Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CLSR ENTEROVES FSTL W/INTESTINE&/BLADDER RESCJ

Professional

Both

$3,683.00

Service Code	HCPCS 44661
Min. Negotiated Rate	$901.84
Max. Negotiated Rate	$2,805.64
Rate for Payer: Aetna Commercial	$2,083.58
Rate for Payer: Aetna Medicare	$1,841.50
Rate for Payer: BCBS Complete	$946.93
Rate for Payer: BCN Commercial	$2,302.66
Rate for Payer: Cash Price	$2,946.40
Rate for Payer: Cash Price	$2,946.40
Rate for Payer: Mclaren Medicaid	$901.84
Rate for Payer: Meridian Medicaid	$946.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,762.25
Rate for Payer: Priority Health Choice Medicaid	$901.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,805.64
Rate for Payer: Priority Health Narrow/Tiered Network	$2,805.64
Rate for Payer: UHC Medicaid	$901.84
Rate for Payer: UHCCP Medicaid	$901.84

PR CLSR ENTEROVES FSTL W/O INTSTINAL/BLADDER RESCJ

Professional

Both

$2,742.00

Service Code	HCPCS 44660
Min. Negotiated Rate	$775.75
Max. Negotiated Rate	$2,435.53
Rate for Payer: Aetna Commercial	$1,795.04
Rate for Payer: Aetna Medicare	$1,371.00
Rate for Payer: BCBS Complete	$814.54
Rate for Payer: BCN Commercial	$1,998.90
Rate for Payer: Cash Price	$2,193.60
Rate for Payer: Cash Price	$2,193.60
Rate for Payer: Mclaren Medicaid	$775.75
Rate for Payer: Meridian Medicaid	$814.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,056.50
Rate for Payer: Priority Health Choice Medicaid	$775.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,435.53
Rate for Payer: Priority Health Narrow/Tiered Network	$2,435.53
Rate for Payer: UHC Medicaid	$775.75
Rate for Payer: UHCCP Medicaid	$775.75

PR CLSR ESOPHAGOSTOMY/FSTL CRV APPR

Professional

Both

$2,774.00

Service Code	HCPCS 43420
Min. Negotiated Rate	$560.40
Max. Negotiated Rate	$2,080.50
Rate for Payer: Aetna Commercial	$1,345.37
Rate for Payer: Aetna Medicare	$1,387.00
Rate for Payer: BCBS Complete	$588.42
Rate for Payer: BCN Commercial	$1,529.30
Rate for Payer: Cash Price	$2,219.20
Rate for Payer: Cash Price	$2,219.20
Rate for Payer: Mclaren Medicaid	$560.40
Rate for Payer: Meridian Medicaid	$588.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,080.50
Rate for Payer: Priority Health Choice Medicaid	$560.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,863.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,863.35
Rate for Payer: UHC Medicaid	$560.40
Rate for Payer: UHCCP Medicaid	$560.40

PR CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR

Professional

Both

$4,302.00

Service Code	HCPCS 43425
Min. Negotiated Rate	$877.35
Max. Negotiated Rate	$3,226.50
Rate for Payer: Aetna Commercial	$1,937.74
Rate for Payer: Aetna Medicare	$2,151.00
Rate for Payer: BCBS Complete	$921.22
Rate for Payer: BCN Commercial	$2,138.83
Rate for Payer: Cash Price	$3,441.60
Rate for Payer: Cash Price	$3,441.60
Rate for Payer: Mclaren Medicaid	$877.35
Rate for Payer: Meridian Medicaid	$921.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,226.50
Rate for Payer: Priority Health Choice Medicaid	$877.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,606.02
Rate for Payer: Priority Health Narrow/Tiered Network	$2,606.02
Rate for Payer: UHC Medicaid	$877.35
Rate for Payer: UHCCP Medicaid	$877.35

