Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT

Professional

Both

$3,844.00

Service Code	HCPCS 27236
Min. Negotiated Rate	$695.02
Max. Negotiated Rate	$2,883.00
Rate for Payer: Aetna Commercial	$1,594.63
Rate for Payer: Aetna Medicare	$1,922.00
Rate for Payer: BCBS Complete	$729.77
Rate for Payer: BCN Commercial	$1,983.13
Rate for Payer: Cash Price	$3,075.20
Rate for Payer: Cash Price	$3,075.20
Rate for Payer: Mclaren Medicaid	$695.02
Rate for Payer: Meridian Medicaid	$729.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,883.00
Rate for Payer: Priority Health Choice Medicaid	$695.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,929.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,929.69
Rate for Payer: UHC Medicaid	$695.02
Rate for Payer: UHCCP Medicaid	$695.02

PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW

Professional

Both

$4,341.00

Service Code	HCPCS 27506
Min. Negotiated Rate	$780.01
Max. Negotiated Rate	$3,255.75
Rate for Payer: Aetna Commercial	$1,786.48
Rate for Payer: Aetna Medicare	$2,170.50
Rate for Payer: BCBS Complete	$819.01
Rate for Payer: BCN Commercial	$2,224.38
Rate for Payer: Cash Price	$3,472.80
Rate for Payer: Cash Price	$3,472.80
Rate for Payer: Mclaren Medicaid	$780.01
Rate for Payer: Meridian Medicaid	$819.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,255.75
Rate for Payer: Priority Health Choice Medicaid	$780.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,164.45
Rate for Payer: Priority Health Narrow/Tiered Network	$2,164.45
Rate for Payer: UHC Medicaid	$780.01
Rate for Payer: UHCCP Medicaid	$780.01

PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$3,963.00

Service Code	HCPCS 27507
Min. Negotiated Rate	$563.39
Max. Negotiated Rate	$2,972.25
Rate for Payer: Aetna Commercial	$1,296.79
Rate for Payer: Aetna Medicare	$1,981.50
Rate for Payer: BCBS Complete	$591.56
Rate for Payer: BCN Commercial	$1,465.06
Rate for Payer: Cash Price	$3,170.40
Rate for Payer: Cash Price	$3,170.40
Rate for Payer: Mclaren Medicaid	$563.39
Rate for Payer: Meridian Medicaid	$591.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,972.25
Rate for Payer: Priority Health Choice Medicaid	$563.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,566.10
Rate for Payer: Priority Health Narrow/Tiered Network	$1,566.10
Rate for Payer: UHC Medicaid	$563.39
Rate for Payer: UHCCP Medicaid	$563.39

PR OPTX GREATER HUMERAL TUBEROSITY FX W/INT FIXJ

Professional

Both

$1,430.00

Service Code	HCPCS 23630
Min. Negotiated Rate	$468.17
Max. Negotiated Rate	$1,276.52
Rate for Payer: Aetna Commercial	$1,039.57
Rate for Payer: Aetna Medicare	$715.00
Rate for Payer: BCBS Complete	$491.58
Rate for Payer: BCN Commercial	$1,194.15
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Mclaren Medicaid	$468.17
Rate for Payer: Meridian Medicaid	$491.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,072.50
Rate for Payer: Priority Health Choice Medicaid	$468.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,276.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,276.52
Rate for Payer: UHC Medicaid	$468.17
Rate for Payer: UHCCP Medicaid	$468.17

PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD

Professional

Both

$3,652.00

Service Code	HCPCS 27254
Min. Negotiated Rate	$737.83
Max. Negotiated Rate	$2,739.00
Rate for Payer: Aetna Commercial	$1,702.05
Rate for Payer: Aetna Medicare	$1,826.00
Rate for Payer: BCBS Complete	$774.72
Rate for Payer: BCN Commercial	$1,921.71
Rate for Payer: Cash Price	$2,921.60
Rate for Payer: Cash Price	$2,921.60
Rate for Payer: Mclaren Medicaid	$737.83
Rate for Payer: Meridian Medicaid	$774.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,739.00
Rate for Payer: Priority Health Choice Medicaid	$737.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,054.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,054.25
Rate for Payer: UHC Medicaid	$737.83
Rate for Payer: UHCCP Medicaid	$737.83

PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ

Professional

Both

$2,422.00

Service Code	HCPCS 27253
Min. Negotiated Rate	$554.65
Max. Negotiated Rate	$1,816.50
Rate for Payer: Aetna Commercial	$1,258.60
Rate for Payer: Aetna Medicare	$1,211.00
Rate for Payer: BCBS Complete	$582.38
Rate for Payer: BCN Commercial	$1,425.72
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Mclaren Medicaid	$554.65
Rate for Payer: Meridian Medicaid	$582.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,816.50
Rate for Payer: Priority Health Choice Medicaid	$554.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,524.05
Rate for Payer: Priority Health Narrow/Tiered Network	$1,524.05
Rate for Payer: UHC Medicaid	$554.65
Rate for Payer: UHCCP Medicaid	$554.65

PR OPTX HUMERAL SHFT FX PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$3,185.00

Service Code	HCPCS 24515
Min. Negotiated Rate	$524.41
Max. Negotiated Rate	$2,388.75
Rate for Payer: Aetna Commercial	$1,174.12
Rate for Payer: Aetna Medicare	$1,592.50
Rate for Payer: BCBS Complete	$550.63
Rate for Payer: BCN Commercial	$1,341.56
Rate for Payer: Cash Price	$2,548.00
Rate for Payer: Cash Price	$2,548.00
Rate for Payer: Mclaren Medicaid	$524.41
Rate for Payer: Meridian Medicaid	$550.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,388.75
Rate for Payer: Priority Health Choice Medicaid	$524.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,434.08
Rate for Payer: Priority Health Narrow/Tiered Network	$1,434.08
Rate for Payer: UHC Medicaid	$524.41
Rate for Payer: UHCCP Medicaid	$524.41

PR OPTX HUMERAL SPRCNYLR/TRANSCNDYLR FRACTURE W/XTN

Professional

Both

$4,101.00

Service Code	HCPCS 24546
Min. Negotiated Rate	$608.12
Max. Negotiated Rate	$3,075.75
Rate for Payer: Aetna Commercial	$1,384.52
Rate for Payer: Aetna Medicare	$2,050.50
Rate for Payer: BCBS Complete	$638.53
Rate for Payer: BCN Commercial	$1,577.61
Rate for Payer: Cash Price	$3,280.80
Rate for Payer: Cash Price	$3,280.80
Rate for Payer: Mclaren Medicaid	$608.12
Rate for Payer: Meridian Medicaid	$638.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,075.75
Rate for Payer: Priority Health Choice Medicaid	$608.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,686.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,686.42
Rate for Payer: UHC Medicaid	$608.12
Rate for Payer: UHCCP Medicaid	$608.12

PR OPTX HUMERAL SPRCNYLR/TRANSCNDYLR FX W/O XTN

Professional

Both

$3,136.00

Service Code	HCPCS 24545
Min. Negotiated Rate	$548.69
Max. Negotiated Rate	$2,352.00
Rate for Payer: Aetna Commercial	$1,239.12
Rate for Payer: Aetna Medicare	$1,568.00
Rate for Payer: BCBS Complete	$576.12
Rate for Payer: BCN Commercial	$1,414.26
Rate for Payer: Cash Price	$2,508.80
Rate for Payer: Cash Price	$2,508.80
Rate for Payer: Mclaren Medicaid	$548.69
Rate for Payer: Meridian Medicaid	$576.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,352.00
Rate for Payer: Priority Health Choice Medicaid	$548.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,511.81
Rate for Payer: Priority Health Narrow/Tiered Network	$1,511.81
Rate for Payer: UHC Medicaid	$548.69
Rate for Payer: UHCCP Medicaid	$548.69

PR OPTX ILIAC TUBRST AVLS/WING FX FIXJ IF PRFRMD

Professional

Both

$2,713.00

Service Code	HCPCS 27215
Min. Negotiated Rate	$345.06
Max. Negotiated Rate	$2,034.75
Rate for Payer: Aetna Commercial	$803.86
Rate for Payer: Aetna Medicare	$1,356.50
Rate for Payer: BCBS Complete	$362.31
Rate for Payer: BCN Commercial	$906.32
Rate for Payer: Cash Price	$2,170.40
Rate for Payer: Cash Price	$2,170.40
Rate for Payer: Mclaren Medicaid	$345.06
Rate for Payer: Meridian Medicaid	$362.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,034.75
Rate for Payer: Priority Health Choice Medicaid	$345.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$968.84
Rate for Payer: Priority Health Narrow/Tiered Network	$968.84
Rate for Payer: UHC Medicaid	$345.06
Rate for Payer: UHCCP Medicaid	$345.06

PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN

Professional

Both

$2,116.00

Service Code	HCPCS 21347
Min. Negotiated Rate	$598.96
Max. Negotiated Rate	$1,669.39
Rate for Payer: Aetna Commercial	$1,362.92
Rate for Payer: Aetna Medicare	$1,058.00
Rate for Payer: BCBS Complete	$628.91
Rate for Payer: BCN Commercial	$1,561.67
Rate for Payer: Cash Price	$1,692.80
Rate for Payer: Cash Price	$1,692.80
Rate for Payer: Mclaren Medicaid	$598.96
Rate for Payer: Meridian Medicaid	$628.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,587.00
Rate for Payer: Priority Health Choice Medicaid	$598.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,669.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,669.39
Rate for Payer: UHC Medicaid	$598.96
Rate for Payer: UHCCP Medicaid	$598.96

PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC

Professional

Both

$1,661.00

Service Code	HCPCS 21390
Min. Negotiated Rate	$451.77
Max. Negotiated Rate	$1,284.51
Rate for Payer: Aetna Commercial	$1,059.79
Rate for Payer: Aetna Medicare	$830.50
Rate for Payer: BCBS Complete	$474.36
Rate for Payer: BCN Commercial	$1,201.62
Rate for Payer: Cash Price	$1,328.80
Rate for Payer: Cash Price	$1,328.80
Rate for Payer: Mclaren Medicaid	$451.77
Rate for Payer: Meridian Medicaid	$474.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,245.75
Rate for Payer: Priority Health Choice Medicaid	$451.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,284.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,284.51
Rate for Payer: UHC Medicaid	$451.77
Rate for Payer: UHCCP Medicaid	$451.77

PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY

Professional

Both

$1,643.00

Service Code	HCPCS 27566
Min. Negotiated Rate	$527.18
Max. Negotiated Rate	$1,452.19
Rate for Payer: Aetna Commercial	$1,193.01
Rate for Payer: Aetna Medicare	$821.50
Rate for Payer: BCBS Complete	$553.54
Rate for Payer: BCN Commercial	$1,358.49
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Cash Price	$1,314.40
Rate for Payer: Mclaren Medicaid	$527.18
Rate for Payer: Meridian Medicaid	$553.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,232.25
Rate for Payer: Priority Health Choice Medicaid	$527.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,452.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,452.19
Rate for Payer: UHC Medicaid	$527.18
Rate for Payer: UHCCP Medicaid	$527.18

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Professional

Both

$2,584.00

Service Code	HCPCS 27524
Min. Negotiated Rate	$449.64
Max. Negotiated Rate	$1,938.00
Rate for Payer: Aetna Commercial	$1,005.26
Rate for Payer: Aetna Medicare	$1,292.00
Rate for Payer: BCBS Complete	$472.12
Rate for Payer: BCN Commercial	$1,263.19
Rate for Payer: Cash Price	$2,067.20
Rate for Payer: Cash Price	$2,067.20
Rate for Payer: Mclaren Medicaid	$449.64
Rate for Payer: Meridian Medicaid	$472.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,938.00
Rate for Payer: Priority Health Choice Medicaid	$449.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,229.14
Rate for Payer: Priority Health Narrow/Tiered Network	$1,229.14
Rate for Payer: UHC Medicaid	$449.64
Rate for Payer: UHCCP Medicaid	$449.64

PR OPTX PERIARTICULAR FRACTURE&/DISLOCATION ELBOW

Professional

Both

$2,005.00

Service Code	HCPCS 24586
Min. Negotiated Rate	$630.91
Max. Negotiated Rate	$1,756.15
Rate for Payer: Aetna Commercial	$1,452.52
Rate for Payer: Aetna Medicare	$1,002.50
Rate for Payer: BCBS Complete	$662.46
Rate for Payer: BCN Commercial	$1,642.84
Rate for Payer: Cash Price	$1,604.00
Rate for Payer: Cash Price	$1,604.00
Rate for Payer: Mclaren Medicaid	$630.91
Rate for Payer: Meridian Medicaid	$662.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,503.75
Rate for Payer: Priority Health Choice Medicaid	$630.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,756.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,756.15
Rate for Payer: UHC Medicaid	$630.91
Rate for Payer: UHCCP Medicaid	$630.91

