Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT

Professional

Both

$2,291.00

Service Code	HCPCS 28420
Min. Negotiated Rate	$770.85
Max. Negotiated Rate	$2,098.44
Rate for Payer: Aetna Commercial	$1,729.13
Rate for Payer: Aetna Medicare	$1,145.50
Rate for Payer: BCBS Complete	$809.39
Rate for Payer: BCN Commercial	$1,963.04
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Mclaren Medicaid	$770.85
Rate for Payer: Meridian Medicaid	$809.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,718.25
Rate for Payer: Priority Health Choice Medicaid	$770.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,098.44
Rate for Payer: Priority Health Narrow/Tiered Network	$2,098.44
Rate for Payer: UHC Medicaid	$770.85
Rate for Payer: UHCCP Medicaid	$770.85

PR OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA

Professional

Both

$4,741.00

Service Code	HCPCS 27828
Min. Negotiated Rate	$784.48
Max. Negotiated Rate	$3,555.75
Rate for Payer: Aetna Commercial	$1,772.06
Rate for Payer: Aetna Medicare	$2,370.50
Rate for Payer: BCBS Complete	$823.70
Rate for Payer: BCN Commercial	$2,000.39
Rate for Payer: Cash Price	$3,792.80
Rate for Payer: Cash Price	$3,792.80
Rate for Payer: Mclaren Medicaid	$784.48
Rate for Payer: Meridian Medicaid	$823.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,555.75
Rate for Payer: Priority Health Choice Medicaid	$784.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,138.36
Rate for Payer: Priority Health Narrow/Tiered Network	$2,138.36
Rate for Payer: UHC Medicaid	$784.48
Rate for Payer: UHCCP Medicaid	$784.48

PR OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA

Professional

Both

$3,194.00

Service Code	HCPCS 27826
Min. Negotiated Rate	$518.44
Max. Negotiated Rate	$2,395.50
Rate for Payer: Aetna Commercial	$1,135.98
Rate for Payer: Aetna Medicare	$1,597.00
Rate for Payer: BCBS Complete	$544.36
Rate for Payer: BCN Commercial	$1,291.76
Rate for Payer: Cash Price	$2,555.20
Rate for Payer: Cash Price	$2,555.20
Rate for Payer: Mclaren Medicaid	$518.44
Rate for Payer: Meridian Medicaid	$544.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,395.50
Rate for Payer: Priority Health Choice Medicaid	$518.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,380.86
Rate for Payer: Priority Health Narrow/Tiered Network	$1,380.86
Rate for Payer: UHC Medicaid	$518.44
Rate for Payer: UHCCP Medicaid	$518.44

PR OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY

Professional

Both

$4,493.00

Service Code	HCPCS 27827
Min. Negotiated Rate	$671.59
Max. Negotiated Rate	$3,369.75
Rate for Payer: Aetna Commercial	$1,490.61
Rate for Payer: Aetna Medicare	$2,246.50
Rate for Payer: BCBS Complete	$705.17
Rate for Payer: BCN Commercial	$1,696.62
Rate for Payer: Cash Price	$3,594.40
Rate for Payer: Cash Price	$3,594.40
Rate for Payer: Mclaren Medicaid	$671.59
Rate for Payer: Meridian Medicaid	$705.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,369.75
Rate for Payer: Priority Health Choice Medicaid	$671.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,813.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,813.65
Rate for Payer: UHC Medicaid	$671.59
Rate for Payer: UHCCP Medicaid	$671.59

PR OPEN TREATMENT GREATER TROCHANTERIC FRACTURE

Professional

Both

$2,076.00

Service Code	HCPCS 27248
Min. Negotiated Rate	$437.29
Max. Negotiated Rate	$1,557.00
Rate for Payer: Aetna Commercial	$996.94
Rate for Payer: Aetna Medicare	$1,038.00
Rate for Payer: BCBS Complete	$459.15
Rate for Payer: BCN Commercial	$1,131.42
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Cash Price	$1,660.80
Rate for Payer: Mclaren Medicaid	$437.29
Rate for Payer: Meridian Medicaid	$459.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,557.00
Rate for Payer: Priority Health Choice Medicaid	$437.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,209.44
Rate for Payer: Priority Health Narrow/Tiered Network	$1,209.44
Rate for Payer: UHC Medicaid	$437.29
Rate for Payer: UHCCP Medicaid	$437.29

