Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION

Professional

Both

$960.00

Service Code	HCPCS 28675
Min. Negotiated Rate	$268.17
Max. Negotiated Rate	$672.00
Rate for Payer: Aetna Commercial	$534.76
Rate for Payer: BCBS Complete	$281.58
Rate for Payer: BCBS Trust/PPO	$671.47
Rate for Payer: Cash Price	$768.00
Rate for Payer: Cash Price	$768.00
Rate for Payer: Mclaren Medicaid	$268.17
Rate for Payer: Meridian Medicaid	$281.58
Rate for Payer: Priority Health Choice Medicaid	$268.17
Rate for Payer: Priority Health Cigna Priority Health	$672.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$631.17
Rate for Payer: Priority Health Narrow Network	$631.17
Rate for Payer: Priority Health SBD	$631.17

PR OPEN TREATMENT LUNATE DISLOCATION

Professional

Both

$1,867.00

Service Code	HCPCS 25695
Min. Negotiated Rate	$412.58
Max. Negotiated Rate	$1,306.90
Rate for Payer: Aetna Commercial	$848.78
Rate for Payer: BCBS Complete	$433.21
Rate for Payer: BCBS Trust/PPO	$1,009.58
Rate for Payer: Cash Price	$1,493.60
Rate for Payer: Cash Price	$1,493.60
Rate for Payer: Mclaren Medicaid	$412.58
Rate for Payer: Meridian Medicaid	$433.21
Rate for Payer: Priority Health Choice Medicaid	$412.58
Rate for Payer: Priority Health Cigna Priority Health	$1,306.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$979.94
Rate for Payer: Priority Health Narrow Network	$979.94
Rate for Payer: Priority Health SBD	$979.94

PR OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE

Professional

Both

$1,679.00

Service Code	HCPCS 21465
Min. Negotiated Rate	$509.71
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$1,066.23
Rate for Payer: BCBS Complete	$535.20
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Mclaren Medicaid	$509.71
Rate for Payer: Meridian Medicaid	$535.20
Rate for Payer: Priority Health Choice Medicaid	$509.71
Rate for Payer: Priority Health Cigna Priority Health	$1,175.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,211.77
Rate for Payer: Priority Health Narrow Network	$1,211.77
Rate for Payer: Priority Health SBD	$1,211.77

PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE

Professional

Both

$2,138.00

Service Code	HCPCS 27766
Min. Negotiated Rate	$392.35
Max. Negotiated Rate	$2,661.86
Rate for Payer: Aetna Commercial	$805.90
Rate for Payer: BCBS Complete	$411.97
Rate for Payer: BCBS Trust/PPO	$2,661.86
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Mclaren Medicaid	$392.35
Rate for Payer: Meridian Medicaid	$411.97
Rate for Payer: Priority Health Choice Medicaid	$392.35
Rate for Payer: Priority Health Cigna Priority Health	$1,496.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$935.51
Rate for Payer: Priority Health Narrow Network	$935.51
Rate for Payer: Priority Health SBD	$935.51

PR OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION

Professional

Both

$1,887.00

Service Code	HCPCS 26715
Min. Negotiated Rate	$374.24
Max. Negotiated Rate	$1,320.90
Rate for Payer: Aetna Commercial	$760.98
Rate for Payer: BCBS Complete	$392.95
Rate for Payer: BCBS Trust/PPO	$381.43
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Mclaren Medicaid	$374.24
Rate for Payer: Meridian Medicaid	$392.95
Rate for Payer: Priority Health Choice Medicaid	$374.24
Rate for Payer: Priority Health Cigna Priority Health	$1,320.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$887.51
Rate for Payer: Priority Health Narrow Network	$887.51
Rate for Payer: Priority Health SBD	$887.51

PR OPEN TREATMENT METATARSAL FRACTURE EACH

Professional

Both

$1,320.00

Service Code	HCPCS 28485
Min. Negotiated Rate	$365.08
Max. Negotiated Rate	$924.00
Rate for Payer: Aetna Commercial	$740.09
Rate for Payer: BCBS Complete	$383.33
Rate for Payer: BCBS Trust/PPO	$613.88
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Mclaren Medicaid	$365.08
Rate for Payer: Meridian Medicaid	$383.33
Rate for Payer: Priority Health Choice Medicaid	$365.08
Rate for Payer: Priority Health Cigna Priority Health	$924.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$861.98
Rate for Payer: Priority Health Narrow Network	$861.98
Rate for Payer: Priority Health SBD	$861.98

