Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ARTHRS KNE SURG ABRASION ARTHRP/MLT DRLG/MICROFX

Professional

Both

$2,601.00

Service Code	HCPCS 29879
Min. Negotiated Rate	$397.46
Max. Negotiated Rate	$1,950.75
Rate for Payer: Aetna Commercial	$882.28
Rate for Payer: Aetna Medicare	$1,300.50
Rate for Payer: BCBS Complete	$417.33
Rate for Payer: BCN Commercial	$1,110.55
Rate for Payer: Cash Price	$2,080.80
Rate for Payer: Cash Price	$2,080.80
Rate for Payer: Mclaren Medicaid	$397.46
Rate for Payer: Meridian Medicaid	$417.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,950.75
Rate for Payer: Priority Health Choice Medicaid	$397.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,080.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,080.62
Rate for Payer: UHC Medicaid	$397.46
Rate for Payer: UHCCP Medicaid	$397.46

PR ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY

Professional

Both

$2,467.00

Service Code	HCPCS 29904
Min. Negotiated Rate	$384.04
Max. Negotiated Rate	$1,850.25
Rate for Payer: Aetna Commercial	$851.15
Rate for Payer: Aetna Medicare	$1,233.50
Rate for Payer: BCBS Complete	$403.24
Rate for Payer: BCN Commercial	$981.02
Rate for Payer: Cash Price	$1,973.60
Rate for Payer: Cash Price	$1,973.60
Rate for Payer: Mclaren Medicaid	$384.04
Rate for Payer: Meridian Medicaid	$403.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,850.25
Rate for Payer: Priority Health Choice Medicaid	$384.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,048.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,048.69
Rate for Payer: UHC Medicaid	$384.04
Rate for Payer: UHCCP Medicaid	$384.04

PR ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT

Professional

Both

$2,100.00

Service Code	HCPCS 29846
Min. Negotiated Rate	$311.19
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Commercial	$696.33
Rate for Payer: Aetna Medicare	$1,050.00
Rate for Payer: BCBS Complete	$326.75
Rate for Payer: BCN Commercial	$802.25
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Mclaren Medicaid	$311.19
Rate for Payer: Meridian Medicaid	$326.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,575.00
Rate for Payer: Priority Health Choice Medicaid	$311.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$857.58
Rate for Payer: Priority Health Narrow/Tiered Network	$857.58
Rate for Payer: UHC Medicaid	$311.19
Rate for Payer: UHCCP Medicaid	$311.19

PR ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB

Professional

Both

$1,262.00

Service Code	HCPCS 23044
Min. Negotiated Rate	$346.34
Max. Negotiated Rate	$946.50
Rate for Payer: Aetna Commercial	$752.51
Rate for Payer: Aetna Medicare	$631.00
Rate for Payer: BCBS Complete	$363.66
Rate for Payer: BCN Commercial	$857.02
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Mclaren Medicaid	$346.34
Rate for Payer: Meridian Medicaid	$363.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$946.50
Rate for Payer: Priority Health Choice Medicaid	$346.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$916.13
Rate for Payer: Priority Health Narrow/Tiered Network	$916.13
Rate for Payer: UHC Medicaid	$346.34
Rate for Payer: UHCCP Medicaid	$346.34

PR ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG

Professional

Both

$829.00

Service Code	HCPCS 23101
Min. Negotiated Rate	$282.86
Max. Negotiated Rate	$753.24
Rate for Payer: Aetna Commercial	$609.14
Rate for Payer: Aetna Medicare	$414.50
Rate for Payer: BCBS Complete	$297.00
Rate for Payer: BCN Commercial	$704.64
Rate for Payer: Cash Price	$663.20
Rate for Payer: Cash Price	$663.20
Rate for Payer: Mclaren Medicaid	$282.86
Rate for Payer: Meridian Medicaid	$297.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.75
Rate for Payer: Priority Health Choice Medicaid	$282.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$753.24
Rate for Payer: Priority Health Narrow/Tiered Network	$753.24
Rate for Payer: UHC Medicaid	$282.86
Rate for Payer: UHCCP Medicaid	$282.86

PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB

Professional

Both

$1,161.00

Service Code	HCPCS 27620
Min. Negotiated Rate	$277.75
Max. Negotiated Rate	$870.75
Rate for Payer: Aetna Commercial	$598.68
Rate for Payer: Aetna Medicare	$580.50
Rate for Payer: BCBS Complete	$291.64
Rate for Payer: BCN Commercial	$686.72
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Mclaren Medicaid	$277.75
Rate for Payer: Meridian Medicaid	$291.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$870.75
Rate for Payer: Priority Health Choice Medicaid	$277.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$734.08
Rate for Payer: Priority Health Narrow/Tiered Network	$734.08
Rate for Payer: UHC Medicaid	$277.75
Rate for Payer: UHCCP Medicaid	$277.75

PR ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX

Professional

Both

$2,125.00

Service Code	HCPCS 24006
Min. Negotiated Rate	$423.66
Max. Negotiated Rate	$1,593.75
Rate for Payer: Aetna Commercial	$949.53
Rate for Payer: Aetna Medicare	$1,062.50
Rate for Payer: BCBS Complete	$444.84
Rate for Payer: BCN Commercial	$1,094.06
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Mclaren Medicaid	$423.66
Rate for Payer: Meridian Medicaid	$444.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,593.75
Rate for Payer: Priority Health Choice Medicaid	$423.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,169.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,169.52
Rate for Payer: UHC Medicaid	$423.66
Rate for Payer: UHCCP Medicaid	$423.66

PR ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB

Professional

Both

$2,099.00

Service Code	HCPCS 24000
Min. Negotiated Rate	$294.15
Max. Negotiated Rate	$1,574.25
Rate for Payer: Aetna Commercial	$635.11
Rate for Payer: Aetna Medicare	$1,049.50
Rate for Payer: BCBS Complete	$308.86
Rate for Payer: BCN Commercial	$738.51
Rate for Payer: Cash Price	$1,679.20
Rate for Payer: Cash Price	$1,679.20
Rate for Payer: Mclaren Medicaid	$294.15
Rate for Payer: Meridian Medicaid	$308.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,574.25
Rate for Payer: Priority Health Choice Medicaid	$294.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$789.44
Rate for Payer: Priority Health Narrow/Tiered Network	$789.44
Rate for Payer: UHC Medicaid	$294.15
Rate for Payer: UHCCP Medicaid	$294.15

PR ARTHRT ELBOW W/JT EXPL W/WOBX W/O RMVL LOOSE/FB

Professional

Both

$1,388.00

Service Code	HCPCS 24101
Min. Negotiated Rate	$307.79
Max. Negotiated Rate	$1,041.00
Rate for Payer: Aetna Commercial	$670.06
Rate for Payer: Aetna Medicare	$694.00
Rate for Payer: BCBS Complete	$323.18
Rate for Payer: BCN Commercial	$775.85
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Mclaren Medicaid	$307.79
Rate for Payer: Meridian Medicaid	$323.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,041.00
Rate for Payer: Priority Health Choice Medicaid	$307.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$829.37
Rate for Payer: Priority Health Narrow/Tiered Network	$829.37
Rate for Payer: UHC Medicaid	$307.79
Rate for Payer: UHCCP Medicaid	$307.79

PR ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT

Professional

Both

$1,329.00

Service Code	HCPCS 26070
Min. Negotiated Rate	$199.58
Max. Negotiated Rate	$996.75
Rate for Payer: Aetna Commercial	$428.74
Rate for Payer: Aetna Medicare	$664.50
Rate for Payer: BCBS Complete	$209.56
Rate for Payer: BCN Commercial	$500.47
Rate for Payer: Cash Price	$1,063.20
Rate for Payer: Cash Price	$1,063.20
Rate for Payer: Mclaren Medicaid	$199.58
Rate for Payer: Meridian Medicaid	$209.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$996.75
Rate for Payer: Priority Health Choice Medicaid	$199.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$534.99
Rate for Payer: Priority Health Narrow/Tiered Network	$534.99
Rate for Payer: UHC Medicaid	$199.58
Rate for Payer: UHCCP Medicaid	$199.58