PR OPEN TREATMENT HUMERAL CONDYLAR FRACTURE

Professional

Both

$2,944.00

Service Code	HCPCS 24579
Min. Negotiated Rate	$497.57
Max. Negotiated Rate	$2,208.00
Rate for Payer: Aetna Commercial	$1,111.10
Rate for Payer: Aetna Medicare	$1,472.00
Rate for Payer: BCBS Complete	$522.45
Rate for Payer: BCN Commercial	$1,276.32
Rate for Payer: Cash Price	$2,355.20
Rate for Payer: Cash Price	$2,355.20
Rate for Payer: Mclaren Medicaid	$497.57
Rate for Payer: Meridian Medicaid	$522.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,208.00
Rate for Payer: Priority Health Choice Medicaid	$497.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,364.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,364.35
Rate for Payer: UHC Medicaid	$497.57
Rate for Payer: UHCCP Medicaid	$497.57

PR OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION

Professional

Both

$1,008.00

Service Code	HCPCS 28675
Min. Negotiated Rate	$251.34
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$534.76
Rate for Payer: Aetna Medicare	$504.00
Rate for Payer: BCBS Complete	$263.91
Rate for Payer: BCN Commercial	$630.44
Rate for Payer: Cash Price	$806.40
Rate for Payer: Cash Price	$806.40
Rate for Payer: Mclaren Medicaid	$251.34
Rate for Payer: Meridian Medicaid	$263.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$756.00
Rate for Payer: Priority Health Choice Medicaid	$251.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$673.93
Rate for Payer: Priority Health Narrow/Tiered Network	$673.93
Rate for Payer: UHC Medicaid	$251.34
Rate for Payer: UHCCP Medicaid	$251.34

PR OPEN TREATMENT LUNATE DISLOCATION

Professional

Both

$1,961.00

Service Code	HCPCS 25695
Min. Negotiated Rate	$383.19
Max. Negotiated Rate	$1,470.75
Rate for Payer: Aetna Commercial	$848.78
Rate for Payer: Aetna Medicare	$980.50
Rate for Payer: BCBS Complete	$402.35
Rate for Payer: BCN Commercial	$973.05
Rate for Payer: Cash Price	$1,568.80
Rate for Payer: Cash Price	$1,568.80
Rate for Payer: Mclaren Medicaid	$383.19
Rate for Payer: Meridian Medicaid	$402.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,470.75
Rate for Payer: Priority Health Choice Medicaid	$383.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,040.17
Rate for Payer: Priority Health Narrow/Tiered Network	$1,040.17
Rate for Payer: UHC Medicaid	$383.19
Rate for Payer: UHCCP Medicaid	$383.19

PR OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE

Professional

Both

$1,764.00

Service Code	HCPCS 21465
Min. Negotiated Rate	$461.57
Max. Negotiated Rate	$1,323.00
Rate for Payer: Aetna Commercial	$1,066.23
Rate for Payer: Aetna Medicare	$882.00
Rate for Payer: BCBS Complete	$484.65
Rate for Payer: BCN Commercial	$1,217.57
Rate for Payer: Cash Price	$1,411.20
Rate for Payer: Cash Price	$1,411.20
Rate for Payer: Mclaren Medicaid	$461.57
Rate for Payer: Meridian Medicaid	$484.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,323.00
Rate for Payer: Priority Health Choice Medicaid	$461.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,301.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,301.54
Rate for Payer: UHC Medicaid	$461.57
Rate for Payer: UHCCP Medicaid	$461.57