PR OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED

Professional

Both

$824.00

Service Code	HCPCS 21325
Min. Negotiated Rate	$286.49
Max. Negotiated Rate	$1,404.22
Rate for Payer: Aetna Commercial	$583.69
Rate for Payer: BCBS Complete	$300.81
Rate for Payer: BCBS Trust/PPO	$1,404.22
Rate for Payer: Cash Price	$659.20
Rate for Payer: Cash Price	$659.20
Rate for Payer: Mclaren Medicaid	$286.49
Rate for Payer: Meridian Medicaid	$300.81
Rate for Payer: Priority Health Choice Medicaid	$286.49
Rate for Payer: Priority Health Cigna Priority Health	$576.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$685.81
Rate for Payer: Priority Health Narrow Network	$685.81
Rate for Payer: Priority Health SBD	$685.81

PR OPEN TREATMENT OF ULNAR SHAFT FRACTURE

Professional

Both

$1,906.00

Service Code	HCPCS 25545
Min. Negotiated Rate	$407.26
Max. Negotiated Rate	$1,334.20
Rate for Payer: Aetna Commercial	$829.87
Rate for Payer: BCBS Complete	$427.62
Rate for Payer: BCBS Trust/PPO	$1,170.18
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Mclaren Medicaid	$407.26
Rate for Payer: Meridian Medicaid	$427.62
Rate for Payer: Priority Health Choice Medicaid	$407.26
Rate for Payer: Priority Health Cigna Priority Health	$1,334.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$966.65
Rate for Payer: Priority Health Narrow Network	$966.65
Rate for Payer: Priority Health SBD	$966.65

PR OPEN TREATMENT PALATAL/MAXILLARY FRACTURE

Professional

Both

$1,317.00

Service Code	HCPCS 21422
Min. Negotiated Rate	$399.38
Max. Negotiated Rate	$22,818.32
Rate for Payer: Aetna Commercial	$849.13
Rate for Payer: BCBS Complete	$419.35
Rate for Payer: BCBS Trust/PPO	$22,818.32
Rate for Payer: Cash Price	$1,053.60
Rate for Payer: Cash Price	$1,053.60
Rate for Payer: Mclaren Medicaid	$399.38
Rate for Payer: Meridian Medicaid	$419.35
Rate for Payer: Priority Health Choice Medicaid	$399.38
Rate for Payer: Priority Health Cigna Priority Health	$921.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$962.57
Rate for Payer: Priority Health Narrow Network	$962.57
Rate for Payer: Priority Health SBD	$962.57

PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE

Professional

Both

$1,272.00

Service Code	HCPCS 27769
Min. Negotiated Rate	$469.67
Max. Negotiated Rate	$2,788.67
Rate for Payer: Aetna Commercial	$976.15
Rate for Payer: BCBS Complete	$493.15
Rate for Payer: BCBS Trust/PPO	$2,788.67
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Mclaren Medicaid	$469.67
Rate for Payer: Meridian Medicaid	$493.15
Rate for Payer: Priority Health Choice Medicaid	$469.67
Rate for Payer: Priority Health Cigna Priority Health	$890.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,117.30
Rate for Payer: Priority Health Narrow Network	$1,117.30
Rate for Payer: Priority Health SBD	$1,117.30

PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE

Professional

Both

$2,233.00

Service Code	HCPCS 27784
Min. Negotiated Rate	$463.49
Max. Negotiated Rate	$2,244.78
Rate for Payer: Aetna Commercial	$940.92
Rate for Payer: BCBS Complete	$486.66
Rate for Payer: BCBS Trust/PPO	$2,244.78
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Mclaren Medicaid	$463.49
Rate for Payer: Meridian Medicaid	$486.66
Rate for Payer: Priority Health Choice Medicaid	$463.49
Rate for Payer: Priority Health Cigna Priority Health	$1,563.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,093.29
Rate for Payer: Priority Health Narrow Network	$1,093.29
Rate for Payer: Priority Health SBD	$1,093.29

