priority Health Medicare	$3,363.71
Rate for Payer: Railroad Medicare Medicare	$3,363.71
Rate for Payer: UHC All Payor (Choice/PPO)	$9,468.51
Rate for Payer: UHC Dual Complete DSNP	$3,363.71
Rate for Payer: UHC Exchange	$6,428.39
Rate for Payer: UHC Medicare Advantage	$3,363.71
Rate for Payer: UHCCP Medicaid	$1,802.95
Rate for Payer: VA VA	$3,363.71

EXCISION OR FULGURATION; URETHRAL CARUNCLE

Facility

$5,623.80

Service Code	CPT 53265
Hospital Revenue Code	360
Min. Negotiated Rate	$1,070.86
Max. Negotiated Rate	$5,623.80
Rate for Payer: Aetna Medicare	$2,077.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,497.34
Rate for Payer: Amish Plain Church Group Commercial	$2,497.34
Rate for Payer: BCBS Complete	$1,124.40
Rate for Payer: BCBS MAPPO	$1,997.87
Rate for Payer: BCN Medicare Advantage	$1,997.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,997.87
Rate for Payer: Mclaren Medicaid	$1,070.86
Rate for Payer: Mclaren Medicare	$1,997.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,097.76
Rate for Payer: Meridian Medicaid	$1,124.40
Rate for Payer: MI Amish Medical Board Commercial	$2,297.55
Rate for Payer: PACE Medicare	$1,897.98
Rate for Payer: PACE SWMI	$1,997.87
Rate for Payer: PHP Medicare Advantage	$1,997.87
Rate for Payer: Priority Health Choice Medicaid	$1,070.86
Rate for Payer: Priority Health Medicare	$1,997.87
Rate for Payer: Railroad Medicare Medicare	$1,997.87
Rate for Payer: UHC All Payor (Choice/PPO)	$5,623.80
Rate for Payer: UHC Dual Complete DSNP	$1,997.87
Rate for Payer: UHC Exchange	$3,818.13
Rate for Payer: UHC Medicare Advantage	$1,997.87
Rate for Payer: UHCCP Medicaid	$1,070.86
Rate for Payer: VA VA	$1,997.87

EXCISION OR FULGURATION; URETHRAL PROLAPSE

Facility

$9,468.51

Service Code	CPT 53275
Hospital Revenue Code	360
Min. Negotiated Rate	$1,802.95
Max. Negotiated Rate	$9,468.51
Rate for Payer: Aetna Medicare	$3,498.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,204.64
Rate for Payer: Amish Plain Church Group Commercial	$4,204.64
Rate for Payer: BCBS Complete	$1,893.10
Rate for Payer: BCBS MAPPO	$3,363.71
Rate for Payer: BCN Medicare Advantage	$3,363.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,363.71
Rate for Payer: Mclaren Medicaid	$1,802.95
Rate for Payer: Mclaren Medicare	$3,363.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,531.90
Rate for Payer: Meridian Medicaid	$1,893.10
Rate for Payer: MI Amish Medical Board Commercial	$3,868.27
Rate for Payer: PACE Medicare	$3,195.52
Rate for Payer: PACE SWMI	$3,363.71
Rate for Payer: PHP Medicare Advantage	$3,363.71
Rate for Payer: Priority Health Choice Medicaid	$1,802.95
Rate for Payer: Priority Health Medicare	$3,363.71
Rate for Payer: Railroad Medicare Medicare	$3,363.71
Rate for Payer: UHC All Payor (Choice/PPO)	$9,468.51
Rate for Payer: UHC Dual Complete DSNP	$3,363.71
Rate for Payer: UHC Exchange	$6,428.39
Rate for Payer: UHC Medicare Advantage	$3,363.71
Rate for Payer: UHCCP Medicaid	$1,802.95
Rate for Payer: VA VA	$3,363.71

EXCISION OR SURGICAL PLANING OF SKIN OF NOSE FOR RHINOPHYMA

Facility

$8,903.25

Service Code	CPT 30120
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.5 CM OR LESS

Facility

$1,931.58

Service Code	CPT 11440
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.6 TO 1.0 CM

Facility

$1,931.58

Service Code	CPT 11441
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM

Facility

$1,931.58

Service Code	CPT 11442
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM

Facility

$4,448.08

Service Code	CPT 11443
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 3.1 TO 4.0 CM

Facility

$4,448.08

Service Code	CPT 11444
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, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM

Facility

$7,857.23

Service Code	CPT 11446
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, PREPATELLAR BURSA

Facility

$8,907.47

Service Code	CPT 27340
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, RADIAL HEAD

Facility

$8,907.47

Service Code	CPT 24130
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 SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL

Facility

$7,857.23

Service Code	CPT 69145
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, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER

Facility

$4,448.08

Service Code	CPT 26111
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, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; LESS THAN 1.5 CM

Facility

$4,448.08

Service Code	CPT 26115
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.

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