PR OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE

Professional

Both

$2,246.00

Service Code	HCPCS 27766
Min. Negotiated Rate	$369.77
Max. Negotiated Rate	$1,684.50
Rate for Payer: Aetna Commercial	$805.90
Rate for Payer: Aetna Medicare	$1,123.00
Rate for Payer: BCBS Complete	$388.26
Rate for Payer: BCN Commercial	$926.25
Rate for Payer: Cash Price	$1,796.80
Rate for Payer: Cash Price	$1,796.80
Rate for Payer: Mclaren Medicaid	$369.77
Rate for Payer: Meridian Medicaid	$388.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,684.50
Rate for Payer: Priority Health Choice Medicaid	$369.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$990.12
Rate for Payer: Priority Health Narrow/Tiered Network	$990.12
Rate for Payer: UHC Medicaid	$369.77
Rate for Payer: UHCCP Medicaid	$369.77

PR OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION

Professional

Both

$1,983.00

Service Code	HCPCS 26715
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$1,487.25
Rate for Payer: Aetna Commercial	$760.98
Rate for Payer: Aetna Medicare	$991.50
Rate for Payer: BCBS Complete	$365.00
Rate for Payer: BCN Commercial	$884.42
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Mclaren Medicaid	$347.62
Rate for Payer: Meridian Medicaid	$365.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,487.25
Rate for Payer: Priority Health Choice Medicaid	$347.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$945.41
Rate for Payer: Priority Health Narrow/Tiered Network	$945.41
Rate for Payer: UHC Medicaid	$347.62
Rate for Payer: UHCCP Medicaid	$347.62

PR OPEN TREATMENT METATARSAL FRACTURE EACH

Professional

Both

$1,386.00

Service Code	HCPCS 28485
Min. Negotiated Rate	$345.70
Max. Negotiated Rate	$1,039.50
Rate for Payer: Aetna Commercial	$740.09
Rate for Payer: Aetna Medicare	$693.00
Rate for Payer: BCBS Complete	$362.99
Rate for Payer: BCN Commercial	$856.03
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Mclaren Medicaid	$345.70
Rate for Payer: Meridian Medicaid	$362.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,039.50
Rate for Payer: Priority Health Choice Medicaid	$345.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$915.08
Rate for Payer: Priority Health Narrow/Tiered Network	$915.08
Rate for Payer: UHC Medicaid	$345.70
Rate for Payer: UHCCP Medicaid	$345.70

PR OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED

Professional

Both

$865.00

Service Code	HCPCS 21325
Min. Negotiated Rate	$263.69
Max. Negotiated Rate	$714.38
Rate for Payer: Aetna Commercial	$583.69
Rate for Payer: Aetna Medicare	$432.50
Rate for Payer: BCBS Complete	$276.87
Rate for Payer: BCN Commercial	$668.29
Rate for Payer: Cash Price	$692.00
Rate for Payer: Cash Price	$692.00
Rate for Payer: Mclaren Medicaid	$263.69
Rate for Payer: Meridian Medicaid	$276.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$648.75
Rate for Payer: Priority Health Choice Medicaid	$263.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$714.38
Rate for Payer: Priority Health Narrow/Tiered Network	$714.38
Rate for Payer: UHC Medicaid	$263.69
Rate for Payer: UHCCP Medicaid	$263.69

PR OPEN TREATMENT PALATAL/MAXILLARY FRACTURE

Professional

Both

$1,383.00

Service Code	HCPCS 21422
Min. Negotiated Rate	$376.37
Max. Negotiated Rate	$1,037.25
Rate for Payer: Aetna Commercial	$849.13
Rate for Payer: Aetna Medicare	$691.50
Rate for Payer: BCBS Complete	$395.19
Rate for Payer: BCN Commercial	$954.63
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Mclaren Medicaid	$376.37
Rate for Payer: Meridian Medicaid	$395.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: Priority Health Choice Medicaid	$376.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,020.47
Rate for Payer: Priority Health Narrow/Tiered Network	$1,020.47
Rate for Payer: UHC Medicaid	$376.37
Rate for Payer: UHCCP Medicaid	$376.37

PR OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE

Professional

Both

$1,336.00

Service Code	HCPCS 27769
Min. Negotiated Rate	$430.90
Max. Negotiated Rate	$1,183.36
Rate for Payer: Aetna Commercial	$976.15
Rate for Payer: Aetna Medicare	$668.00
Rate for Payer: BCBS Complete	$452.44
Rate for Payer: BCN Commercial	$1,107.01
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Mclaren Medicaid	$430.90
Rate for Payer: Meridian Medicaid	$452.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.00
Rate for Payer: Priority Health Choice Medicaid	$430.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,183.36
Rate for Payer: Priority Health Narrow/Tiered Network	$1,183.36
Rate for Payer: UHC Medicaid	$430.90
Rate for Payer: UHCCP Medicaid	$430.90

