Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CLOSED RX PELV RING FX/SUBLUX,MANIP

Professional

Both

$1,903.00

Service Code	HCPCS 27194
Min. Negotiated Rate	$761.20
Max. Negotiated Rate	$1,332.10
Rate for Payer: BCBS Complete	$761.20
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Priority Health Cigna Priority Health	$1,332.10

PR CLOSED RX RIB FRACTURE

Professional

Both

$220.00

Service Code	HCPCS 21800
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$154.00
Rate for Payer: BCBS Complete	$88.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Priority Health Cigna Priority Health	$154.00

PR CLOSED TREATMENT COCCYGEAL FRACTURE

Professional

Both

$382.00

Service Code	HCPCS 27200
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,904.52
Rate for Payer: Aetna Commercial	$246.94
Rate for Payer: BCBS Complete	$133.74
Rate for Payer: BCBS Trust/PPO	$1,904.52
Rate for Payer: Cash Price	$305.60
Rate for Payer: Cash Price	$305.60
Rate for Payer: Mclaren Medicaid	$127.37
Rate for Payer: Meridian Medicaid	$133.74
Rate for Payer: Priority Health Choice Medicaid	$127.37
Rate for Payer: Priority Health Cigna Priority Health	$267.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$294.65
Rate for Payer: Priority Health Narrow Network	$294.65
Rate for Payer: Priority Health SBD	$294.65

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ

Professional

Both

$750.00

Service Code	HCPCS 27768
Min. Negotiated Rate	$295.64
Max. Negotiated Rate	$3,241.12
Rate for Payer: Aetna Commercial	$593.02
Rate for Payer: BCBS Complete	$310.42
Rate for Payer: BCBS Trust/PPO	$3,241.12
Rate for Payer: Cash Price	$600.00
Rate for Payer: Cash Price	$600.00
Rate for Payer: Mclaren Medicaid	$295.64
Rate for Payer: Meridian Medicaid	$310.42
Rate for Payer: Priority Health Choice Medicaid	$295.64
Rate for Payer: Priority Health Cigna Priority Health	$525.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$697.55
Rate for Payer: Priority Health Narrow Network	$697.55
Rate for Payer: Priority Health SBD	$697.55

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ

Professional

Both

$713.00

Service Code	HCPCS 27767
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$563.09
Rate for Payer: Aetna Commercial	$380.80
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCBS Trust/PPO	$563.09
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$570.40
Rate for Payer: Mclaren Medicaid	$192.98
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health	$499.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$455.49
Rate for Payer: Priority Health Narrow Network	$455.49
Rate for Payer: Priority Health SBD	$455.49

PR CLOSED TREATMENT SESAMOID FRACTURE

Professional

Both

$345.00

Service Code	HCPCS 28530
Min. Negotiated Rate	$67.31
Max. Negotiated Rate	$1,243.09
Rate for Payer: Aetna Commercial	$129.88
Rate for Payer: BCBS Complete	$70.68
Rate for Payer: BCBS Trust/PPO	$1,243.09
Rate for Payer: Cash Price	$276.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Mclaren Medicaid	$67.31
Rate for Payer: Meridian Medicaid	$70.68
Rate for Payer: Priority Health Choice Medicaid	$67.31
Rate for Payer: Priority Health Cigna Priority Health	$241.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.24
Rate for Payer: Priority Health Narrow Network	$155.24
Rate for Payer: Priority Health SBD	$155.24

PR CLOSED TREATMENT STERNUM FRACTURE

Professional

Both

$190.00

Service Code	HCPCS 21820
Min. Negotiated Rate	$98.19
Max. Negotiated Rate	$230.81
Rate for Payer: Aetna Commercial	$191.49
Rate for Payer: BCBS Complete	$103.10
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$98.19
Rate for Payer: Meridian Medicaid	$103.10
Rate for Payer: Priority Health Choice Medicaid	$98.19
Rate for Payer: Priority Health Cigna Priority Health	$133.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$230.81
Rate for Payer: Priority Health Narrow Network	$230.81
Rate for Payer: Priority Health SBD	$230.81

