Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CLOSED RX PELVIC RING FX/SUBLUX

Professional

Both

$999.00

Service Code	HCPCS 27193
Min. Negotiated Rate	$399.60
Max. Negotiated Rate	$749.25
Rate for Payer: Aetna Medicare	$499.50
Rate for Payer: BCBS Complete	$399.60
Rate for Payer: Cash Price	$799.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$749.25

PR CLOSED RX PELV RING FX/SUBLUX,MANIP

Professional

Both

$1,999.00

Service Code	HCPCS 27194
Min. Negotiated Rate	$799.60
Max. Negotiated Rate	$1,499.25
Rate for Payer: Aetna Medicare	$999.50
Rate for Payer: BCBS Complete	$799.60
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,499.25

PR CLOSED RX RIB FRACTURE

Professional

Both

$231.00

Service Code	HCPCS 21800
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$173.25
Rate for Payer: Aetna Medicare	$115.50
Rate for Payer: BCBS Complete	$92.40
Rate for Payer: Cash Price	$184.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$173.25

PR CLOSED TREATMENT COCCYGEAL FRACTURE

Professional

Both

$402.00

Service Code	HCPCS 27200
Min. Negotiated Rate	$128.01
Max. Negotiated Rate	$323.12
Rate for Payer: Aetna Commercial	$246.94
Rate for Payer: Aetna Medicare	$201.00
Rate for Payer: BCBS Complete	$134.41
Rate for Payer: BCN Commercial	$302.28
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Mclaren Medicaid	$128.01
Rate for Payer: Meridian Medicaid	$134.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$301.50
Rate for Payer: Priority Health Choice Medicaid	$128.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$323.12
Rate for Payer: Priority Health Narrow/Tiered Network	$323.12
Rate for Payer: UHC Medicaid	$128.01
Rate for Payer: UHCCP Medicaid	$128.01

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ

Professional

Both

$788.00

Service Code	HCPCS 27768
Min. Negotiated Rate	$282.01
Max. Negotiated Rate	$745.78
Rate for Payer: Aetna Commercial	$593.02
Rate for Payer: Aetna Medicare	$394.00
Rate for Payer: BCBS Complete	$296.11
Rate for Payer: BCN Commercial	$697.67
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Mclaren Medicaid	$282.01
Rate for Payer: Meridian Medicaid	$296.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$591.00
Rate for Payer: Priority Health Choice Medicaid	$282.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$745.78
Rate for Payer: Priority Health Narrow/Tiered Network	$745.78
Rate for Payer: UHC Medicaid	$282.01
Rate for Payer: UHCCP Medicaid	$282.01

PR CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ

Professional

Both

$749.00

Service Code	HCPCS 27767
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$561.75
Rate for Payer: Aetna Commercial	$380.80
Rate for Payer: Aetna Medicare	$374.50
Rate for Payer: BCBS Complete	$201.28
Rate for Payer: BCN Commercial	$460.13
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cash Price	$599.20
Rate for Payer: Mclaren Medicaid	$191.70
Rate for Payer: Meridian Medicaid	$201.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$561.75
Rate for Payer: Priority Health Choice Medicaid	$191.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$491.87
Rate for Payer: Priority Health Narrow/Tiered Network	$491.87
Rate for Payer: UHC Medicaid	$191.70
Rate for Payer: UHCCP Medicaid	$191.70

PR CLOSED TREATMENT SESAMOID FRACTURE

Professional

Both

$363.00

Service Code	HCPCS 28530
Min. Negotiated Rate	$65.82
Max. Negotiated Rate	$272.25
Rate for Payer: Aetna Commercial	$129.88
Rate for Payer: Aetna Medicare	$181.50
Rate for Payer: BCBS Complete	$69.11
Rate for Payer: BCN Commercial	$161.85
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Mclaren Medicaid	$65.82
Rate for Payer: Meridian Medicaid	$69.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$272.25
Rate for Payer: Priority Health Choice Medicaid	$65.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.01
Rate for Payer: Priority Health Narrow/Tiered Network	$173.01
Rate for Payer: UHC Medicaid	$65.82
Rate for Payer: UHCCP Medicaid	$65.82

PR CLOSED TREATMENT STERNUM FRACTURE

Professional

Both

$200.00

Service Code	HCPCS 21820
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$250.72
Rate for Payer: Aetna Commercial	$191.49
Rate for Payer: Aetna Medicare	$100.00
Rate for Payer: BCBS Complete	$113.17
Rate for Payer: BCN Commercial	$234.54
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Mclaren Medicaid	$107.78
Rate for Payer: Meridian Medicaid	$113.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.00
Rate for Payer: Priority Health Choice Medicaid	$107.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$250.72
Rate for Payer: Priority Health Narrow/Tiered Network	$250.72
Rate for Payer: UHC Medicaid	$107.78
Rate for Payer: UHCCP Medicaid	$107.78