PR OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE

Professional

Both

$2,346.00

Service Code	HCPCS 27784
Min. Negotiated Rate	$429.20
Max. Negotiated Rate	$1,759.50
Rate for Payer: Aetna Commercial	$940.92
Rate for Payer: Aetna Medicare	$1,173.00
Rate for Payer: BCBS Complete	$450.66
Rate for Payer: BCN Commercial	$1,083.61
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Mclaren Medicaid	$429.20
Rate for Payer: Meridian Medicaid	$450.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,759.50
Rate for Payer: Priority Health Choice Medicaid	$429.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,158.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,158.35
Rate for Payer: UHC Medicaid	$429.20
Rate for Payer: UHCCP Medicaid	$429.20

PR OPEN TREATMENT RADIAL SHAFT FRACTURE W/INT FIXJ

Professional

Both

$2,125.00

Service Code	HCPCS 25515
Min. Negotiated Rate	$404.27
Max. Negotiated Rate	$1,593.75
Rate for Payer: Aetna Commercial	$891.56
Rate for Payer: Aetna Medicare	$1,062.50
Rate for Payer: BCBS Complete	$424.48
Rate for Payer: BCN Commercial	$1,029.32
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Cash Price	$1,700.00
Rate for Payer: Mclaren Medicaid	$404.27
Rate for Payer: Meridian Medicaid	$424.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,593.75
Rate for Payer: Priority Health Choice Medicaid	$404.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,100.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,100.32
Rate for Payer: UHC Medicaid	$404.27
Rate for Payer: UHCCP Medicaid	$404.27

PR OPEN TREATMENT TALOTARSAL JOINT DISLOCATION

Professional

Both

$2,056.00

Service Code	HCPCS 28585
Min. Negotiated Rate	$430.90
Max. Negotiated Rate	$1,542.00
Rate for Payer: Aetna Commercial	$912.33
Rate for Payer: Aetna Medicare	$1,028.00
Rate for Payer: BCBS Complete	$452.44
Rate for Payer: BCN Commercial	$1,084.10
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Mclaren Medicaid	$430.90
Rate for Payer: Meridian Medicaid	$452.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,542.00
Rate for Payer: Priority Health Choice Medicaid	$430.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,158.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,158.87
Rate for Payer: UHC Medicaid	$430.90
Rate for Payer: UHCCP Medicaid	$430.90

PR OPEN TREATMENT TALUS FRACTURE

Professional

Both

$3,236.00

Service Code	HCPCS 28445
Min. Negotiated Rate	$622.60
Max. Negotiated Rate	$2,427.00
Rate for Payer: Aetna Commercial	$1,370.13
Rate for Payer: Aetna Medicare	$1,618.00
Rate for Payer: BCBS Complete	$653.73
Rate for Payer: BCN Commercial	$1,584.08
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Mclaren Medicaid	$622.60
Rate for Payer: Meridian Medicaid	$653.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,427.00
Rate for Payer: Priority Health Choice Medicaid	$622.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,693.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,693.33
Rate for Payer: UHC Medicaid	$622.60
Rate for Payer: UHCCP Medicaid	$622.60

PR OPEN TREATMENT TARSAL BONE DISLOCATION

Professional

Both

$1,780.00

Service Code	HCPCS 28555
Min. Negotiated Rate	$390.22
Max. Negotiated Rate	$1,335.00
Rate for Payer: Aetna Commercial	$870.72
Rate for Payer: Aetna Medicare	$890.00
Rate for Payer: BCBS Complete	$409.73
Rate for Payer: BCN Commercial	$988.00
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Mclaren Medicaid	$390.22
Rate for Payer: Meridian Medicaid	$409.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,335.00
Rate for Payer: Priority Health Choice Medicaid	$390.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,056.13
Rate for Payer: Priority Health Narrow/Tiered Network	$1,056.13
Rate for Payer: UHC Medicaid	$390.22
Rate for Payer: UHCCP Medicaid	$390.22

