Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM

Professional

Both

$2,820.00

Service Code	HCPCS 25077
Min. Negotiated Rate	$256.75
Max. Negotiated Rate	$1,974.00
Rate for Payer: Aetna Commercial	$1,186.63
Rate for Payer: BCBS Complete	$580.60
Rate for Payer: BCBS Trust/PPO	$256.75
Rate for Payer: Cash Price	$2,256.00
Rate for Payer: Cash Price	$2,256.00
Rate for Payer: Mclaren Medicaid	$552.95
Rate for Payer: Meridian Medicaid	$580.60
Rate for Payer: Priority Health Choice Medicaid	$552.95
Rate for Payer: Priority Health Cigna Priority Health	$1,974.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,358.84
Rate for Payer: Priority Health Narrow Network	$1,358.84
Rate for Payer: Priority Health SBD	$1,358.84

PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM

Professional

Both

$1,644.00

Service Code	HCPCS 21557
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$1,459.44
Rate for Payer: Aetna Commercial	$1,274.88
Rate for Payer: BCBS Complete	$645.90
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Mclaren Medicaid	$615.14
Rate for Payer: Meridian Medicaid	$645.90
Rate for Payer: Priority Health Choice Medicaid	$615.14
Rate for Payer: Priority Health Cigna Priority Health	$1,150.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,459.44
Rate for Payer: Priority Health Narrow Network	$1,459.44
Rate for Payer: Priority Health SBD	$1,459.44

PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>

Professional

Both

$3,351.00

Service Code	HCPCS 21558
Min. Negotiated Rate	$57.48
Max. Negotiated Rate	$2,345.70
Rate for Payer: Aetna Commercial	$1,800.42
Rate for Payer: BCBS Complete	$900.20
Rate for Payer: BCBS Trust/PPO	$57.48
Rate for Payer: Cash Price	$2,680.80
Rate for Payer: Cash Price	$2,680.80
Rate for Payer: Mclaren Medicaid	$857.33
Rate for Payer: Meridian Medicaid	$900.20
Rate for Payer: Priority Health Choice Medicaid	$857.33
Rate for Payer: Priority Health Cigna Priority Health	$2,345.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,050.77
Rate for Payer: Priority Health Narrow Network	$2,050.77
Rate for Payer: Priority Health SBD	$2,050.77

PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM

Professional

Both

$2,315.00

Service Code	HCPCS 26117
Min. Negotiated Rate	$171.92
Max. Negotiated Rate	$1,620.50
Rate for Payer: Aetna Commercial	$984.86
Rate for Payer: BCBS Complete	$505.67
Rate for Payer: BCBS Trust/PPO	$171.92
Rate for Payer: Cash Price	$1,852.00
Rate for Payer: Cash Price	$1,852.00
Rate for Payer: Mclaren Medicaid	$481.59
Rate for Payer: Meridian Medicaid	$505.67
Rate for Payer: Priority Health Choice Medicaid	$481.59
Rate for Payer: Priority Health Cigna Priority Health	$1,620.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,140.79
Rate for Payer: Priority Health Narrow Network	$1,140.79
Rate for Payer: Priority Health SBD	$1,140.79

PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM

Professional

Both

$3,100.00

Service Code	HCPCS 27049
Min. Negotiated Rate	$913.34
Max. Negotiated Rate	$4,326.25
Rate for Payer: Aetna Commercial	$1,808.92
Rate for Payer: BCBS Complete	$959.01
Rate for Payer: BCBS Trust/PPO	$4,326.25
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Mclaren Medicaid	$913.34
Rate for Payer: Meridian Medicaid	$959.01
Rate for Payer: Priority Health Choice Medicaid	$913.34
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,044.12
Rate for Payer: Priority Health Narrow Network	$2,044.12
Rate for Payer: Priority Health SBD	$2,044.12

PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM

Professional

Both

$3,312.00

Service Code	HCPCS 27329
Min. Negotiated Rate	$668.39
Max. Negotiated Rate	$2,318.40
Rate for Payer: Aetna Commercial	$1,391.29
Rate for Payer: BCBS Complete	$701.81
Rate for Payer: BCBS Trust/PPO	$1,157.51
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Mclaren Medicaid	$668.39
Rate for Payer: Meridian Medicaid	$701.81
Rate for Payer: Priority Health Choice Medicaid	$668.39
Rate for Payer: Priority Health Cigna Priority Health	$2,318.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,591.69
Rate for Payer: Priority Health Narrow Network	$1,591.69
Rate for Payer: Priority Health SBD	$1,591.69