PR CLSR LACRIMAL PUNCTUM PLUG EACH

Professional

Both

$314.00

Service Code	HCPCS 68761
Min. Negotiated Rate	$66.03
Max. Negotiated Rate	$235.50
Rate for Payer: Aetna Commercial	$152.10
Rate for Payer: Aetna Medicare	$157.00
Rate for Payer: BCBS Complete	$69.33
Rate for Payer: BCN Commercial	$137.05
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Mclaren Medicaid	$66.03
Rate for Payer: Meridian Medicaid	$69.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.50
Rate for Payer: Priority Health Choice Medicaid	$66.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.58
Rate for Payer: Priority Health Narrow/Tiered Network	$203.58
Rate for Payer: UHC Medicaid	$66.03
Rate for Payer: UHCCP Medicaid	$66.03

PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT

Professional

Both

$3,000.00

Service Code	HCPCS 44625
Min. Negotiated Rate	$595.34
Max. Negotiated Rate	$2,250.00
Rate for Payer: Aetna Commercial	$1,357.27
Rate for Payer: Aetna Medicare	$1,500.00
Rate for Payer: BCBS Complete	$625.11
Rate for Payer: BCN Commercial	$1,508.39
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Mclaren Medicaid	$595.34
Rate for Payer: Meridian Medicaid	$625.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,250.00
Rate for Payer: Priority Health Choice Medicaid	$595.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,837.88
Rate for Payer: Priority Health Narrow/Tiered Network	$1,837.88
Rate for Payer: UHC Medicaid	$595.34
Rate for Payer: UHCCP Medicaid	$595.34

PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS

Professional

Both

$3,061.00

Service Code	HCPCS 44626
Min. Negotiated Rate	$928.68
Max. Negotiated Rate	$2,886.96
Rate for Payer: Aetna Commercial	$2,151.52
Rate for Payer: Aetna Medicare	$1,530.50
Rate for Payer: BCBS Complete	$975.11
Rate for Payer: BCN Commercial	$2,369.39
Rate for Payer: Cash Price	$2,448.80
Rate for Payer: Cash Price	$2,448.80
Rate for Payer: Mclaren Medicaid	$928.68
Rate for Payer: Meridian Medicaid	$975.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,295.75
Rate for Payer: Priority Health Choice Medicaid	$928.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,886.96
Rate for Payer: Priority Health Narrow/Tiered Network	$2,886.96
Rate for Payer: UHC Medicaid	$928.68
Rate for Payer: UHCCP Medicaid	$928.68

PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ

Professional

Both

$1,515.00

Service Code	HCPCS 57308
Min. Negotiated Rate	$402.14
Max. Negotiated Rate	$1,136.25
Rate for Payer: Aetna Commercial	$782.21
Rate for Payer: Aetna Medicare	$757.50
Rate for Payer: BCBS Complete	$422.25
Rate for Payer: BCN Commercial	$999.45
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Cash Price	$1,212.00
Rate for Payer: Mclaren Medicaid	$402.14
Rate for Payer: Meridian Medicaid	$422.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,136.25
Rate for Payer: Priority Health Choice Medicaid	$402.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,012.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,012.22
Rate for Payer: UHC Medicaid	$402.14
Rate for Payer: UHCCP Medicaid	$402.14

PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH

Professional

Both

$2,035.00

Service Code	HCPCS 57305
Min. Negotiated Rate	$573.40
Max. Negotiated Rate	$1,526.25
Rate for Payer: Aetna Commercial	$1,168.24
Rate for Payer: Aetna Medicare	$1,017.50
Rate for Payer: BCBS Complete	$602.07
Rate for Payer: BCN Commercial	$1,458.59
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Mclaren Medicaid	$573.40
Rate for Payer: Meridian Medicaid	$602.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,526.25
Rate for Payer: Priority Health Choice Medicaid	$573.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,477.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,477.23
Rate for Payer: UHC Medicaid	$573.40
Rate for Payer: UHCCP Medicaid	$573.40

PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR

Professional

Both

$1,361.00

Service Code	HCPCS 57300
Min. Negotiated Rate	$359.76
Max. Negotiated Rate	$1,020.75
Rate for Payer: Aetna Commercial	$717.48
Rate for Payer: Aetna Medicare	$680.50
Rate for Payer: BCBS Complete	$377.75
Rate for Payer: BCN Commercial	$919.27
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Mclaren Medicaid	$359.76
Rate for Payer: Meridian Medicaid	$377.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,020.75
Rate for Payer: Priority Health Choice Medicaid	$359.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$931.03
Rate for Payer: Priority Health Narrow/Tiered Network	$931.03
Rate for Payer: UHC Medicaid	$359.76
Rate for Payer: UHCCP Medicaid	$359.76

PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX

Professional

Both

$1,188.00

Service Code	HCPCS 53520
Min. Negotiated Rate	$326.74
Max. Negotiated Rate	$916.22
Rate for Payer: Aetna Commercial	$715.24
Rate for Payer: Aetna Medicare	$594.00
Rate for Payer: BCBS Complete	$343.08
Rate for Payer: BCN Commercial	$841.09
Rate for Payer: Cash Price	$950.40
Rate for Payer: Cash Price	$950.40
Rate for Payer: Mclaren Medicaid	$326.74
Rate for Payer: Meridian Medicaid	$343.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$891.00
Rate for Payer: Priority Health Choice Medicaid	$326.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$916.22
Rate for Payer: Priority Health Narrow/Tiered Network	$916.22
Rate for Payer: UHC Medicaid	$326.74
Rate for Payer: UHCCP Medicaid	$326.74

PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL

Professional

Both

$1,136.00

Service Code	HCPCS 57311
Min. Negotiated Rate	$321.42
Max. Negotiated Rate	$852.00
Rate for Payer: Aetna Commercial	$653.71
Rate for Payer: Aetna Medicare	$568.00
Rate for Payer: BCBS Complete	$337.49
Rate for Payer: BCN Commercial	$835.61
Rate for Payer: Cash Price	$908.80
Rate for Payer: Cash Price	$908.80
Rate for Payer: Mclaren Medicaid	$321.42
Rate for Payer: Meridian Medicaid	$337.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$852.00
Rate for Payer: Priority Health Choice Medicaid	$321.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$846.29
Rate for Payer: Priority Health Narrow/Tiered Network	$846.29
Rate for Payer: UHC Medicaid	$321.42
Rate for Payer: UHCCP Medicaid	$321.42

PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH

Professional

Both

$4,033.00

Service Code	HCPCS 51900
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$3,024.75
Rate for Payer: Aetna Commercial	$1,056.40
Rate for Payer: Aetna Medicare	$2,016.50
Rate for Payer: BCBS Complete	$498.96
Rate for Payer: BCN Commercial	$1,234.99
Rate for Payer: Cash Price	$3,226.40
Rate for Payer: Cash Price	$3,226.40
Rate for Payer: Mclaren Medicaid	$475.20
Rate for Payer: Meridian Medicaid	$498.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,024.75
Rate for Payer: Priority Health Choice Medicaid	$475.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,345.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,345.30
Rate for Payer: UHC Medicaid	$475.20
Rate for Payer: UHCCP Medicaid	$475.20

PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ

Professional

Both

$2,342.00

Service Code	HCPCS 27222
Min. Negotiated Rate	$583.83
Max. Negotiated Rate	$1,756.50
Rate for Payer: Aetna Commercial	$1,306.47
Rate for Payer: Aetna Medicare	$1,171.00
Rate for Payer: BCBS Complete	$613.02
Rate for Payer: BCN Commercial	$1,489.46
Rate for Payer: Cash Price	$1,873.60
Rate for Payer: Cash Price	$1,873.60
Rate for Payer: Mclaren Medicaid	$583.83
Rate for Payer: Meridian Medicaid	$613.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,756.50
Rate for Payer: Priority Health Choice Medicaid	$583.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,592.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,592.19
Rate for Payer: UHC Medicaid	$583.83
Rate for Payer: UHCCP Medicaid	$583.83

PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ

Professional

Both

$1,729.00

Service Code	HCPCS 27220
Min. Negotiated Rate	$249.00
Max. Negotiated Rate	$1,296.75
Rate for Payer: Aetna Commercial	$550.55
Rate for Payer: Aetna Medicare	$864.50
Rate for Payer: BCBS Complete	$261.45
Rate for Payer: BCN Commercial	$633.93
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Mclaren Medicaid	$249.00
Rate for Payer: Meridian Medicaid	$261.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,296.75
Rate for Payer: Priority Health Choice Medicaid	$249.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$677.65
Rate for Payer: Priority Health Narrow/Tiered Network	$677.65
Rate for Payer: UHC Medicaid	$249.00
Rate for Payer: UHCCP Medicaid	$249.00

PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ

Professional

Both

$1,456.00

Service Code	HCPCS 27842
Min. Negotiated Rate	$313.11
Max. Negotiated Rate	$1,092.00
Rate for Payer: Aetna Commercial	$660.07
Rate for Payer: Aetna Medicare	$728.00
Rate for Payer: BCBS Complete	$328.77
Rate for Payer: BCN Commercial	$758.43
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Cash Price	$1,164.80
Rate for Payer: Mclaren Medicaid	$313.11
Rate for Payer: Meridian Medicaid	$328.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,092.00
Rate for Payer: Priority Health Choice Medicaid	$313.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$810.74
Rate for Payer: Priority Health Narrow/Tiered Network	$810.74
Rate for Payer: UHC Medicaid	$313.11
Rate for Payer: UHCCP Medicaid	$313.11

PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ

Professional

Both

$963.00

Service Code	HCPCS 26742
Min. Negotiated Rate	$217.26
Max. Negotiated Rate	$722.25
Rate for Payer: Aetna Commercial	$448.66
Rate for Payer: Aetna Medicare	$481.50
Rate for Payer: BCBS Complete	$228.12
Rate for Payer: BCN Commercial	$525.37
Rate for Payer: Cash Price	$770.40
Rate for Payer: Cash Price	$770.40
Rate for Payer: Mclaren Medicaid	$217.26
Rate for Payer: Meridian Medicaid	$228.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$722.25
Rate for Payer: Priority Health Choice Medicaid	$217.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$561.61
Rate for Payer: Priority Health Narrow/Tiered Network	$561.61
Rate for Payer: UHC Medicaid	$217.26
Rate for Payer: UHCCP Medicaid	$217.26

PR CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ

Professional

Both

$651.00

Service Code	HCPCS 26740
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$488.25
Rate for Payer: Aetna Commercial	$289.66
Rate for Payer: Aetna Medicare	$325.50
Rate for Payer: BCBS Complete	$151.41
Rate for Payer: BCN Commercial	$351.07
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Mclaren Medicaid	$144.20
Rate for Payer: Meridian Medicaid	$151.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$488.25
Rate for Payer: Priority Health Choice Medicaid	$144.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$375.29
Rate for Payer: Priority Health Narrow/Tiered Network	$375.29
Rate for Payer: UHC Medicaid	$144.20
Rate for Payer: UHCCP Medicaid	$144.20

PR CLTX CARPAL BONE FX W/MNPJ EACH BONE

Professional

Both

$1,157.00

Service Code	HCPCS 25635
Min. Negotiated Rate	$269.87
Max. Negotiated Rate	$867.75
Rate for Payer: Aetna Commercial	$560.87
Rate for Payer: Aetna Medicare	$578.50
Rate for Payer: BCBS Complete	$283.36
Rate for Payer: BCN Commercial	$663.31
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cash Price	$925.60
Rate for Payer: Mclaren Medicaid	$269.87
Rate for Payer: Meridian Medicaid	$283.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$867.75
Rate for Payer: Priority Health Choice Medicaid	$269.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$709.07
Rate for Payer: Priority Health Narrow/Tiered Network	$709.07
Rate for Payer: UHC Medicaid	$269.87
Rate for Payer: UHCCP Medicaid	$269.87

PR CLTX CARPAL BONE FX W/O MNPJ EACH BONE

Professional

Both

$735.00

Service Code	HCPCS 25630
Min. Negotiated Rate	$185.31
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial	$376.68
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$194.58
Rate for Payer: BCN Commercial	$450.17
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$185.31
Rate for Payer: Meridian Medicaid	$194.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$185.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$481.22
Rate for Payer: Priority Health Narrow/Tiered Network	$481.22
Rate for Payer: UHC Medicaid	$185.31
Rate for Payer: UHCCP Medicaid	$185.31