PR OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION

Professional

Both

$1,849.00

Service Code	HCPCS 28615
Min. Negotiated Rate	$505.88
Max. Negotiated Rate	$1,386.75
Rate for Payer: Aetna Commercial	$1,091.05
Rate for Payer: Aetna Medicare	$924.50
Rate for Payer: BCBS Complete	$531.17
Rate for Payer: BCN Commercial	$1,257.90
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Mclaren Medicaid	$505.88
Rate for Payer: Meridian Medicaid	$531.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,386.75
Rate for Payer: Priority Health Choice Medicaid	$505.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,344.66
Rate for Payer: Priority Health Narrow/Tiered Network	$1,344.66
Rate for Payer: UHC Medicaid	$505.88
Rate for Payer: UHCCP Medicaid	$505.88

PR OPEN TREATMENT ULNAR FRACTURE PROXIMAL END W/FIX

Professional

Both

$2,413.00

Service Code	HCPCS 24685
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$1,809.75
Rate for Payer: Aetna Commercial	$871.05
Rate for Payer: Aetna Medicare	$1,206.50
Rate for Payer: BCBS Complete	$416.66
Rate for Payer: BCN Commercial	$1,002.94
Rate for Payer: Cash Price	$1,930.40
Rate for Payer: Cash Price	$1,930.40
Rate for Payer: Mclaren Medicaid	$396.82
Rate for Payer: Meridian Medicaid	$416.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,809.75
Rate for Payer: Priority Health Choice Medicaid	$396.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,072.11
Rate for Payer: Priority Health Narrow/Tiered Network	$1,072.11
Rate for Payer: UHC Medicaid	$396.82
Rate for Payer: UHCCP Medicaid	$396.82

PR OPEN TREATMENT ULNAR SHAFT FRACTURE W/INT FIXJ

Professional

Both

$2,002.00

Service Code	HCPCS 25545
Min. Negotiated Rate	$379.35
Max. Negotiated Rate	$1,501.50
Rate for Payer: Aetna Commercial	$829.87
Rate for Payer: Aetna Medicare	$1,001.00
Rate for Payer: BCBS Complete	$398.32
Rate for Payer: BCN Commercial	$962.10
Rate for Payer: Cash Price	$1,601.60
Rate for Payer: Cash Price	$1,601.60
Rate for Payer: Mclaren Medicaid	$379.35
Rate for Payer: Meridian Medicaid	$398.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,501.50
Rate for Payer: Priority Health Choice Medicaid	$379.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,028.45
Rate for Payer: Priority Health Narrow/Tiered Network	$1,028.45
Rate for Payer: UHC Medicaid	$379.35
Rate for Payer: UHCCP Medicaid	$379.35

PR OPEN TREATMENT ULNAR STYLOID FRACTURE

Professional

Both

$1,717.00

Service Code	HCPCS 25652
Min. Negotiated Rate	$376.80
Max. Negotiated Rate	$1,287.75
Rate for Payer: Aetna Commercial	$828.66
Rate for Payer: Aetna Medicare	$858.50
Rate for Payer: BCBS Complete	$395.64
Rate for Payer: BCN Commercial	$960.61
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Mclaren Medicaid	$376.80
Rate for Payer: Meridian Medicaid	$395.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,287.75
Rate for Payer: Priority Health Choice Medicaid	$376.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,026.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,026.85
Rate for Payer: UHC Medicaid	$376.80
Rate for Payer: UHCCP Medicaid	$376.80

PR OPEN TREAT RIB FRACTURE W/INT FIXATION, UNILATERAL, 1-2 RIBS

Professional

Both

$3,448.00

Service Code	HCPCS 0245T
Min. Negotiated Rate	$1,379.20
Max. Negotiated Rate	$2,586.00
Rate for Payer: Aetna Medicare	$1,724.00
Rate for Payer: BCBS Complete	$1,379.20
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,586.00

Know your out-of-pocket cost for care.

All Charges