PR OPTX PERIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHRP

Professional

Both

$1,996.00

Service Code	HCPCS 24587
Min. Negotiated Rate	$637.30
Max. Negotiated Rate	$1,763.60
Rate for Payer: Aetna Commercial	$1,453.71
Rate for Payer: Aetna Medicare	$998.00
Rate for Payer: BCBS Complete	$669.16
Rate for Payer: BCN Commercial	$1,649.81
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Mclaren Medicaid	$637.30
Rate for Payer: Meridian Medicaid	$669.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,497.00
Rate for Payer: Priority Health Choice Medicaid	$637.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,763.60
Rate for Payer: Priority Health Narrow/Tiered Network	$1,763.60
Rate for Payer: UHC Medicaid	$637.30
Rate for Payer: UHCCP Medicaid	$637.30

PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD

Professional

Both

$4,037.00

Service Code	HCPCS 27218
Min. Negotiated Rate	$651.78
Max. Negotiated Rate	$3,027.75
Rate for Payer: Aetna Commercial	$1,541.82
Rate for Payer: Aetna Medicare	$2,018.50
Rate for Payer: BCBS Complete	$684.37
Rate for Payer: BCN Commercial	$1,727.50
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Cash Price	$3,229.60
Rate for Payer: Mclaren Medicaid	$651.78
Rate for Payer: Meridian Medicaid	$684.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,027.75
Rate for Payer: Priority Health Choice Medicaid	$651.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,846.64
Rate for Payer: Priority Health Narrow/Tiered Network	$1,846.64
Rate for Payer: UHC Medicaid	$651.78
Rate for Payer: UHCCP Medicaid	$651.78

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Professional

Both

$3,288.00

Service Code	HCPCS 23615
Min. Negotiated Rate	$525.26
Max. Negotiated Rate	$2,466.00
Rate for Payer: Aetna Commercial	$1,179.32
Rate for Payer: Aetna Medicare	$1,644.00
Rate for Payer: BCBS Complete	$551.52
Rate for Payer: BCN Commercial	$1,345.55
Rate for Payer: Cash Price	$2,630.40
Rate for Payer: Cash Price	$2,630.40
Rate for Payer: Mclaren Medicaid	$525.26
Rate for Payer: Meridian Medicaid	$551.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,466.00
Rate for Payer: Priority Health Choice Medicaid	$525.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,438.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,438.35
Rate for Payer: UHC Medicaid	$525.26
Rate for Payer: UHCCP Medicaid	$525.26

PR OPTX PROX HUMRL FX W/INT FIXJ RPR TUBRST RPLCMT

Professional

Both

$2,448.00

Service Code	HCPCS 23616
Min. Negotiated Rate	$715.25
Max. Negotiated Rate	$1,995.70
Rate for Payer: Aetna Commercial	$1,651.81
Rate for Payer: Aetna Medicare	$1,224.00
Rate for Payer: BCBS Complete	$751.01
Rate for Payer: BCN Commercial	$1,866.93
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Cash Price	$1,958.40
Rate for Payer: Mclaren Medicaid	$715.25
Rate for Payer: Meridian Medicaid	$751.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.00
Rate for Payer: Priority Health Choice Medicaid	$715.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,995.70
Rate for Payer: Priority Health Narrow/Tiered Network	$1,995.70
Rate for Payer: UHC Medicaid	$715.25
Rate for Payer: UHCCP Medicaid	$715.25

PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ

Professional

Both

$3,191.00

Service Code	HCPCS 27226
Min. Negotiated Rate	$616.85
Max. Negotiated Rate	$2,393.25
Rate for Payer: Aetna Commercial	$1,412.38
Rate for Payer: Aetna Medicare	$1,595.50
Rate for Payer: BCBS Complete	$647.69
Rate for Payer: BCN Commercial	$1,594.54
Rate for Payer: Cash Price	$2,552.80
Rate for Payer: Cash Price	$2,552.80
Rate for Payer: Mclaren Medicaid	$616.85
Rate for Payer: Meridian Medicaid	$647.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,393.25
Rate for Payer: Priority Health Choice Medicaid	$616.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,704.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,704.51
Rate for Payer: UHC Medicaid	$616.85
Rate for Payer: UHCCP Medicaid	$616.85