PR CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ

Professional

Both

$774.00

Service Code	HCPCS 26641
Min. Negotiated Rate	$244.95
Max. Negotiated Rate	$641.46
Rate for Payer: Aetna Commercial	$505.26
Rate for Payer: Aetna Medicare	$387.00
Rate for Payer: BCBS Complete	$257.20
Rate for Payer: BCN Commercial	$600.06
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$244.95
Rate for Payer: Meridian Medicaid	$257.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$580.50
Rate for Payer: Priority Health Choice Medicaid	$244.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$641.46
Rate for Payer: Priority Health Narrow/Tiered Network	$641.46
Rate for Payer: UHC Medicaid	$244.95
Rate for Payer: UHCCP Medicaid	$244.95

PR CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ

Professional

Both

$1,049.00

Service Code	HCPCS 26645
Min. Negotiated Rate	$249.85
Max. Negotiated Rate	$786.75
Rate for Payer: Aetna Commercial	$526.41
Rate for Payer: Aetna Medicare	$524.50
Rate for Payer: BCBS Complete	$262.34
Rate for Payer: BCN Commercial	$618.00
Rate for Payer: Cash Price	$839.20
Rate for Payer: Cash Price	$839.20
Rate for Payer: Mclaren Medicaid	$249.85
Rate for Payer: Meridian Medicaid	$262.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$786.75
Rate for Payer: Priority Health Choice Medicaid	$249.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$660.62
Rate for Payer: Priority Health Narrow/Tiered Network	$660.62
Rate for Payer: UHC Medicaid	$249.85
Rate for Payer: UHCCP Medicaid	$249.85

PR CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES

Professional

Both

$623.00

Service Code	HCPCS 26670
Min. Negotiated Rate	$227.91
Max. Negotiated Rate	$531.27
Rate for Payer: Aetna Commercial	$415.80
Rate for Payer: Aetna Medicare	$311.50
Rate for Payer: BCBS Complete	$239.31
Rate for Payer: BCN Commercial	$496.98
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cash Price	$498.40
Rate for Payer: Mclaren Medicaid	$227.91
Rate for Payer: Meridian Medicaid	$239.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$467.25
Rate for Payer: Priority Health Choice Medicaid	$227.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$531.27
Rate for Payer: Priority Health Narrow/Tiered Network	$531.27
Rate for Payer: UHC Medicaid	$227.91
Rate for Payer: UHCCP Medicaid	$227.91

PR CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES

Professional

Both

$1,303.00

Service Code	HCPCS 26675
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$977.25
Rate for Payer: Aetna Commercial	$561.06
Rate for Payer: Aetna Medicare	$651.50
Rate for Payer: BCBS Complete	$280.69
Rate for Payer: BCN Commercial	$660.82
Rate for Payer: Cash Price	$1,042.40
Rate for Payer: Cash Price	$1,042.40
Rate for Payer: Mclaren Medicaid	$267.32
Rate for Payer: Meridian Medicaid	$280.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$977.25
Rate for Payer: Priority Health Choice Medicaid	$267.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$706.40
Rate for Payer: Priority Health Narrow/Tiered Network	$706.40
Rate for Payer: UHC Medicaid	$267.32
Rate for Payer: UHCCP Medicaid	$267.32

PR CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ

Professional

Both

$1,345.00

Service Code	HCPCS 27516
Min. Negotiated Rate	$304.59
Max. Negotiated Rate	$1,008.75
Rate for Payer: Aetna Commercial	$641.97
Rate for Payer: Aetna Medicare	$672.50
Rate for Payer: BCBS Complete	$319.82
Rate for Payer: BCN Commercial	$754.94
Rate for Payer: Cash Price	$1,076.00
Rate for Payer: Cash Price	$1,076.00
Rate for Payer: Mclaren Medicaid	$304.59
Rate for Payer: Meridian Medicaid	$319.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,008.75
Rate for Payer: Priority Health Choice Medicaid	$304.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$807.00
Rate for Payer: Priority Health Narrow/Tiered Network	$807.00
Rate for Payer: UHC Medicaid	$304.59
Rate for Payer: UHCCP Medicaid	$304.59

Know your out-of-pocket cost for care.

All Charges