Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

Facility

$1,906.00

Service Code	CPT 25607
Hospital Charge Code	25607
Min. Negotiated Rate	$740.02
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Commercial	$1,620.10
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,238.90
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	$2,889.06
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cofinity Commercial	$1,334.20
Rate for Payer: Cofinity Commercial	$1,639.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$1,715.40
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	$1,620.10
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$1,620.10
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	$1,334.20
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health SBD	$1,200.78
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$814.02
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$740.02
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

Facility

$1,906.00

Service Code	CPT 25607
Hospital Charge Code	25607
Min. Negotiated Rate	$1,200.78
Max. Negotiated Rate	$1,715.40
Rate for Payer: Aetna Commercial	$1,620.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,238.90
Rate for Payer: Cash Price	$1,524.80
Rate for Payer: Cofinity Commercial	$1,334.20
Rate for Payer: Cofinity Commercial	$1,639.16
Rate for Payer: Healthscope Commercial	$1,715.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,620.10
Rate for Payer: PHP Commercial	$1,620.10
Rate for Payer: Priority Health Cigna Priority Health	$1,334.20
Rate for Payer: Priority Health SBD	$1,200.78

PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT

Professional

Both

$3,659.00

Service Code	HCPCS 27236
Min. Negotiated Rate	$766.59
Max. Negotiated Rate	$2,561.30
Rate for Payer: Aetna Commercial	$1,594.63
Rate for Payer: BCBS Complete	$804.92
Rate for Payer: BCBS Trust/PPO	$1,339.77
Rate for Payer: Cash Price	$2,927.20
Rate for Payer: Cash Price	$2,927.20
Rate for Payer: Mclaren Medicaid	$766.59
Rate for Payer: Meridian Medicaid	$804.92
Rate for Payer: Priority Health Choice Medicaid	$766.59
Rate for Payer: Priority Health Cigna Priority Health	$2,561.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,823.02
Rate for Payer: Priority Health Narrow Network	$1,823.02
Rate for Payer: Priority Health SBD	$1,823.02

PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW

Professional

Both

$4,132.00

Service Code	HCPCS 27506
Min. Negotiated Rate	$763.92
Max. Negotiated Rate	$2,892.40
Rate for Payer: Aetna Commercial	$1,786.48
Rate for Payer: BCBS Complete	$902.20
Rate for Payer: BCBS Trust/PPO	$763.92
Rate for Payer: Cash Price	$3,305.60
Rate for Payer: Cash Price	$3,305.60
Rate for Payer: Mclaren Medicaid	$859.24
Rate for Payer: Meridian Medicaid	$902.20
Rate for Payer: Priority Health Choice Medicaid	$859.24
Rate for Payer: Priority Health Cigna Priority Health	$2,892.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,045.15
Rate for Payer: Priority Health Narrow Network	$2,045.15
Rate for Payer: Priority Health SBD	$2,045.15

PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$3,773.00

Service Code	HCPCS 27507
Min. Negotiated Rate	$621.11
Max. Negotiated Rate	$2,641.10
Rate for Payer: Aetna Commercial	$1,296.79
Rate for Payer: BCBS Complete	$652.17
Rate for Payer: BCBS Trust/PPO	$1,019.62
Rate for Payer: Cash Price	$3,018.40
Rate for Payer: Cash Price	$3,018.40
Rate for Payer: Mclaren Medicaid	$621.11
Rate for Payer: Meridian Medicaid	$652.17
Rate for Payer: Priority Health Choice Medicaid	$621.11
Rate for Payer: Priority Health Cigna Priority Health	$2,641.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,480.37
Rate for Payer: Priority Health Narrow Network	$1,480.37
Rate for Payer: Priority Health SBD	$1,480.37

PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ

Professional

Both

$1,361.00

Service Code	HCPCS 23630
Min. Negotiated Rate	$265.21
Max. Negotiated Rate	$1,201.57
Rate for Payer: Aetna Commercial	$1,039.57
Rate for Payer: BCBS Complete	$531.39
Rate for Payer: BCBS Trust/PPO	$265.21
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Mclaren Medicaid	$506.09
Rate for Payer: Meridian Medicaid	$531.39
Rate for Payer: Priority Health Choice Medicaid	$506.09
Rate for Payer: Priority Health Cigna Priority Health	$952.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,201.57
Rate for Payer: Priority Health Narrow Network	$1,201.57
Rate for Payer: Priority Health SBD	$1,201.57

PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD

Professional

Both

$3,476.00

Service Code	HCPCS 27254
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$2,549.58
Rate for Payer: Aetna Commercial	$1,702.05
Rate for Payer: BCBS Complete	$856.80
Rate for Payer: BCBS Trust/PPO	$2,549.58
Rate for Payer: Cash Price	$2,780.80
Rate for Payer: Cash Price	$2,780.80
Rate for Payer: Mclaren Medicaid	$816.00
Rate for Payer: Meridian Medicaid	$856.80
Rate for Payer: Priority Health Choice Medicaid	$816.00
Rate for Payer: Priority Health Cigna Priority Health	$2,433.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,943.03
Rate for Payer: Priority Health Narrow Network	$1,943.03
Rate for Payer: Priority Health SBD	$1,943.03

PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ

Professional

Both

$2,305.00

Service Code	HCPCS 27253
Min. Negotiated Rate	$604.92
Max. Negotiated Rate	$2,442.33
Rate for Payer: Aetna Commercial	$1,258.60
Rate for Payer: BCBS Complete	$635.17
Rate for Payer: BCBS Trust/PPO	$2,442.33
Rate for Payer: Cash Price	$1,844.00
Rate for Payer: Cash Price	$1,844.00
Rate for Payer: Mclaren Medicaid	$604.92
Rate for Payer: Meridian Medicaid	$635.17
Rate for Payer: Priority Health Choice Medicaid	$604.92
Rate for Payer: Priority Health Cigna Priority Health	$1,613.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,441.06
Rate for Payer: Priority Health Narrow Network	$1,441.06
Rate for Payer: Priority Health SBD	$1,441.06

PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE

Professional

Both

$3,031.00

Service Code	HCPCS 24515
Min. Negotiated Rate	$338.11
Max. Negotiated Rate	$2,121.70
Rate for Payer: Aetna Commercial	$1,174.12
Rate for Payer: BCBS Complete	$597.60
Rate for Payer: BCBS Trust/PPO	$338.11
Rate for Payer: Cash Price	$2,424.80
Rate for Payer: Cash Price	$2,424.80
Rate for Payer: Mclaren Medicaid	$569.14
Rate for Payer: Meridian Medicaid	$597.60
Rate for Payer: Priority Health Choice Medicaid	$569.14
Rate for Payer: Priority Health Cigna Priority Health	$2,121.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,354.25
Rate for Payer: Priority Health Narrow Network	$1,354.25
Rate for Payer: Priority Health SBD	$1,354.25

PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD

Professional

Both

$2,582.00

Service Code	HCPCS 27215
Min. Negotiated Rate	$387.02
Max. Negotiated Rate	$1,807.40
Rate for Payer: Aetna Commercial	$803.86
Rate for Payer: BCBS Complete	$406.37
Rate for Payer: BCBS Trust/PPO	$1,741.81
Rate for Payer: Cash Price	$2,065.60
Rate for Payer: Cash Price	$2,065.60
Rate for Payer: Mclaren Medicaid	$387.02
Rate for Payer: Meridian Medicaid	$406.37
Rate for Payer: Priority Health Choice Medicaid	$387.02
Rate for Payer: Priority Health Cigna Priority Health	$1,807.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$921.22
Rate for Payer: Priority Health Narrow Network	$921.22
Rate for Payer: Priority Health SBD	$921.22

PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN

Professional

Both

$2,014.00

Service Code	HCPCS 21347
Min. Negotiated Rate	$86.11
Max. Negotiated Rate	$1,596.80
Rate for Payer: Aetna Commercial	$1,362.92
Rate for Payer: BCBS Complete	$697.79
Rate for Payer: BCBS Trust/PPO	$86.11
Rate for Payer: Cash Price	$1,611.20
Rate for Payer: Cash Price	$1,611.20
Rate for Payer: Mclaren Medicaid	$664.56
Rate for Payer: Meridian Medicaid	$697.79
Rate for Payer: Priority Health Choice Medicaid	$664.56
Rate for Payer: Priority Health Cigna Priority Health	$1,409.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,596.80
Rate for Payer: Priority Health Narrow Network	$1,596.80
Rate for Payer: Priority Health SBD	$1,596.80

PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC

Professional

Both

$1,581.00

Service Code	HCPCS 21390
Min. Negotiated Rate	$514.18
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$1,059.79
Rate for Payer: BCBS Complete	$539.89
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$1,264.80
Rate for Payer: Cash Price	$1,264.80
Rate for Payer: Mclaren Medicaid	$514.18
Rate for Payer: Meridian Medicaid	$539.89
Rate for Payer: Priority Health Choice Medicaid	$514.18
Rate for Payer: Priority Health Cigna Priority Health	$1,106.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,227.09
Rate for Payer: Priority Health Narrow Network	$1,227.09
Rate for Payer: Priority Health SBD	$1,227.09

PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY

Professional

Both

$1,564.00

Service Code	HCPCS 27566
Min. Negotiated Rate	$576.38
Max. Negotiated Rate	$1,369.56
Rate for Payer: Aetna Commercial	$1,193.01
Rate for Payer: BCBS Complete	$605.20
Rate for Payer: BCBS Trust/PPO	$897.05
Rate for Payer: Cash Price	$1,251.20
Rate for Payer: Cash Price	$1,251.20
Rate for Payer: Mclaren Medicaid	$576.38
Rate for Payer: Meridian Medicaid	$605.20
Rate for Payer: Priority Health Choice Medicaid	$576.38
Rate for Payer: Priority Health Cigna Priority Health	$1,094.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,369.56
Rate for Payer: Priority Health Narrow Network	$1,369.56
Rate for Payer: Priority Health SBD	$1,369.56

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Professional

Both

$2,460.00

Service Code	HCPCS 27524
Min. Negotiated Rate	$487.56
Max. Negotiated Rate	$1,722.00
Rate for Payer: Aetna Commercial	$1,005.26
Rate for Payer: BCBS Complete	$511.94
Rate for Payer: BCBS Trust/PPO	$1,260.52
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Mclaren Medicaid	$487.56
Rate for Payer: Meridian Medicaid	$511.94
Rate for Payer: Priority Health Choice Medicaid	$487.56
Rate for Payer: Priority Health Cigna Priority Health	$1,722.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,159.18
Rate for Payer: Priority Health Narrow Network	$1,159.18
Rate for Payer: Priority Health SBD	$1,159.18

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Professional

Both

$2,460.00

Service Code	HCPCS 27524
Hospital Charge Code	27524
Min. Negotiated Rate	$487.56
Max. Negotiated Rate	$1,722.00
Rate for Payer: Aetna Commercial	$1,005.26
Rate for Payer: BCBS Complete	$511.94
Rate for Payer: BCBS Trust/PPO	$1,260.52
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Mclaren Medicaid	$487.56
Rate for Payer: Meridian Medicaid	$511.94
Rate for Payer: Priority Health Choice Medicaid	$487.56
Rate for Payer: Priority Health Cigna Priority Health	$1,722.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,159.18
Rate for Payer: Priority Health Narrow Network	$1,159.18
Rate for Payer: Priority Health SBD	$1,159.18

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Facility

$2,460.00

Service Code	CPT 27524
Hospital Charge Code	27524
Min. Negotiated Rate	$1,549.80
Max. Negotiated Rate	$2,214.00
Rate for Payer: Aetna Commercial	$2,091.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,599.00
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cofinity Commercial	$1,722.00
Rate for Payer: Cofinity Commercial	$2,115.60
Rate for Payer: Healthscope Commercial	$2,214.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,091.00
Rate for Payer: PHP Commercial	$2,091.00
Rate for Payer: Priority Health Cigna Priority Health	$1,722.00
Rate for Payer: Priority Health SBD	$1,549.80