PR RAPID DESENSITIZATION PROCEDURE EACH HOUR

Professional

Both

$248.00

Service Code	HCPCS 95180
Min. Negotiated Rate	$64.54
Max. Negotiated Rate	$430.04
Rate for Payer: Aetna Commercial	$105.91
Rate for Payer: BCBS Complete	$67.77
Rate for Payer: BCBS Trust/PPO	$430.04
Rate for Payer: Cash Price	$198.40
Rate for Payer: Cash Price	$198.40
Rate for Payer: Mclaren Medicaid	$64.54
Rate for Payer: Meridian Medicaid	$67.77
Rate for Payer: Priority Health Choice Medicaid	$64.54
Rate for Payer: Priority Health Cigna Priority Health	$173.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$125.82
Rate for Payer: Priority Health Narrow Network	$125.82
Rate for Payer: Priority Health SBD	$125.82

PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

Facility

$834.00

Service Code	CPT 28313
Hospital Charge Code	28313
Min. Negotiated Rate	$525.42
Max. Negotiated Rate	$750.60
Rate for Payer: Aetna Commercial	$708.90
Rate for Payer: Aetna New Business (MI Preferred)	$542.10
Rate for Payer: Cash Price	$667.20
Rate for Payer: Cofinity Commercial	$717.24
Rate for Payer: Cofinity Commercial	$583.80
Rate for Payer: Healthscope Commercial	$750.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$708.90
Rate for Payer: PHP Commercial	$708.90
Rate for Payer: Priority Health Cigna Priority Health	$583.80
Rate for Payer: Priority Health SBD	$525.42

PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

Professional

Both

$834.00

Service Code	HCPCS 28313
Min. Negotiated Rate	$333.60
Max. Negotiated Rate	$1,777.73
Rate for Payer: Aetna Commercial	$475.12
Rate for Payer: BCBS Complete	$333.60
Rate for Payer: BCBS Trust/PPO	$1,777.73
Rate for Payer: Cash Price	$667.20
Rate for Payer: Cash Price	$667.20
Rate for Payer: Priority Health Cigna Priority Health	$583.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$550.47
Rate for Payer: Priority Health Narrow Network	$550.47
Rate for Payer: Priority Health SBD	$550.47

PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

Facility

$834.00

Service Code	CPT 28313
Hospital Charge Code	28313
Min. Negotiated Rate	$359.53
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$708.90
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$542.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,058.03
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$667.20
Rate for Payer: Cash Price	$667.20
Rate for Payer: Cofinity Commercial	$583.80
Rate for Payer: Cofinity Commercial	$717.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$750.60
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$708.90
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$708.90
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$583.80
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$525.42
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$395.48
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$359.53
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

Professional

Both

$834.00

Service Code	HCPCS 28313
Hospital Charge Code	28313
Min. Negotiated Rate	$333.60
Max. Negotiated Rate	$1,777.73
Rate for Payer: Aetna Commercial	$475.12
Rate for Payer: BCBS Complete	$333.60
Rate for Payer: BCBS Trust/PPO	$1,777.73
Rate for Payer: Cash Price	$667.20
Rate for Payer: Cash Price	$667.20
Rate for Payer: Priority Health Cigna Priority Health	$583.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$550.47
Rate for Payer: Priority Health Narrow Network	$550.47
Rate for Payer: Priority Health SBD	$550.47

PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD

Professional

Both

$7,055.00

Service Code	HCPCS 21175
Min. Negotiated Rate	$377.57
Max. Negotiated Rate	$4,938.50
Rate for Payer: Aetna Commercial	$2,954.27
Rate for Payer: BCBS Complete	$1,476.31
Rate for Payer: BCBS Trust/PPO	$377.57
Rate for Payer: Cash Price	$5,644.00
Rate for Payer: Cash Price	$5,644.00
Rate for Payer: Mclaren Medicaid	$1,406.01
Rate for Payer: Meridian Medicaid	$1,476.31
Rate for Payer: Priority Health Choice Medicaid	$1,406.01
Rate for Payer: Priority Health Cigna Priority Health	$4,938.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,370.30
Rate for Payer: Priority Health Narrow Network	$3,370.30
Rate for Payer: Priority Health SBD	$3,370.30

PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT

Professional

Both

$1,192.00

Service Code	HCPCS 26545
Min. Negotiated Rate	$149.51
Max. Negotiated Rate	$1,139.77
Rate for Payer: Aetna Commercial	$969.02
Rate for Payer: BCBS Complete	$500.08
Rate for Payer: BCBS Trust/PPO	$149.51
Rate for Payer: Cash Price	$953.60
Rate for Payer: Cash Price	$953.60
Rate for Payer: Mclaren Medicaid	$476.27
Rate for Payer: Meridian Medicaid	$500.08
Rate for Payer: Priority Health Choice Medicaid	$476.27
Rate for Payer: Priority Health Cigna Priority Health	$834.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,139.77
Rate for Payer: Priority Health Narrow Network	$1,139.77
Rate for Payer: Priority Health SBD	$1,139.77