PR OPEN TREATMENT RADIAL SHAFT FRACTURE

Professional

Both

$2,023.00

Service Code	HCPCS 25515
Min. Negotiated Rate	$436.44
Max. Negotiated Rate	$1,416.10
Rate for Payer: Aetna Commercial	$891.56
Rate for Payer: BCBS Complete	$458.26
Rate for Payer: BCBS Trust/PPO	$1,387.32
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Mclaren Medicaid	$436.44
Rate for Payer: Meridian Medicaid	$458.26
Rate for Payer: Priority Health Choice Medicaid	$436.44
Rate for Payer: Priority Health Cigna Priority Health	$1,416.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,034.07
Rate for Payer: Priority Health Narrow Network	$1,034.07
Rate for Payer: Priority Health SBD	$1,034.07

PR OPEN TREATMENT TALOTARSAL JOINT DISLOCATION

Professional

Both

$1,957.00

Service Code	HCPCS 28585
Min. Negotiated Rate	$312.23
Max. Negotiated Rate	$1,369.90
Rate for Payer: Aetna Commercial	$912.33
Rate for Payer: BCBS Complete	$478.83
Rate for Payer: BCBS Trust/PPO	$312.23
Rate for Payer: Cash Price	$1,565.60
Rate for Payer: Cash Price	$1,565.60
Rate for Payer: Mclaren Medicaid	$456.03
Rate for Payer: Meridian Medicaid	$478.83
Rate for Payer: Priority Health Choice Medicaid	$456.03
Rate for Payer: Priority Health Cigna Priority Health	$1,369.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,065.22
Rate for Payer: Priority Health Narrow Network	$1,065.22
Rate for Payer: Priority Health SBD	$1,065.22

PR OPEN TREATMENT TALUS FRACTURE

Professional

Both

$3,080.00

Service Code	HCPCS 28445
Min. Negotiated Rate	$588.53
Max. Negotiated Rate	$2,156.00
Rate for Payer: Aetna Commercial	$1,370.13
Rate for Payer: BCBS Complete	$708.97
Rate for Payer: BCBS Trust/PPO	$588.53
Rate for Payer: Cash Price	$2,464.00
Rate for Payer: Cash Price	$2,464.00
Rate for Payer: Mclaren Medicaid	$675.21
Rate for Payer: Meridian Medicaid	$708.97
Rate for Payer: Priority Health Choice Medicaid	$675.21
Rate for Payer: Priority Health Cigna Priority Health	$2,156.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,589.66
Rate for Payer: Priority Health Narrow Network	$1,589.66
Rate for Payer: Priority Health SBD	$1,589.66

PR OPEN TREATMENT TARSAL BONE DISLOCATION

Professional

Both

$1,694.00

Service Code	HCPCS 28555
Min. Negotiated Rate	$427.92
Max. Negotiated Rate	$1,185.80
Rate for Payer: Aetna Commercial	$870.72
Rate for Payer: BCBS Complete	$449.32
Rate for Payer: BCBS Trust/PPO	$645.58
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Mclaren Medicaid	$427.92
Rate for Payer: Meridian Medicaid	$449.32
Rate for Payer: Priority Health Choice Medicaid	$427.92
Rate for Payer: Priority Health Cigna Priority Health	$1,185.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,017.72
Rate for Payer: Priority Health Narrow Network	$1,017.72
Rate for Payer: Priority Health SBD	$1,017.72

PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION

Professional

Both

$1,760.00

Service Code	HCPCS 28615
Min. Negotiated Rate	$535.48
Max. Negotiated Rate	$1,778.26
Rate for Payer: Aetna Commercial	$1,091.05
Rate for Payer: BCBS Complete	$562.25
Rate for Payer: BCBS Trust/PPO	$1,778.26
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Cash Price	$1,408.00
Rate for Payer: Mclaren Medicaid	$535.48
Rate for Payer: Meridian Medicaid	$562.25
Rate for Payer: Priority Health Choice Medicaid	$535.48
Rate for Payer: Priority Health Cigna Priority Health	$1,232.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,268.97
Rate for Payer: Priority Health Narrow Network	$1,268.97
Rate for Payer: Priority Health SBD	$1,268.97

PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END

Facility

$2,297.00

Service Code	CPT 24685
Hospital Charge Code	24685
Min. Negotiated Rate	$1,447.11
Max. Negotiated Rate	$2,067.30
Rate for Payer: Aetna Commercial	$1,952.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,493.05
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Cofinity Commercial	$1,607.90
Rate for Payer: Cofinity Commercial	$1,975.42
Rate for Payer: Healthscope Commercial	$2,067.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,952.45
Rate for Payer: PHP Commercial	$1,952.45
Rate for Payer: Priority Health Cigna Priority Health	$1,607.90
Rate for Payer: Priority Health SBD	$1,447.11

PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END

Facility

$2,297.00

Service Code	CPT 24685
Hospital Charge Code	24685
Min. Negotiated Rate	$653.90
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Commercial	$1,952.45
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,493.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$3,655.42
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Cofinity Commercial	$1,975.42
Rate for Payer: Cofinity Commercial	$1,607.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$2,067.30
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,952.45
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$1,952.45
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$1,607.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,834.21
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,867.37
Rate for Payer: Priority Health SBD	$1,447.11
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$719.29
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$653.90
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END

Professional

Both

$2,297.00

Service Code	HCPCS 24685
Hospital Charge Code	24685
Min. Negotiated Rate	$338.11
Max. Negotiated Rate	$1,607.90
Rate for Payer: Aetna Commercial	$871.05
Rate for Payer: BCBS Complete	$446.63
Rate for Payer: BCBS Trust/PPO	$338.11
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Mclaren Medicaid	$425.36
Rate for Payer: Meridian Medicaid	$446.63
Rate for Payer: Priority Health Choice Medicaid	$425.36
Rate for Payer: Priority Health Cigna Priority Health	$1,607.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.04
Rate for Payer: Priority Health Narrow Network	$1,009.04
Rate for Payer: Priority Health SBD	$1,009.04

PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END

Professional

Both

$2,297.00

Service Code	HCPCS 24685
Min. Negotiated Rate	$338.11
Max. Negotiated Rate	$1,607.90
Rate for Payer: Aetna Commercial	$871.05
Rate for Payer: BCBS Complete	$446.63
Rate for Payer: BCBS Trust/PPO	$338.11
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Cash Price	$1,837.60
Rate for Payer: Mclaren Medicaid	$425.36
Rate for Payer: Meridian Medicaid	$446.63
Rate for Payer: Priority Health Choice Medicaid	$425.36
Rate for Payer: Priority Health Cigna Priority Health	$1,607.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.04
Rate for Payer: Priority Health Narrow Network	$1,009.04
Rate for Payer: Priority Health SBD	$1,009.04

PR OPEN TREATMENT ULNAR STYLOID FRACTURE

Professional

Both

$1,634.00

Service Code	HCPCS 25652
Min. Negotiated Rate	$405.98
Max. Negotiated Rate	$1,501.43
Rate for Payer: Aetna Commercial	$828.66
Rate for Payer: BCBS Complete	$426.28
Rate for Payer: BCBS Trust/PPO	$1,501.43
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$405.98
Rate for Payer: Meridian Medicaid	$426.28
Rate for Payer: Priority Health Choice Medicaid	$405.98
Rate for Payer: Priority Health Cigna Priority Health	$1,143.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$963.59
Rate for Payer: Priority Health Narrow Network	$963.59
Rate for Payer: Priority Health SBD	$963.59

PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 1-2 RIBS

Professional

Both

$3,282.00

Service Code	HCPCS 0245T
Min. Negotiated Rate	$1,312.80
Max. Negotiated Rate	$2,297.40
Rate for Payer: BCBS Complete	$1,312.80
Rate for Payer: Cash Price	$2,625.60
Rate for Payer: Priority Health Cigna Priority Health	$2,297.40

PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 3-4 RIBS

Professional

Both

$3,617.00

Service Code	HCPCS 0246T
Min. Negotiated Rate	$1,446.80
Max. Negotiated Rate	$2,531.90
Rate for Payer: BCBS Complete	$1,446.80
Rate for Payer: Cash Price	$2,893.60
Rate for Payer: Priority Health Cigna Priority Health	$2,531.90

PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 5-6 RIBS

Professional

Both

$4,000.00

Service Code	HCPCS 0247T
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$2,800.00
Rate for Payer: BCBS Complete	$1,600.00
Rate for Payer: Cash Price	$3,200.00
Rate for Payer: Priority Health Cigna Priority Health	$2,800.00

PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 7+ RIBS

Professional

Both

$4,617.00

Service Code	HCPCS 0248T
Min. Negotiated Rate	$1,846.80
Max. Negotiated Rate	$3,231.90
Rate for Payer: BCBS Complete	$1,846.80
Rate for Payer: Cash Price	$3,693.60
Rate for Payer: Priority Health Cigna Priority Health	$3,231.90

Know your out-of-pocket cost for care.

All Charges