Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION

Professional

Both

$528.00

Service Code	HCPCS 28470
Min. Negotiated Rate	$135.89
Max. Negotiated Rate	$915.02
Rate for Payer: Aetna Commercial	$268.17
Rate for Payer: BCBS Complete	$142.68
Rate for Payer: BCBS Trust/PPO	$915.02
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Mclaren Medicaid	$135.89
Rate for Payer: Meridian Medicaid	$142.68
Rate for Payer: Priority Health Choice Medicaid	$135.89
Rate for Payer: Priority Health Cigna Priority Health	$369.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$318.14
Rate for Payer: Priority Health Narrow Network	$318.14
Rate for Payer: Priority Health SBD	$318.14

PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ

Professional

Both

$1,608.00

Service Code	HCPCS 24620
Min. Negotiated Rate	$385.32
Max. Negotiated Rate	$1,125.60
Rate for Payer: Aetna Commercial	$749.39
Rate for Payer: BCBS Complete	$404.59
Rate for Payer: BCBS Trust/PPO	$793.51
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Cash Price	$1,286.40
Rate for Payer: Mclaren Medicaid	$385.32
Rate for Payer: Meridian Medicaid	$404.59
Rate for Payer: Priority Health Choice Medicaid	$385.32
Rate for Payer: Priority Health Cigna Priority Health	$1,125.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$911.52
Rate for Payer: Priority Health Narrow Network	$911.52
Rate for Payer: Priority Health SBD	$911.52

PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION

Professional

Both

$442.00

Service Code	HCPCS 21315
Min. Negotiated Rate	$38.13
Max. Negotiated Rate	$2,948.86
Rate for Payer: Aetna Commercial	$201.65
Rate for Payer: BCBS Complete	$40.04
Rate for Payer: BCBS Trust/PPO	$2,948.86
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Mclaren Medicaid	$38.13
Rate for Payer: Meridian Medicaid	$40.04
Rate for Payer: Priority Health Choice Medicaid	$38.13
Rate for Payer: Priority Health Cigna Priority Health	$309.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.92
Rate for Payer: Priority Health Narrow Network	$91.92
Rate for Payer: Priority Health SBD	$91.92

PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION

Professional

Both

$407.00

Service Code	HCPCS 21320
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$284.90
Rate for Payer: Aetna Commercial	$176.51
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: BCBS Trust/PPO	$140.42
Rate for Payer: Cash Price	$325.60
Rate for Payer: Cash Price	$325.60
Rate for Payer: Mclaren Medicaid	$60.71
Rate for Payer: Meridian Medicaid	$63.75
Rate for Payer: Priority Health Choice Medicaid	$60.71
Rate for Payer: Priority Health Cigna Priority Health	$284.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$144.51
Rate for Payer: Priority Health Narrow Network	$144.51
Rate for Payer: Priority Health SBD	$144.51

PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION

Professional

Both

$645.00

Service Code	HCPCS 21337
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$462.14
Rate for Payer: Aetna Commercial	$388.27
Rate for Payer: BCBS Complete	$204.41
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$516.00
Rate for Payer: Cash Price	$516.00
Rate for Payer: Mclaren Medicaid	$194.68
Rate for Payer: Meridian Medicaid	$204.41
Rate for Payer: Priority Health Choice Medicaid	$194.68
Rate for Payer: Priority Health Cigna Priority Health	$451.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$462.14
Rate for Payer: Priority Health Narrow Network	$462.14
Rate for Payer: Priority Health SBD	$462.14

PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT

Professional

Both

$1,302.00

Service Code	HCPCS 21421
Min. Negotiated Rate	$348.26
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$736.23
Rate for Payer: BCBS Complete	$365.67
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$1,041.60
Rate for Payer: Cash Price	$1,041.60
Rate for Payer: Mclaren Medicaid	$348.26
Rate for Payer: Meridian Medicaid	$365.67
Rate for Payer: Priority Health Choice Medicaid	$348.26
Rate for Payer: Priority Health Cigna Priority Health	$911.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$832.87
Rate for Payer: Priority Health Narrow Network	$832.87
Rate for Payer: Priority Health SBD	$832.87

PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA

Professional

Both

$602.00

Service Code	HCPCS 27560
Min. Negotiated Rate	$226.63
Max. Negotiated Rate	$2,121.65
Rate for Payer: Aetna Commercial	$457.80
Rate for Payer: BCBS Complete	$237.96
Rate for Payer: BCBS Trust/PPO	$2,121.65
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cash Price	$481.60
Rate for Payer: Mclaren Medicaid	$226.63
Rate for Payer: Meridian Medicaid	$237.96
Rate for Payer: Priority Health Choice Medicaid	$226.63
Rate for Payer: Priority Health Cigna Priority Health	$421.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$536.69
Rate for Payer: Priority Health Narrow Network	$536.69
Rate for Payer: Priority Health SBD	$536.69

PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION

Professional

Both

$638.00

Service Code	HCPCS 27520
Min. Negotiated Rate	$49.13
Max. Negotiated Rate	$473.37
Rate for Payer: Aetna Commercial	$396.99
Rate for Payer: BCBS Complete	$210.68
Rate for Payer: BCBS Trust/PPO	$49.13
Rate for Payer: Cash Price	$510.40
Rate for Payer: Cash Price	$510.40
Rate for Payer: Mclaren Medicaid	$200.65
Rate for Payer: Meridian Medicaid	$210.68
Rate for Payer: Priority Health Choice Medicaid	$200.65
Rate for Payer: Priority Health Cigna Priority Health	$446.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$473.37
Rate for Payer: Priority Health Narrow Network	$473.37
Rate for Payer: Priority Health SBD	$473.37

PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION

Professional

Both

$942.00

Service Code	HCPCS 24655
Min. Negotiated Rate	$269.66
Max. Negotiated Rate	$979.47
Rate for Payer: Aetna Commercial	$532.95
Rate for Payer: BCBS Complete	$283.14
Rate for Payer: BCBS Trust/PPO	$979.47
Rate for Payer: Cash Price	$753.60
Rate for Payer: Cash Price	$753.60
Rate for Payer: Mclaren Medicaid	$269.66
Rate for Payer: Meridian Medicaid	$283.14
Rate for Payer: Priority Health Choice Medicaid	$269.66
Rate for Payer: Priority Health Cigna Priority Health	$659.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$632.69
Rate for Payer: Priority Health Narrow Network	$632.69
Rate for Payer: Priority Health SBD	$632.69

PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION

Professional

Both

$632.00

Service Code	HCPCS 24650
Min. Negotiated Rate	$164.86
Max. Negotiated Rate	$1,113.13
Rate for Payer: Aetna Commercial	$323.50
Rate for Payer: BCBS Complete	$173.10
Rate for Payer: BCBS Trust/PPO	$1,113.13
Rate for Payer: Cash Price	$505.60
Rate for Payer: Cash Price	$505.60
Rate for Payer: Mclaren Medicaid	$164.86
Rate for Payer: Meridian Medicaid	$173.10
Rate for Payer: Priority Health Choice Medicaid	$164.86
Rate for Payer: Priority Health Cigna Priority Health	$442.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.07
Rate for Payer: Priority Health Narrow Network	$387.07
Rate for Payer: Priority Health SBD	$387.07

PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION

Professional

Both

$1,245.00

Service Code	HCPCS 25505
Min. Negotiated Rate	$305.23
Max. Negotiated Rate	$1,458.11
Rate for Payer: Aetna Commercial	$609.77
Rate for Payer: BCBS Complete	$320.49
Rate for Payer: BCBS Trust/PPO	$1,458.11
Rate for Payer: Cash Price	$996.00
Rate for Payer: Cash Price	$996.00
Rate for Payer: Mclaren Medicaid	$305.23
Rate for Payer: Meridian Medicaid	$320.49
Rate for Payer: Priority Health Choice Medicaid	$305.23
Rate for Payer: Priority Health Cigna Priority Health	$871.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$720.53
Rate for Payer: Priority Health Narrow Network	$720.53
Rate for Payer: Priority Health SBD	$720.53

PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$442.00

Service Code	HCPCS 25500
Min. Negotiated Rate	$172.74
Max. Negotiated Rate	$1,850.63
Rate for Payer: Aetna Commercial	$339.01
Rate for Payer: BCBS Complete	$181.38
Rate for Payer: BCBS Trust/PPO	$1,850.63
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Mclaren Medicaid	$172.74
Rate for Payer: Meridian Medicaid	$181.38
Rate for Payer: Priority Health Choice Medicaid	$172.74
Rate for Payer: Priority Health Cigna Priority Health	$309.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$405.45
Rate for Payer: Priority Health Narrow Network	$405.45
Rate for Payer: Priority Health SBD	$405.45

PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ

Professional

Both

$1,400.00

Service Code	HCPCS 25565
Min. Negotiated Rate	$306.93
Max. Negotiated Rate	$2,806.33
Rate for Payer: Aetna Commercial	$619.55
Rate for Payer: BCBS Complete	$322.28
Rate for Payer: BCBS Trust/PPO	$2,806.33
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Cash Price	$1,120.00
Rate for Payer: Mclaren Medicaid	$306.93
Rate for Payer: Meridian Medicaid	$322.28
Rate for Payer: Priority Health Choice Medicaid	$306.93
Rate for Payer: Priority Health Cigna Priority Health	$980.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$728.70
Rate for Payer: Priority Health Narrow Network	$728.70
Rate for Payer: Priority Health SBD	$728.70

PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN

Professional

Both

$700.00

Service Code	HCPCS 25560
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$1,599.69
Rate for Payer: Aetna Commercial	$340.68
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCBS Trust/PPO	$1,599.69
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
Rate for Payer: Mclaren Medicaid	$173.60
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health	$490.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$408.01
Rate for Payer: Priority Health Narrow Network	$408.01
Rate for Payer: Priority Health SBD	$408.01

PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION

Professional

Both

$602.00

Service Code	HCPCS 23570
Min. Negotiated Rate	$162.31
Max. Negotiated Rate	$553.66
Rate for Payer: Aetna Commercial	$319.45
Rate for Payer: BCBS Complete	$170.43
Rate for Payer: BCBS Trust/PPO	$553.66
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cash Price	$481.60
Rate for Payer: Mclaren Medicaid	$162.31
Rate for Payer: Meridian Medicaid	$170.43
Rate for Payer: Priority Health Choice Medicaid	$162.31
Rate for Payer: Priority Health Cigna Priority Health	$421.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$380.95
Rate for Payer: Priority Health Narrow Network	$380.95
Rate for Payer: Priority Health SBD	$380.95

PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION

Professional

Both

$768.00

Service Code	HCPCS 23525
Min. Negotiated Rate	$241.33
Max. Negotiated Rate	$568.86
Rate for Payer: Aetna Commercial	$478.72
Rate for Payer: BCBS Complete	$253.40
Rate for Payer: BCBS Trust/PPO	$399.45
Rate for Payer: Cash Price	$614.40
Rate for Payer: Cash Price	$614.40
Rate for Payer: Mclaren Medicaid	$241.33
Rate for Payer: Meridian Medicaid	$253.40
Rate for Payer: Priority Health Choice Medicaid	$241.33
Rate for Payer: Priority Health Cigna Priority Health	$537.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$568.86
Rate for Payer: Priority Health Narrow Network	$568.86
Rate for Payer: Priority Health SBD	$568.86

PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES

Professional

Both

$351.00

Service Code	HCPCS 28570
Min. Negotiated Rate	$131.42
Max. Negotiated Rate	$1,383.62
Rate for Payer: Aetna Commercial	$255.65
Rate for Payer: BCBS Complete	$137.99
Rate for Payer: BCBS Trust/PPO	$1,383.62
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Mclaren Medicaid	$131.42
Rate for Payer: Meridian Medicaid	$137.99
Rate for Payer: Priority Health Choice Medicaid	$131.42
Rate for Payer: Priority Health Cigna Priority Health	$245.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$307.41
Rate for Payer: Priority Health Narrow Network	$307.41
Rate for Payer: Priority Health SBD	$307.41

PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES

Professional

Both

$792.00

Service Code	HCPCS 28575
Min. Negotiated Rate	$224.50
Max. Negotiated Rate	$804.60
Rate for Payer: Aetna Commercial	$445.15
Rate for Payer: BCBS Complete	$235.72
Rate for Payer: BCBS Trust/PPO	$804.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Mclaren Medicaid	$224.50
Rate for Payer: Meridian Medicaid	$235.72
Rate for Payer: Priority Health Choice Medicaid	$224.50
Rate for Payer: Priority Health Cigna Priority Health	$554.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$529.54
Rate for Payer: Priority Health Narrow Network	$529.54
Rate for Payer: Priority Health SBD	$529.54

PR CLOSED TX TALUS FRACTURE W/MANIPULATION

Professional

Both

$792.00

Service Code	HCPCS 28435
Min. Negotiated Rate	$217.26
Max. Negotiated Rate	$1,149.05
Rate for Payer: Aetna Commercial	$390.08
Rate for Payer: BCBS Complete	$228.12
Rate for Payer: BCBS Trust/PPO	$1,149.05
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Mclaren Medicaid	$217.26
Rate for Payer: Meridian Medicaid	$228.12
Rate for Payer: Priority Health Choice Medicaid	$217.26
Rate for Payer: Priority Health Cigna Priority Health	$554.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$512.18
Rate for Payer: Priority Health Narrow Network	$512.18
Rate for Payer: Priority Health SBD	$512.18