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS

Professional

Both

$3,496.00

Service Code	HCPCS 26542
Min. Negotiated Rate	$467.96
Max. Negotiated Rate	$2,447.20
Rate for Payer: Aetna Commercial	$954.95
Rate for Payer: BCBS Complete	$491.36
Rate for Payer: BCBS Trust/PPO	$1,587.54
Rate for Payer: Cash Price	$2,796.80
Rate for Payer: Cash Price	$2,796.80
Rate for Payer: Mclaren Medicaid	$467.96
Rate for Payer: Meridian Medicaid	$491.36
Rate for Payer: Priority Health Choice Medicaid	$467.96
Rate for Payer: Priority Health Cigna Priority Health	$2,447.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,121.90
Rate for Payer: Priority Health Narrow Network	$1,121.90
Rate for Payer: Priority Health SBD	$1,121.90

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF

Professional

Both

$2,333.00

Service Code	HCPCS 26541
Min. Negotiated Rate	$540.81
Max. Negotiated Rate	$1,633.10
Rate for Payer: Aetna Commercial	$1,106.28
Rate for Payer: BCBS Complete	$567.85
Rate for Payer: BCBS Trust/PPO	$544.15
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Mclaren Medicaid	$540.81
Rate for Payer: Meridian Medicaid	$567.85
Rate for Payer: Priority Health Choice Medicaid	$540.81
Rate for Payer: Priority Health Cigna Priority Health	$1,633.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,293.47
Rate for Payer: Priority Health Narrow Network	$1,293.47
Rate for Payer: Priority Health SBD	$1,293.47

PR RCNSTJ DISLC PATELLA W/PATELLECTOMY

Professional

Both

$1,489.00

Service Code	HCPCS 27424
Min. Negotiated Rate	$485.21
Max. Negotiated Rate	$1,153.56
Rate for Payer: Aetna Commercial	$999.14
Rate for Payer: BCBS Complete	$509.47
Rate for Payer: BCBS Trust/PPO	$1,069.81
Rate for Payer: Cash Price	$1,191.20
Rate for Payer: Cash Price	$1,191.20
Rate for Payer: Mclaren Medicaid	$485.21
Rate for Payer: Meridian Medicaid	$509.47
Rate for Payer: Priority Health Choice Medicaid	$485.21
Rate for Payer: Priority Health Cigna Priority Health	$1,042.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,153.56
Rate for Payer: Priority Health Narrow Network	$1,153.56
Rate for Payer: Priority Health SBD	$1,153.56

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Professional

Both

$2,268.00

Service Code	HCPCS 27422
Hospital Charge Code	27422
Min. Negotiated Rate	$478.11
Max. Negotiated Rate	$1,587.60
Rate for Payer: Aetna Commercial	$992.84
Rate for Payer: BCBS Complete	$504.56
Rate for Payer: BCBS Trust/PPO	$478.11
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Mclaren Medicaid	$480.53
Rate for Payer: Meridian Medicaid	$504.56
Rate for Payer: Priority Health Choice Medicaid	$480.53
Rate for Payer: Priority Health Cigna Priority Health	$1,587.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,142.33
Rate for Payer: Priority Health Narrow Network	$1,142.33
Rate for Payer: Priority Health SBD	$1,142.33

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Professional

Both

$2,268.00

Service Code	HCPCS 27422
Min. Negotiated Rate	$478.11
Max. Negotiated Rate	$1,587.60
Rate for Payer: Aetna Commercial	$992.84
Rate for Payer: BCBS Complete	$504.56
Rate for Payer: BCBS Trust/PPO	$478.11
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Mclaren Medicaid	$480.53
Rate for Payer: Meridian Medicaid	$504.56
Rate for Payer: Priority Health Choice Medicaid	$480.53
Rate for Payer: Priority Health Cigna Priority Health	$1,587.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,142.33
Rate for Payer: Priority Health Narrow Network	$1,142.33
Rate for Payer: Priority Health SBD	$1,142.33

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Facility

$2,268.00

Service Code	CPT 27422
Hospital Charge Code	27422
Hospital Revenue Code	960
Min. Negotiated Rate	$1,428.84
Max. Negotiated Rate	$2,041.20
Rate for Payer: Aetna Commercial	$1,927.80
Rate for Payer: Aetna New Business (MI Preferred)	$1,474.20
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cofinity Commercial	$1,950.48
Rate for Payer: Cofinity Commercial	$1,587.60
Rate for Payer: Healthscope Commercial	$2,041.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,927.80
Rate for Payer: PHP Commercial	$1,927.80
Rate for Payer: Priority Health Cigna Priority Health	$1,587.60
Rate for Payer: Priority Health SBD	$1,428.84