PR CLOSED TREATMENT ULNAR STYLOID FRACTURE

Professional

Both

$858.00

Service Code	HCPCS 25650
Min. Negotiated Rate	$207.25
Max. Negotiated Rate	$643.50
Rate for Payer: Aetna Commercial	$404.75
Rate for Payer: Aetna Medicare	$429.00
Rate for Payer: BCBS Complete	$217.61
Rate for Payer: BCN Commercial	$482.54
Rate for Payer: Cash Price	$686.40
Rate for Payer: Cash Price	$686.40
Rate for Payer: Mclaren Medicaid	$207.25
Rate for Payer: Meridian Medicaid	$217.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$643.50
Rate for Payer: Priority Health Choice Medicaid	$207.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$515.83
Rate for Payer: Priority Health Narrow/Tiered Network	$515.83
Rate for Payer: UHC Medicaid	$207.25
Rate for Payer: UHCCP Medicaid	$207.25

PR CLOSED TREAT SPINE PROCESS FX

Professional

Both

$436.00

Service Code	HCPCS 22305
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$327.00
Rate for Payer: Aetna Medicare	$218.00
Rate for Payer: BCBS Complete	$174.40
Rate for Payer: Cash Price	$348.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$327.00

PR CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA

Professional

Both

$949.00

Service Code	HCPCS 27840
Min. Negotiated Rate	$288.83
Max. Negotiated Rate	$711.75
Rate for Payer: Aetna Commercial	$504.89
Rate for Payer: Aetna Medicare	$474.50
Rate for Payer: BCBS Complete	$303.27
Rate for Payer: BCN Commercial	$602.06
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cash Price	$759.20
Rate for Payer: Mclaren Medicaid	$288.83
Rate for Payer: Meridian Medicaid	$303.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.75
Rate for Payer: Priority Health Choice Medicaid	$288.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$643.59
Rate for Payer: Priority Health Narrow/Tiered Network	$643.59
Rate for Payer: UHC Medicaid	$288.83
Rate for Payer: UHCCP Medicaid	$288.83

PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ

Professional

Both

$1,226.00

Service Code	HCPCS 27810
Min. Negotiated Rate	$296.07
Max. Negotiated Rate	$919.50
Rate for Payer: Aetna Commercial	$566.31
Rate for Payer: Aetna Medicare	$613.00
Rate for Payer: BCBS Complete	$310.87
Rate for Payer: BCN Commercial	$665.30
Rate for Payer: Cash Price	$980.80
Rate for Payer: Cash Price	$980.80
Rate for Payer: Mclaren Medicaid	$296.07
Rate for Payer: Meridian Medicaid	$310.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$919.50
Rate for Payer: Priority Health Choice Medicaid	$296.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$711.19
Rate for Payer: Priority Health Narrow/Tiered Network	$711.19
Rate for Payer: UHC Medicaid	$296.07
Rate for Payer: UHCCP Medicaid	$296.07

PR CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ

Professional

Both

$898.00

Service Code	HCPCS 27808
Min. Negotiated Rate	$204.05
Max. Negotiated Rate	$673.50
Rate for Payer: Aetna Commercial	$403.72
Rate for Payer: Aetna Medicare	$449.00
Rate for Payer: BCBS Complete	$214.25
Rate for Payer: BCN Commercial	$481.54
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Mclaren Medicaid	$204.05
Rate for Payer: Meridian Medicaid	$214.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$673.50
Rate for Payer: Priority Health Choice Medicaid	$204.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$514.76
Rate for Payer: Priority Health Narrow/Tiered Network	$514.76
Rate for Payer: UHC Medicaid	$204.05
Rate for Payer: UHCCP Medicaid	$204.05

PR CLOSED TX CALCANEAL FRACTURE W/MANIPULATION

Professional

Both

$1,199.00

Service Code	HCPCS 28405
Min. Negotiated Rate	$254.96
Max. Negotiated Rate	$899.25
Rate for Payer: Aetna Commercial	$471.72
Rate for Payer: Aetna Medicare	$599.50
Rate for Payer: BCBS Complete	$267.71
Rate for Payer: BCN Commercial	$633.43
Rate for Payer: Cash Price	$959.20
Rate for Payer: Cash Price	$959.20
Rate for Payer: Mclaren Medicaid	$254.96
Rate for Payer: Meridian Medicaid	$267.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$899.25
Rate for Payer: Priority Health Choice Medicaid	$254.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$677.13
Rate for Payer: Priority Health Narrow/Tiered Network	$677.13
Rate for Payer: UHC Medicaid	$254.96
Rate for Payer: UHCCP Medicaid	$254.96