PR CLOSED TX TALUS FRACTURE W/O MANIPULATION

Professional

Both

$660.00

Service Code	HCPCS 28430
Min. Negotiated Rate	$139.52
Max. Negotiated Rate	$540.45
Rate for Payer: Aetna Commercial	$277.32
Rate for Payer: BCBS Complete	$146.50
Rate for Payer: BCBS Trust/PPO	$540.45
Rate for Payer: Cash Price	$528.00
Rate for Payer: Cash Price	$528.00
Rate for Payer: Mclaren Medicaid	$139.52
Rate for Payer: Meridian Medicaid	$146.50
Rate for Payer: Priority Health Choice Medicaid	$139.52
Rate for Payer: Priority Health Cigna Priority Health	$462.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$328.34
Rate for Payer: Priority Health Narrow Network	$328.34
Rate for Payer: Priority Health SBD	$328.34

PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES

Professional

Both

$792.00

Service Code	HCPCS 28605
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$2,031.31
Rate for Payer: Aetna Commercial	$398.51
Rate for Payer: BCBS Complete	$212.47
Rate for Payer: BCBS Trust/PPO	$2,031.31
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Mclaren Medicaid	$202.35
Rate for Payer: Meridian Medicaid	$212.47
Rate for Payer: Priority Health Choice Medicaid	$202.35
Rate for Payer: Priority Health Cigna Priority Health	$554.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$475.93
Rate for Payer: Priority Health Narrow Network	$475.93
Rate for Payer: Priority Health SBD	$475.93

PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES

Professional

Both

$370.00

Service Code	HCPCS 28600
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$1,628.75
Rate for Payer: Aetna Commercial	$242.75
Rate for Payer: BCBS Complete	$110.71
Rate for Payer: BCBS Trust/PPO	$1,628.75
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Mclaren Medicaid	$105.44
Rate for Payer: Meridian Medicaid	$110.71
Rate for Payer: Priority Health Choice Medicaid	$105.44
Rate for Payer: Priority Health Cigna Priority Health	$259.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$288.51
Rate for Payer: Priority Health Narrow Network	$288.51
Rate for Payer: Priority Health SBD	$288.51

PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ

Professional

Both

$1,067.00

Service Code	HCPCS 21485
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$1,218.41
Rate for Payer: Aetna Commercial	$1,032.91
Rate for Payer: BCBS Complete	$524.91
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$853.60
Rate for Payer: Cash Price	$853.60
Rate for Payer: Mclaren Medicaid	$499.91
Rate for Payer: Meridian Medicaid	$524.91
Rate for Payer: Priority Health Choice Medicaid	$499.91
Rate for Payer: Priority Health Cigna Priority Health	$746.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,218.41
Rate for Payer: Priority Health Narrow Network	$1,218.41
Rate for Payer: Priority Health SBD	$1,218.41

PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ

Professional

Both

$139.00

Service Code	HCPCS 21480
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$42.88
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Mclaren Medicaid	$19.81
Rate for Payer: Meridian Medicaid	$20.80
Rate for Payer: Priority Health Choice Medicaid	$19.81
Rate for Payer: Priority Health Cigna Priority Health	$97.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$47.50
Rate for Payer: Priority Health Narrow Network	$47.50
Rate for Payer: Priority Health SBD	$47.50

PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ

Professional

Both

$1,230.00

Service Code	HCPCS 24675
Min. Negotiated Rate	$276.26
Max. Negotiated Rate	$1,365.66
Rate for Payer: Aetna Commercial	$553.15
Rate for Payer: BCBS Complete	$290.07
Rate for Payer: BCBS Trust/PPO	$1,365.66
Rate for Payer: Cash Price	$984.00
Rate for Payer: Cash Price	$984.00
Rate for Payer: Mclaren Medicaid	$276.26
Rate for Payer: Meridian Medicaid	$290.07
Rate for Payer: Priority Health Choice Medicaid	$276.26
Rate for Payer: Priority Health Cigna Priority Health	$861.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$652.61
Rate for Payer: Priority Health Narrow Network	$652.61
Rate for Payer: Priority Health SBD	$652.61

Know your out-of-pocket cost for care.

All Charges