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Facility

$2,268.00

Service Code	CPT 27422
Hospital Charge Code	27422
Hospital Revenue Code	960
Min. Negotiated Rate	$738.71
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Commercial	$1,927.80
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,474.20
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	$2,299.99
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cash Price	$1,814.40
Rate for Payer: Cofinity Commercial	$1,950.48
Rate for Payer: Cofinity Commercial	$1,587.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$2,041.20
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	$1,927.80
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$1,927.80
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	$1,587.60
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health SBD	$1,428.84
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$812.58
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$738.71
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR RCNSTJ DISLOCATING PATELLA

Professional

Both

$2,289.00

Service Code	HCPCS 27420
Min. Negotiated Rate	$486.07
Max. Negotiated Rate	$1,602.30
Rate for Payer: Aetna Commercial	$992.16
Rate for Payer: BCBS Complete	$510.37
Rate for Payer: BCBS Trust/PPO	$1,012.22
Rate for Payer: Cash Price	$1,831.20
Rate for Payer: Cash Price	$1,831.20
Rate for Payer: Mclaren Medicaid	$486.07
Rate for Payer: Meridian Medicaid	$510.37
Rate for Payer: Priority Health Choice Medicaid	$486.07
Rate for Payer: Priority Health Cigna Priority Health	$1,602.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,148.96
Rate for Payer: Priority Health Narrow Network	$1,148.96
Rate for Payer: Priority Health SBD	$1,148.96

PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT

Professional

Both

$2,961.00

Service Code	HCPCS 24344
Min. Negotiated Rate	$200.75
Max. Negotiated Rate	$2,072.70
Rate for Payer: Aetna Commercial	$1,457.34
Rate for Payer: BCBS Complete	$749.01
Rate for Payer: BCBS Trust/PPO	$200.75
Rate for Payer: Cash Price	$2,368.80
Rate for Payer: Cash Price	$2,368.80
Rate for Payer: Mclaren Medicaid	$713.34
Rate for Payer: Meridian Medicaid	$749.01
Rate for Payer: Priority Health Choice Medicaid	$713.34
Rate for Payer: Priority Health Cigna Priority Health	$2,072.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,674.93
Rate for Payer: Priority Health Narrow Network	$1,674.93
Rate for Payer: Priority Health SBD	$1,674.93

PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF

Professional

Both

$3,270.00

Service Code	HCPCS 24346
Min. Negotiated Rate	$272.60
Max. Negotiated Rate	$2,289.00
Rate for Payer: Aetna Commercial	$1,470.76
Rate for Payer: BCBS Complete	$749.01
Rate for Payer: BCBS Trust/PPO	$272.60
Rate for Payer: Cash Price	$2,616.00
Rate for Payer: Cash Price	$2,616.00
Rate for Payer: Mclaren Medicaid	$713.34
Rate for Payer: Meridian Medicaid	$749.01
Rate for Payer: Priority Health Choice Medicaid	$713.34
Rate for Payer: Priority Health Cigna Priority Health	$2,289.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,694.85
Rate for Payer: Priority Health Narrow Network	$1,694.85
Rate for Payer: Priority Health SBD	$1,694.85

PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT

Professional

Both

$6,334.00

Service Code	HCPCS 21194
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$4,433.80
Rate for Payer: Aetna Commercial	$1,893.04
Rate for Payer: BCBS Complete	$948.73
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: Cash Price	$5,067.20
Rate for Payer: Cash Price	$5,067.20
Rate for Payer: Mclaren Medicaid	$903.55
Rate for Payer: Meridian Medicaid	$948.73
Rate for Payer: Priority Health Choice Medicaid	$903.55
Rate for Payer: Priority Health Cigna Priority Health	$4,433.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,169.76
Rate for Payer: Priority Health Narrow Network	$2,169.76
Rate for Payer: Priority Health SBD	$2,169.76

PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE

Professional

Both

$3,440.00

Service Code	HCPCS 21244
Min. Negotiated Rate	$110.96
Max. Negotiated Rate	$2,408.00
Rate for Payer: Aetna Commercial	$1,342.79
Rate for Payer: BCBS Complete	$675.87
Rate for Payer: BCBS Trust/PPO	$110.96
Rate for Payer: Cash Price	$2,752.00
Rate for Payer: Cash Price	$2,752.00
Rate for Payer: Mclaren Medicaid	$643.69
Rate for Payer: Meridian Medicaid	$675.87
Rate for Payer: Priority Health Choice Medicaid	$643.69
Rate for Payer: Priority Health Cigna Priority Health	$2,408.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,541.15
Rate for Payer: Priority Health Narrow Network	$1,541.15
Rate for Payer: Priority Health SBD	$1,541.15

Know your out-of-pocket cost for care.

All Charges