PR ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA

Professional

Both

$1,122.00

Service Code	HCPCS 26080
Min. Negotiated Rate	$247.29
Max. Negotiated Rate	$841.50
Rate for Payer: Aetna Commercial	$525.93
Rate for Payer: Aetna Medicare	$561.00
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCN Commercial	$618.49
Rate for Payer: Cash Price	$897.60
Rate for Payer: Cash Price	$897.60
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$841.50
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$661.15
Rate for Payer: Priority Health Narrow/Tiered Network	$661.15
Rate for Payer: UHC Medicaid	$247.29
Rate for Payer: UHCCP Medicaid	$247.29

PR ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA

Professional

Both

$590.00

Service Code	HCPCS 26075
Min. Negotiated Rate	$210.44
Max. Negotiated Rate	$561.07
Rate for Payer: Aetna Commercial	$447.37
Rate for Payer: Aetna Medicare	$295.00
Rate for Payer: BCBS Complete	$220.96
Rate for Payer: BCN Commercial	$524.87
Rate for Payer: Cash Price	$472.00
Rate for Payer: Cash Price	$472.00
Rate for Payer: Mclaren Medicaid	$210.44
Rate for Payer: Meridian Medicaid	$220.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$442.50
Rate for Payer: Priority Health Choice Medicaid	$210.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$561.07
Rate for Payer: Priority Health Narrow/Tiered Network	$561.07
Rate for Payer: UHC Medicaid	$210.44
Rate for Payer: UHCCP Medicaid	$210.44

PR ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB

Professional

Both

$1,293.00

Service Code	HCPCS 23107
Min. Negotiated Rate	$399.38
Max. Negotiated Rate	$1,087.55
Rate for Payer: Aetna Commercial	$882.97
Rate for Payer: Aetna Medicare	$646.50
Rate for Payer: BCBS Complete	$419.35
Rate for Payer: BCN Commercial	$1,017.37
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Cash Price	$1,034.40
Rate for Payer: Mclaren Medicaid	$399.38
Rate for Payer: Meridian Medicaid	$419.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$969.75
Rate for Payer: Priority Health Choice Medicaid	$399.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,087.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,087.55
Rate for Payer: UHC Medicaid	$399.38
Rate for Payer: UHCCP Medicaid	$399.38

PR ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX

Professional

Both

$1,031.00

Service Code	HCPCS 23106
Min. Negotiated Rate	$311.19
Max. Negotiated Rate	$828.30
Rate for Payer: Aetna Commercial	$668.25
Rate for Payer: Aetna Medicare	$515.50
Rate for Payer: BCBS Complete	$326.75
Rate for Payer: BCN Commercial	$774.86
Rate for Payer: Cash Price	$824.80
Rate for Payer: Cash Price	$824.80
Rate for Payer: Mclaren Medicaid	$311.19
Rate for Payer: Meridian Medicaid	$326.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$773.25
Rate for Payer: Priority Health Choice Medicaid	$311.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$828.30
Rate for Payer: Priority Health Narrow/Tiered Network	$828.30
Rate for Payer: UHC Medicaid	$311.19
Rate for Payer: UHCCP Medicaid	$311.19

PR ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY

Professional

Both

$1,168.00

Service Code	HCPCS 23105
Min. Negotiated Rate	$385.96
Max. Negotiated Rate	$1,050.29
Rate for Payer: Aetna Commercial	$855.39
Rate for Payer: Aetna Medicare	$584.00
Rate for Payer: BCBS Complete	$405.26
Rate for Payer: BCN Commercial	$982.52
Rate for Payer: Cash Price	$934.40
Rate for Payer: Cash Price	$934.40
Rate for Payer: Mclaren Medicaid	$385.96
Rate for Payer: Meridian Medicaid	$405.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$876.00
Rate for Payer: Priority Health Choice Medicaid	$385.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,050.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,050.29
Rate for Payer: UHC Medicaid	$385.96
Rate for Payer: UHCCP Medicaid	$385.96