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Facility

$2,460.00

Service Code	CPT 27524
Hospital Charge Code	27524
Min. Negotiated Rate	$749.51
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Commercial	$2,091.00
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,599.00
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	$3,616.30
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cash Price	$1,968.00
Rate for Payer: Cofinity Commercial	$2,115.60
Rate for Payer: Cofinity Commercial	$1,722.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$2,214.00
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	$2,091.00
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$2,091.00
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	$1,722.00
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	$1,549.80
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$824.46
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$749.51
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO

Professional

Both

$1,909.00

Service Code	HCPCS 24586
Min. Negotiated Rate	$194.94
Max. Negotiated Rate	$1,664.71
Rate for Payer: Aetna Commercial	$1,452.52
Rate for Payer: BCBS Complete	$734.24
Rate for Payer: BCBS Trust/PPO	$194.94
Rate for Payer: Cash Price	$1,527.20
Rate for Payer: Cash Price	$1,527.20
Rate for Payer: Mclaren Medicaid	$699.28
Rate for Payer: Meridian Medicaid	$734.24
Rate for Payer: Priority Health Choice Medicaid	$699.28
Rate for Payer: Priority Health Cigna Priority Health	$1,336.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,664.71
Rate for Payer: Priority Health Narrow Network	$1,664.71
Rate for Payer: Priority Health SBD	$1,664.71

PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD

Professional

Both

$3,842.00

Service Code	HCPCS 27218
Min. Negotiated Rate	$736.77
Max. Negotiated Rate	$2,689.40
Rate for Payer: Aetna Commercial	$1,541.82
Rate for Payer: BCBS Complete	$773.61
Rate for Payer: BCBS Trust/PPO	$758.64
Rate for Payer: Cash Price	$3,073.60
Rate for Payer: Cash Price	$3,073.60
Rate for Payer: Mclaren Medicaid	$736.77
Rate for Payer: Meridian Medicaid	$773.61
Rate for Payer: Priority Health Choice Medicaid	$736.77
Rate for Payer: Priority Health Cigna Priority Health	$2,689.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,755.10
Rate for Payer: Priority Health Narrow Network	$1,755.10
Rate for Payer: Priority Health SBD	$1,755.10

PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR

Professional

Both

$1,900.00

Service Code	HCPCS 24587
Min. Negotiated Rate	$435.85
Max. Negotiated Rate	$1,667.79
Rate for Payer: Aetna Commercial	$1,453.71
Rate for Payer: BCBS Complete	$735.81
Rate for Payer: BCBS Trust/PPO	$435.85
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Mclaren Medicaid	$700.77
Rate for Payer: Meridian Medicaid	$735.81
Rate for Payer: Priority Health Choice Medicaid	$700.77
Rate for Payer: Priority Health Cigna Priority Health	$1,330.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,667.79
Rate for Payer: Priority Health Narrow Network	$1,667.79
Rate for Payer: Priority Health SBD	$1,667.79

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Professional

Both

$3,129.00

Service Code	HCPCS 23615
Min. Negotiated Rate	$333.89
Max. Negotiated Rate	$2,190.30
Rate for Payer: Aetna Commercial	$1,179.32
Rate for Payer: BCBS Complete	$599.16
Rate for Payer: BCBS Trust/PPO	$333.89
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Mclaren Medicaid	$570.63
Rate for Payer: Meridian Medicaid	$599.16
Rate for Payer: Priority Health Choice Medicaid	$570.63
Rate for Payer: Priority Health Cigna Priority Health	$2,190.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,356.79
Rate for Payer: Priority Health Narrow Network	$1,356.79
Rate for Payer: Priority Health SBD	$1,356.79