PR CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION

Professional

Both

$740.00

Service Code	HCPCS 28400
Min. Negotiated Rate	$149.31
Max. Negotiated Rate	$555.00
Rate for Payer: Aetna Commercial	$299.58
Rate for Payer: Aetna Medicare	$370.00
Rate for Payer: BCBS Complete	$156.78
Rate for Payer: BCN Commercial	$359.04
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Mclaren Medicaid	$149.31
Rate for Payer: Meridian Medicaid	$156.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$555.00
Rate for Payer: Priority Health Choice Medicaid	$149.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$383.81
Rate for Payer: Priority Health Narrow/Tiered Network	$383.81
Rate for Payer: UHC Medicaid	$149.31
Rate for Payer: UHCCP Medicaid	$149.31

PR CLOSED TX CARPAL SCAPHOID FRACTURE W/MNPJ

Professional

Both

$779.00

Service Code	HCPCS 25624
Min. Negotiated Rate	$284.57
Max. Negotiated Rate	$746.33
Rate for Payer: Aetna Commercial	$588.21
Rate for Payer: Aetna Medicare	$389.50
Rate for Payer: BCBS Complete	$298.80
Rate for Payer: BCN Commercial	$698.17
Rate for Payer: Cash Price	$623.20
Rate for Payer: Cash Price	$623.20
Rate for Payer: Mclaren Medicaid	$284.57
Rate for Payer: Meridian Medicaid	$298.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$584.25
Rate for Payer: Priority Health Choice Medicaid	$284.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$746.33
Rate for Payer: Priority Health Narrow/Tiered Network	$746.33
Rate for Payer: UHC Medicaid	$284.57
Rate for Payer: UHCCP Medicaid	$284.57

PR CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ

Professional

Both

$818.00

Service Code	HCPCS 25622
Min. Negotiated Rate	$188.72
Max. Negotiated Rate	$613.50
Rate for Payer: Aetna Commercial	$373.80
Rate for Payer: Aetna Medicare	$409.00
Rate for Payer: BCBS Complete	$198.16
Rate for Payer: BCN Commercial	$354.61
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$654.40
Rate for Payer: Mclaren Medicaid	$188.72
Rate for Payer: Meridian Medicaid	$198.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$613.50
Rate for Payer: Priority Health Choice Medicaid	$188.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$480.69
Rate for Payer: Priority Health Narrow/Tiered Network	$480.69
Rate for Payer: UHC Medicaid	$188.72
Rate for Payer: UHCCP Medicaid	$188.72

PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MNPJ

Professional

Both

$1,062.00

Service Code	HCPCS 25675
Min. Negotiated Rate	$312.05
Max. Negotiated Rate	$796.50
Rate for Payer: Aetna Commercial	$536.39
Rate for Payer: Aetna Medicare	$531.00
Rate for Payer: BCBS Complete	$327.65
Rate for Payer: BCN Commercial	$647.87
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Mclaren Medicaid	$312.05
Rate for Payer: Meridian Medicaid	$327.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$796.50
Rate for Payer: Priority Health Choice Medicaid	$312.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$692.56
Rate for Payer: Priority Health Narrow/Tiered Network	$692.56
Rate for Payer: UHC Medicaid	$312.05
Rate for Payer: UHCCP Medicaid	$312.05

PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ

Professional

Both

$829.00

Service Code	HCPCS 27268
Min. Negotiated Rate	$329.30
Max. Negotiated Rate	$895.38
Rate for Payer: Aetna Commercial	$725.37
Rate for Payer: Aetna Medicare	$414.50
Rate for Payer: BCBS Complete	$345.76
Rate for Payer: BCN Commercial	$837.60
Rate for Payer: Cash Price	$663.20
Rate for Payer: Cash Price	$663.20
Rate for Payer: Mclaren Medicaid	$329.30
Rate for Payer: Meridian Medicaid	$345.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.75
Rate for Payer: Priority Health Choice Medicaid	$329.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$895.38
Rate for Payer: Priority Health Narrow/Tiered Network	$895.38
Rate for Payer: UHC Medicaid	$329.30
Rate for Payer: UHCCP Medicaid	$329.30

PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION

Professional

Both

$1,320.00

Service Code	HCPCS 27500
Min. Negotiated Rate	$296.50
Max. Negotiated Rate	$990.00
Rate for Payer: Aetna Commercial	$641.93
Rate for Payer: Aetna Medicare	$660.00
Rate for Payer: BCBS Complete	$311.32
Rate for Payer: BCN Commercial	$739.01
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Mclaren Medicaid	$296.50
Rate for Payer: Meridian Medicaid	$311.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$990.00
Rate for Payer: Priority Health Choice Medicaid	$296.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$789.97
Rate for Payer: Priority Health Narrow/Tiered Network	$789.97
Rate for Payer: UHC Medicaid	$296.50
Rate for Payer: UHCCP Medicaid	$296.50

PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA

Professional

Both

$905.00

Service Code	HCPCS 27552
Min. Negotiated Rate	$386.60
Max. Negotiated Rate	$1,042.29
Rate for Payer: Aetna Commercial	$844.11
Rate for Payer: Aetna Medicare	$452.50
Rate for Payer: BCBS Complete	$405.93
Rate for Payer: BCN Commercial	$975.05
Rate for Payer: Cash Price	$724.00
Rate for Payer: Cash Price	$724.00
Rate for Payer: Mclaren Medicaid	$386.60
Rate for Payer: Meridian Medicaid	$405.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$678.75
Rate for Payer: Priority Health Choice Medicaid	$386.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,042.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,042.29
Rate for Payer: UHC Medicaid	$386.60
Rate for Payer: UHCCP Medicaid	$386.60

PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA

Professional

Both

$870.00

Service Code	HCPCS 27550
Min. Negotiated Rate	$333.56
Max. Negotiated Rate	$779.32
Rate for Payer: Aetna Commercial	$647.69
Rate for Payer: Aetna Medicare	$435.00
Rate for Payer: BCBS Complete	$350.24
Rate for Payer: BCN Commercial	$729.05
Rate for Payer: Cash Price	$696.00
Rate for Payer: Cash Price	$696.00
Rate for Payer: Mclaren Medicaid	$333.56
Rate for Payer: Meridian Medicaid	$350.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$652.50
Rate for Payer: Priority Health Choice Medicaid	$333.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$779.32
Rate for Payer: Priority Health Narrow/Tiered Network	$779.32
Rate for Payer: UHC Medicaid	$333.56
Rate for Payer: UHCCP Medicaid	$333.56

PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION

Professional

Both

$867.00

Service Code	HCPCS 25690
Min. Negotiated Rate	$307.57
Max. Negotiated Rate	$816.60
Rate for Payer: Aetna Commercial	$651.62
Rate for Payer: Aetna Medicare	$433.50
Rate for Payer: BCBS Complete	$322.95
Rate for Payer: BCN Commercial	$763.90
Rate for Payer: Cash Price	$693.60
Rate for Payer: Cash Price	$693.60
Rate for Payer: Mclaren Medicaid	$307.57
Rate for Payer: Meridian Medicaid	$322.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$650.25
Rate for Payer: Priority Health Choice Medicaid	$307.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$816.60
Rate for Payer: Priority Health Narrow/Tiered Network	$816.60
Rate for Payer: UHC Medicaid	$307.57
Rate for Payer: UHCCP Medicaid	$307.57

PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION

Professional

Both

$1,243.00

Service Code	HCPCS 21451
Min. Negotiated Rate	$387.87
Max. Negotiated Rate	$1,026.33
Rate for Payer: Aetna Commercial	$849.59
Rate for Payer: Aetna Medicare	$621.50
Rate for Payer: BCBS Complete	$407.26
Rate for Payer: BCN Commercial	$960.10
Rate for Payer: Cash Price	$994.40
Rate for Payer: Cash Price	$994.40
Rate for Payer: Mclaren Medicaid	$387.87
Rate for Payer: Meridian Medicaid	$407.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$932.25
Rate for Payer: Priority Health Choice Medicaid	$387.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,026.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,026.33
Rate for Payer: UHC Medicaid	$387.87
Rate for Payer: UHCCP Medicaid	$387.87

PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION

Professional

Both

$1,205.00

Service Code	HCPCS 21450
Min. Negotiated Rate	$293.30
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$634.10
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$307.96
Rate for Payer: BCN Commercial	$719.59
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$293.30
Rate for Payer: Meridian Medicaid	$307.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$293.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$769.22
Rate for Payer: Priority Health Narrow/Tiered Network	$769.22
Rate for Payer: UHC Medicaid	$293.30
Rate for Payer: UHCCP Medicaid	$293.30

Know your out-of-pocket cost for care.

All Charges