PR ARTHRT KNE W/EXPL DRG/RMVL FB

Professional

Both

$2,772.00

Service Code	HCPCS 27310
Min. Negotiated Rate	$439.42
Max. Negotiated Rate	$2,079.00
Rate for Payer: Aetna Commercial	$976.42
Rate for Payer: Aetna Medicare	$1,386.00
Rate for Payer: BCBS Complete	$461.39
Rate for Payer: BCN Commercial	$1,119.46
Rate for Payer: Cash Price	$2,217.60
Rate for Payer: Cash Price	$2,217.60
Rate for Payer: Mclaren Medicaid	$439.42
Rate for Payer: Meridian Medicaid	$461.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,079.00
Rate for Payer: Priority Health Choice Medicaid	$439.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,196.67
Rate for Payer: Priority Health Narrow/Tiered Network	$1,196.67
Rate for Payer: UHC Medicaid	$439.42
Rate for Payer: UHCCP Medicaid	$439.42

PR ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB

Professional

Both

$1,801.00

Service Code	HCPCS 27331
Min. Negotiated Rate	$293.09
Max. Negotiated Rate	$1,350.75
Rate for Payer: Aetna Commercial	$634.56
Rate for Payer: Aetna Medicare	$900.50
Rate for Payer: BCBS Complete	$307.74
Rate for Payer: BCN Commercial	$736.01
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Mclaren Medicaid	$293.09
Rate for Payer: Meridian Medicaid	$307.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,350.75
Rate for Payer: Priority Health Choice Medicaid	$293.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$786.78
Rate for Payer: Priority Health Narrow/Tiered Network	$786.78
Rate for Payer: UHC Medicaid	$293.09
Rate for Payer: UHCCP Medicaid	$293.09

PR ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT

Professional

Both

$515.00

Service Code	HCPCS 28052
Min. Negotiated Rate	$154.64
Max. Negotiated Rate	$414.68
Rate for Payer: Aetna Commercial	$374.25
Rate for Payer: Aetna Medicare	$257.50
Rate for Payer: BCBS Complete	$162.37
Rate for Payer: BCN Commercial	$387.93
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$412.00
Rate for Payer: Mclaren Medicaid	$154.64
Rate for Payer: Meridian Medicaid	$162.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$386.25
Rate for Payer: Priority Health Choice Medicaid	$154.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$414.68
Rate for Payer: Priority Health Narrow/Tiered Network	$414.68
Rate for Payer: UHC Medicaid	$154.64
Rate for Payer: UHCCP Medicaid	$154.64

PR ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH

Professional

Both

$2,234.00

Service Code	HCPCS 27612
Min. Negotiated Rate	$345.27
Max. Negotiated Rate	$1,675.50
Rate for Payer: Aetna Commercial	$742.06
Rate for Payer: Aetna Medicare	$1,117.00
Rate for Payer: BCBS Complete	$362.53
Rate for Payer: BCN Commercial	$876.45
Rate for Payer: Cash Price	$1,787.20
Rate for Payer: Cash Price	$1,787.20
Rate for Payer: Mclaren Medicaid	$345.27
Rate for Payer: Meridian Medicaid	$362.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,675.50
Rate for Payer: Priority Health Choice Medicaid	$345.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$936.90
Rate for Payer: Priority Health Narrow/Tiered Network	$936.90
Rate for Payer: UHC Medicaid	$345.27
Rate for Payer: UHCCP Medicaid	$345.27

PR ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB

Professional

Both

$1,945.00

Service Code	HCPCS 25040
Min. Negotiated Rate	$334.62
Max. Negotiated Rate	$1,458.75
Rate for Payer: Aetna Commercial	$746.44
Rate for Payer: Aetna Medicare	$972.50
Rate for Payer: BCBS Complete	$351.35
Rate for Payer: BCN Commercial	$859.02
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Mclaren Medicaid	$334.62
Rate for Payer: Meridian Medicaid	$351.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,458.75
Rate for Payer: Priority Health Choice Medicaid	$334.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$918.27
Rate for Payer: Priority Health Narrow/Tiered Network	$918.27
Rate for Payer: UHC Medicaid	$334.62
Rate for Payer: UHCCP Medicaid	$334.62

PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT

Professional

Both

$2,461.00

Service Code	HCPCS 27332
Min. Negotiated Rate	$392.13
Max. Negotiated Rate	$1,845.75
Rate for Payer: Aetna Commercial	$860.52
Rate for Payer: Aetna Medicare	$1,230.50
Rate for Payer: BCBS Complete	$411.74
Rate for Payer: BCN Commercial	$991.48
Rate for Payer: Cash Price	$1,968.80
Rate for Payer: Cash Price	$1,968.80
Rate for Payer: Mclaren Medicaid	$392.13
Rate for Payer: Meridian Medicaid	$411.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,845.75
Rate for Payer: Priority Health Choice Medicaid	$392.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,059.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,059.87
Rate for Payer: UHC Medicaid	$392.13
Rate for Payer: UHCCP Medicaid	$392.13

PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT

Professional

Both

$755.00

Service Code	HCPCS 28024
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$566.25
Rate for Payer: Aetna Commercial	$400.11
Rate for Payer: Aetna Medicare	$377.50
Rate for Payer: BCBS Complete	$199.50
Rate for Payer: BCN Commercial	$473.58
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cash Price	$604.00
Rate for Payer: Mclaren Medicaid	$190.00
Rate for Payer: Meridian Medicaid	$199.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$566.25
Rate for Payer: Priority Health Choice Medicaid	$190.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$506.25
Rate for Payer: Priority Health Narrow/Tiered Network	$506.25
Rate for Payer: UHC Medicaid	$190.00
Rate for Payer: UHCCP Medicaid	$190.00

PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT

Professional

Both

$861.00

Service Code	HCPCS 28022
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$645.75
Rate for Payer: Aetna Commercial	$430.37
Rate for Payer: Aetna Medicare	$430.50
Rate for Payer: BCBS Complete	$210.23
Rate for Payer: BCN Commercial	$498.48
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cash Price	$688.80
Rate for Payer: Mclaren Medicaid	$200.22
Rate for Payer: Meridian Medicaid	$210.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.75
Rate for Payer: Priority Health Choice Medicaid	$200.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$532.86
Rate for Payer: Priority Health Narrow/Tiered Network	$532.86
Rate for Payer: UHC Medicaid	$200.22
Rate for Payer: UHCCP Medicaid	$200.22

PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT

Professional

Both

$947.00

Service Code	HCPCS 28020
Min. Negotiated Rate	$223.86
Max. Negotiated Rate	$710.25
Rate for Payer: Aetna Commercial	$485.15
Rate for Payer: Aetna Medicare	$473.50
Rate for Payer: BCBS Complete	$235.05
Rate for Payer: BCN Commercial	$550.77
Rate for Payer: Cash Price	$757.60
Rate for Payer: Cash Price	$757.60
Rate for Payer: Mclaren Medicaid	$223.86
Rate for Payer: Meridian Medicaid	$235.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$710.25
Rate for Payer: Priority Health Choice Medicaid	$223.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$588.75
Rate for Payer: Priority Health Narrow/Tiered Network	$588.75
Rate for Payer: UHC Medicaid	$223.86
Rate for Payer: UHCCP Medicaid	$223.86

PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB

Professional

Both

$1,418.00

Service Code	HCPCS 25101
Min. Negotiated Rate	$250.06
Max. Negotiated Rate	$1,063.50
Rate for Payer: Aetna Commercial	$537.23
Rate for Payer: Aetna Medicare	$709.00
Rate for Payer: BCBS Complete	$262.56
Rate for Payer: BCN Commercial	$628.95
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Mclaren Medicaid	$250.06
Rate for Payer: Meridian Medicaid	$262.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,063.50
Rate for Payer: Priority Health Choice Medicaid	$250.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$672.34
Rate for Payer: Priority Health Narrow/Tiered Network	$672.34
Rate for Payer: UHC Medicaid	$250.06
Rate for Payer: UHCCP Medicaid	$250.06

Know your out-of-pocket cost for care.

All Charges