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Professional

Both

$3,129.00

Service Code	HCPCS 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$333.89
Max. Negotiated Rate	$2,190.30
Rate for Payer: Aetna Commercial	$1,179.32
Rate for Payer: BCBS Complete	$599.16
Rate for Payer: BCBS Trust/PPO	$333.89
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Mclaren Medicaid	$570.63
Rate for Payer: Meridian Medicaid	$599.16
Rate for Payer: Priority Health Choice Medicaid	$570.63
Rate for Payer: Priority Health Cigna Priority Health	$2,190.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,356.79
Rate for Payer: Priority Health Narrow Network	$1,356.79
Rate for Payer: Priority Health SBD	$1,356.79

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Facility

$3,129.00

Service Code	CPT 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$1,971.27
Max. Negotiated Rate	$2,816.10
Rate for Payer: Aetna Commercial	$2,659.65
Rate for Payer: Aetna New Business (MI Preferred)	$2,033.85
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cofinity Commercial	$2,190.30
Rate for Payer: Cofinity Commercial	$2,690.94
Rate for Payer: Healthscope Commercial	$2,816.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,659.65
Rate for Payer: PHP Commercial	$2,659.65
Rate for Payer: Priority Health Cigna Priority Health	$2,190.30
Rate for Payer: Priority Health SBD	$1,971.27

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Facility

$3,129.00

Service Code	CPT 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$877.22
Max. Negotiated Rate	$14,638.36
Rate for Payer: Aetna Commercial	$2,659.65
Rate for Payer: Aetna Medicare	$12,179.12
Rate for Payer: Aetna New Business (MI Preferred)	$2,033.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,638.36
Rate for Payer: Amish Plain Church Group Commercial	$14,638.36
Rate for Payer: BCBS Complete	$6,726.62
Rate for Payer: BCBS MAPPO	$11,710.69
Rate for Payer: BCBS Trust/PPO	$4,214.48
Rate for Payer: BCN Medicare Advantage	$11,710.69
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cash Price	$2,503.20
Rate for Payer: Cofinity Commercial	$2,190.30
Rate for Payer: Cofinity Commercial	$2,690.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,710.69
Rate for Payer: Healthscope Commercial	$2,816.10
Rate for Payer: Mclaren Medicaid	$6,405.75
Rate for Payer: Mclaren Medicare	$11,710.69
Rate for Payer: Meridian Medicaid	$6,726.62
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,296.22
Rate for Payer: MI Amish Medical Board Commercial	$13,467.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,659.65
Rate for Payer: PACE Medicare	$11,125.16
Rate for Payer: PACE SWMI	$11,710.69
Rate for Payer: PHP Commercial	$2,659.65
Rate for Payer: PHP Medicare Advantage	$11,710.69
Rate for Payer: Priority Health Choice Medicaid	$6,405.75
Rate for Payer: Priority Health Cigna Priority Health	$2,190.30
Rate for Payer: Priority Health Medicare	$11,710.69
Rate for Payer: Priority Health SBD	$1,971.27
Rate for Payer: Railroad Medicare Medicare	$11,710.69
Rate for Payer: UHC All Payor (Choice/PPO)	$964.94
Rate for Payer: UHC Dual Complete DSNP	$11,710.69
Rate for Payer: UHC Exchange	$877.22
Rate for Payer: UHC Medicare Advantage	$12,062.01
Rate for Payer: VA VA	$11,710.69

PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT

Professional

Both

$2,330.00

Service Code	HCPCS 23616
Min. Negotiated Rate	$496.07
Max. Negotiated Rate	$1,890.42
Rate for Payer: Aetna Commercial	$1,651.81
Rate for Payer: BCBS Complete	$833.99
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: Cash Price	$1,864.00
Rate for Payer: Cash Price	$1,864.00
Rate for Payer: Mclaren Medicaid	$794.28
Rate for Payer: Meridian Medicaid	$833.99
Rate for Payer: Priority Health Choice Medicaid	$794.28
Rate for Payer: Priority Health Cigna Priority Health	$1,631.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,890.42
Rate for Payer: Priority Health Narrow Network	$1,890.42
Rate for Payer: Priority Health SBD	$1,890.42

Know your out-of-pocket cost for care.

All Charges