PR CLOSED TREATMENT ULNAR STYLOID FRACTURE

Professional

Both

$817.00

Service Code	HCPCS 25650
Min. Negotiated Rate	$204.05
Max. Negotiated Rate	$1,117.88
Rate for Payer: Aetna Commercial	$404.75
Rate for Payer: BCBS Complete	$214.25
Rate for Payer: BCBS Trust/PPO	$1,117.88
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Mclaren Medicaid	$204.05
Rate for Payer: Meridian Medicaid	$214.25
Rate for Payer: Priority Health Choice Medicaid	$204.05
Rate for Payer: Priority Health Cigna Priority Health	$571.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$483.07
Rate for Payer: Priority Health Narrow Network	$483.07
Rate for Payer: Priority Health SBD	$483.07

PR CLOSED TREAT SPINE PROCESS FX

Professional

Both

$415.00

Service Code	HCPCS 22305
Min. Negotiated Rate	$166.00
Max. Negotiated Rate	$290.50
Rate for Payer: BCBS Complete	$166.00
Rate for Payer: Cash Price	$332.00
Rate for Payer: Priority Health Cigna Priority Health	$290.50

PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA

Professional

Both

$903.00

Service Code	HCPCS 27840
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$1,414.69
Rate for Payer: Aetna Commercial	$504.89
Rate for Payer: BCBS Complete	$268.38
Rate for Payer: BCBS Trust/PPO	$1,414.69
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Mclaren Medicaid	$255.60
Rate for Payer: Meridian Medicaid	$268.38
Rate for Payer: Priority Health Choice Medicaid	$255.60
Rate for Payer: Priority Health Cigna Priority Health	$632.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$603.59
Rate for Payer: Priority Health Narrow Network	$603.59
Rate for Payer: Priority Health SBD	$603.59

PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ

Professional

Both

$1,167.00

Service Code	HCPCS 27810
Min. Negotiated Rate	$282.65
Max. Negotiated Rate	$2,867.08
Rate for Payer: Aetna Commercial	$566.31
Rate for Payer: BCBS Complete	$296.78
Rate for Payer: BCBS Trust/PPO	$2,867.08
Rate for Payer: Cash Price	$933.60
Rate for Payer: Cash Price	$933.60
Rate for Payer: Mclaren Medicaid	$282.65
Rate for Payer: Meridian Medicaid	$296.78
Rate for Payer: Priority Health Choice Medicaid	$282.65
Rate for Payer: Priority Health Cigna Priority Health	$816.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$667.43
Rate for Payer: Priority Health Narrow Network	$667.43
Rate for Payer: Priority Health SBD	$667.43

PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ

Professional

Both

$855.00

Service Code	HCPCS 27808
Min. Negotiated Rate	$203.84
Max. Negotiated Rate	$598.50
Rate for Payer: Aetna Commercial	$403.72
Rate for Payer: BCBS Complete	$214.03
Rate for Payer: BCBS Trust/PPO	$556.11
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Mclaren Medicaid	$203.84
Rate for Payer: Meridian Medicaid	$214.03
Rate for Payer: Priority Health Choice Medicaid	$203.84
Rate for Payer: Priority Health Cigna Priority Health	$598.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$480.01
Rate for Payer: Priority Health Narrow Network	$480.01
Rate for Payer: Priority Health SBD	$480.01

PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION

Professional

Both

$1,141.00

Service Code	HCPCS 28405
Min. Negotiated Rate	$267.53
Max. Negotiated Rate	$1,513.05
Rate for Payer: Aetna Commercial	$471.72
Rate for Payer: BCBS Complete	$280.91
Rate for Payer: BCBS Trust/PPO	$1,513.05
Rate for Payer: Cash Price	$912.80
Rate for Payer: Cash Price	$912.80
Rate for Payer: Mclaren Medicaid	$267.53
Rate for Payer: Meridian Medicaid	$280.91
Rate for Payer: Priority Health Choice Medicaid	$267.53
Rate for Payer: Priority Health Cigna Priority Health	$798.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$631.67
Rate for Payer: Priority Health Narrow Network	$631.67
Rate for Payer: Priority Health SBD	$631.67

PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION

Professional

Both

$704.00

Service Code	HCPCS 28400
Min. Negotiated Rate	$152.30
Max. Negotiated Rate	$1,304.90
Rate for Payer: Aetna Commercial	$299.58
Rate for Payer: BCBS Complete	$159.92
Rate for Payer: BCBS Trust/PPO	$1,304.90
Rate for Payer: Cash Price	$563.20
Rate for Payer: Cash Price	$563.20
Rate for Payer: Mclaren Medicaid	$152.30
Rate for Payer: Meridian Medicaid	$159.92
Rate for Payer: Priority Health Choice Medicaid	$152.30
Rate for Payer: Priority Health Cigna Priority Health	$492.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$357.97
Rate for Payer: Priority Health Narrow Network	$357.97
Rate for Payer: Priority Health SBD	$357.97

PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ

Professional

Both

$741.00

Service Code	HCPCS 25624
Min. Negotiated Rate	$295.22
Max. Negotiated Rate	$939.26
Rate for Payer: Aetna Commercial	$588.21
Rate for Payer: BCBS Complete	$309.98
Rate for Payer: BCBS Trust/PPO	$939.26
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Mclaren Medicaid	$295.22
Rate for Payer: Meridian Medicaid	$309.98
Rate for Payer: Priority Health Choice Medicaid	$295.22
Rate for Payer: Priority Health Cigna Priority Health	$518.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$696.52
Rate for Payer: Priority Health Narrow Network	$696.52
Rate for Payer: Priority Health SBD	$696.52

PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ

Professional

Both

$778.00

Service Code	HCPCS 25622
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$939.26
Rate for Payer: Aetna Commercial	$373.80
Rate for Payer: BCBS Complete	$199.50
Rate for Payer: BCBS Trust/PPO	$939.26
Rate for Payer: Cash Price	$622.40
Rate for Payer: Cash Price	$622.40
Rate for Payer: Mclaren Medicaid	$190.00
Rate for Payer: Meridian Medicaid	$199.50
Rate for Payer: Priority Health Choice Medicaid	$190.00
Rate for Payer: Priority Health Cigna Priority Health	$544.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$447.84
Rate for Payer: Priority Health Narrow Network	$447.84
Rate for Payer: Priority Health SBD	$447.84

PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ

Professional

Both

$1,011.00

Service Code	HCPCS 25675
Min. Negotiated Rate	$273.71
Max. Negotiated Rate	$1,123.17
Rate for Payer: Aetna Commercial	$536.39
Rate for Payer: BCBS Complete	$287.40
Rate for Payer: BCBS Trust/PPO	$1,123.17
Rate for Payer: Cash Price	$808.80
Rate for Payer: Cash Price	$808.80
Rate for Payer: Mclaren Medicaid	$273.71
Rate for Payer: Meridian Medicaid	$287.40
Rate for Payer: Priority Health Choice Medicaid	$273.71
Rate for Payer: Priority Health Cigna Priority Health	$707.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$644.96
Rate for Payer: Priority Health Narrow Network	$644.96
Rate for Payer: Priority Health SBD	$644.96

PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ

Professional

Both

$789.00

Service Code	HCPCS 27268
Min. Negotiated Rate	$354.86
Max. Negotiated Rate	$3,411.76
Rate for Payer: Aetna Commercial	$725.37
Rate for Payer: BCBS Complete	$372.60
Rate for Payer: BCBS Trust/PPO	$3,411.76
Rate for Payer: Cash Price	$631.20
Rate for Payer: Cash Price	$631.20
Rate for Payer: Mclaren Medicaid	$354.86
Rate for Payer: Meridian Medicaid	$372.60
Rate for Payer: Priority Health Choice Medicaid	$354.86
Rate for Payer: Priority Health Cigna Priority Health	$552.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$842.06
Rate for Payer: Priority Health Narrow Network	$842.06
Rate for Payer: Priority Health SBD	$842.06

PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION

Professional

Both

$1,257.00

Service Code	HCPCS 27500
Min. Negotiated Rate	$313.96
Max. Negotiated Rate	$2,223.09
Rate for Payer: Aetna Commercial	$641.93
Rate for Payer: BCBS Complete	$329.66
Rate for Payer: BCBS Trust/PPO	$2,223.09
Rate for Payer: Cash Price	$1,005.60
Rate for Payer: Cash Price	$1,005.60
Rate for Payer: Mclaren Medicaid	$313.96
Rate for Payer: Meridian Medicaid	$329.66
Rate for Payer: Priority Health Choice Medicaid	$313.96
Rate for Payer: Priority Health Cigna Priority Health	$879.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$746.57
Rate for Payer: Priority Health Narrow Network	$746.57
Rate for Payer: Priority Health SBD	$746.57

PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA

Professional

Both

$862.00

Service Code	HCPCS 27552
Min. Negotiated Rate	$413.43
Max. Negotiated Rate	$1,159.09
Rate for Payer: Aetna Commercial	$844.11
Rate for Payer: BCBS Complete	$434.10
Rate for Payer: BCBS Trust/PPO	$1,159.09
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cash Price	$689.60
Rate for Payer: Mclaren Medicaid	$413.43
Rate for Payer: Meridian Medicaid	$434.10
Rate for Payer: Priority Health Choice Medicaid	$413.43
Rate for Payer: Priority Health Cigna Priority Health	$603.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$978.41
Rate for Payer: Priority Health Narrow Network	$978.41
Rate for Payer: Priority Health SBD	$978.41

PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA

Professional

Both

$828.00

Service Code	HCPCS 27550
Min. Negotiated Rate	$309.06
Max. Negotiated Rate	$736.35
Rate for Payer: Aetna Commercial	$647.69
Rate for Payer: BCBS Complete	$324.51
Rate for Payer: BCBS Trust/PPO	$710.04
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cash Price	$662.40
Rate for Payer: Mclaren Medicaid	$309.06
Rate for Payer: Meridian Medicaid	$324.51
Rate for Payer: Priority Health Choice Medicaid	$309.06
Rate for Payer: Priority Health Cigna Priority Health	$579.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$736.35
Rate for Payer: Priority Health Narrow Network	$736.35
Rate for Payer: Priority Health SBD	$736.35

PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION

Professional

Both

$825.00

Service Code	HCPCS 25690
Min. Negotiated Rate	$324.19
Max. Negotiated Rate	$2,554.86
Rate for Payer: Aetna Commercial	$651.62
Rate for Payer: BCBS Complete	$340.40
Rate for Payer: BCBS Trust/PPO	$2,554.86
Rate for Payer: Cash Price	$660.00
Rate for Payer: Cash Price	$660.00
Rate for Payer: Mclaren Medicaid	$324.19
Rate for Payer: Meridian Medicaid	$340.40
Rate for Payer: Priority Health Choice Medicaid	$324.19
Rate for Payer: Priority Health Cigna Priority Health	$577.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$765.47
Rate for Payer: Priority Health Narrow Network	$765.47
Rate for Payer: Priority Health SBD	$765.47

PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION

Professional

Both

$1,183.00

Service Code	HCPCS 21451
Min. Negotiated Rate	$409.39
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$849.59
Rate for Payer: BCBS Complete	$429.86
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$946.40
Rate for Payer: Cash Price	$946.40
Rate for Payer: Mclaren Medicaid	$409.39
Rate for Payer: Meridian Medicaid	$429.86
Rate for Payer: Priority Health Choice Medicaid	$409.39
Rate for Payer: Priority Health Cigna Priority Health	$828.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$985.55
Rate for Payer: Priority Health Narrow Network	$985.55
Rate for Payer: Priority Health SBD	$985.55

PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION

Professional

Both

$1,147.00

Service Code	HCPCS 21450
Min. Negotiated Rate	$307.15
Max. Negotiated Rate	$10,328.77
Rate for Payer: Aetna Commercial	$634.10
Rate for Payer: BCBS Complete	$322.51
Rate for Payer: BCBS Trust/PPO	$10,328.77
Rate for Payer: Cash Price	$917.60
Rate for Payer: Cash Price	$917.60
Rate for Payer: Mclaren Medicaid	$307.15
Rate for Payer: Meridian Medicaid	$322.51
Rate for Payer: Priority Health Choice Medicaid	$307.15
Rate for Payer: Priority Health Cigna Priority Health	$802.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$738.40
Rate for Payer: Priority Health Narrow Network	$738.40
Rate for Payer: Priority Health SBD	$738.40

PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION

Professional

Both

$1,388.00

Service Code	HCPCS 21453
Min. Negotiated Rate	$594.91
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$1,208.80
Rate for Payer: BCBS Complete	$624.66
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Mclaren Medicaid	$594.91
Rate for Payer: Meridian Medicaid	$624.66
Rate for Payer: Priority Health Choice Medicaid	$594.91
Rate for Payer: Priority Health Cigna Priority Health	$971.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,431.87
Rate for Payer: Priority Health Narrow Network	$1,431.87
Rate for Payer: Priority Health SBD	$1,431.87

Know your out-of-pocket cost for care.

All Charges