PR OPTX RADIAL HEAD/NECK FRACTURE PROSTHETIC RPLCMT

Professional

Both

$2,992.00

Service Code	HCPCS 24666
Min. Negotiated Rate	$436.86
Max. Negotiated Rate	$2,244.00
Rate for Payer: Aetna Commercial	$977.72
Rate for Payer: Aetna Medicare	$1,496.00
Rate for Payer: BCBS Complete	$458.70
Rate for Payer: BCN Commercial	$1,120.46
Rate for Payer: Cash Price	$2,393.60
Rate for Payer: Cash Price	$2,393.60
Rate for Payer: Mclaren Medicaid	$436.86
Rate for Payer: Meridian Medicaid	$458.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,244.00
Rate for Payer: Priority Health Choice Medicaid	$436.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,197.74
Rate for Payer: Priority Health Narrow/Tiered Network	$1,197.74
Rate for Payer: UHC Medicaid	$436.86
Rate for Payer: UHCCP Medicaid	$436.86

PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS&ULNA

Professional

Both

$2,616.00

Service Code	HCPCS 25575
Min. Negotiated Rate	$539.32
Max. Negotiated Rate	$1,962.00
Rate for Payer: Aetna Commercial	$1,204.50
Rate for Payer: Aetna Medicare	$1,308.00
Rate for Payer: BCBS Complete	$566.29
Rate for Payer: BCN Commercial	$1,381.40
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Cash Price	$2,092.80
Rate for Payer: Mclaren Medicaid	$539.32
Rate for Payer: Meridian Medicaid	$566.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,962.00
Rate for Payer: Priority Health Choice Medicaid	$539.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,476.67
Rate for Payer: Priority Health Narrow/Tiered Network	$1,476.67
Rate for Payer: UHC Medicaid	$539.32
Rate for Payer: UHCCP Medicaid	$539.32

PR OPTX RADIAL&ULNAR SHFT FX W/INT FIXJ RADIUS/ULNA

Professional

Both

$1,926.00

Service Code	HCPCS 25574
Min. Negotiated Rate	$408.75
Max. Negotiated Rate	$1,444.50
Rate for Payer: Aetna Commercial	$898.86
Rate for Payer: Aetna Medicare	$963.00
Rate for Payer: BCBS Complete	$429.19
Rate for Payer: BCN Commercial	$1,038.29
Rate for Payer: Cash Price	$1,540.80
Rate for Payer: Cash Price	$1,540.80
Rate for Payer: Mclaren Medicaid	$408.75
Rate for Payer: Meridian Medicaid	$429.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,444.50
Rate for Payer: Priority Health Choice Medicaid	$408.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,109.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,109.90
Rate for Payer: UHC Medicaid	$408.75
Rate for Payer: UHCCP Medicaid	$408.75

PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT

Professional

Both

$5,882.00

Service Code	HCPCS 22318
Min. Negotiated Rate	$1,036.03
Max. Negotiated Rate	$4,411.50
Rate for Payer: Aetna Commercial	$2,196.46
Rate for Payer: Aetna Medicare	$2,941.00
Rate for Payer: BCBS Complete	$1,087.83
Rate for Payer: BCN Commercial	$2,765.43
Rate for Payer: Cash Price	$4,705.60
Rate for Payer: Cash Price	$4,705.60
Rate for Payer: Mclaren Medicaid	$1,036.03
Rate for Payer: Meridian Medicaid	$1,087.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,411.50
Rate for Payer: Priority Health Choice Medicaid	$1,036.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,690.92
Rate for Payer: Priority Health Narrow/Tiered Network	$2,690.92
Rate for Payer: UHC Medicaid	$1,036.03
Rate for Payer: UHCCP Medicaid	$1,036.03

PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ

Professional

Both

$11,064.00

Service Code	HCPCS 22319
Min. Negotiated Rate	$1,154.03
Max. Negotiated Rate	$8,298.00
Rate for Payer: Aetna Commercial	$2,450.58
Rate for Payer: Aetna Medicare	$5,532.00
Rate for Payer: BCBS Complete	$1,211.73
Rate for Payer: BCN Commercial	$2,796.66
Rate for Payer: Cash Price	$8,851.20
Rate for Payer: Cash Price	$8,851.20
Rate for Payer: Mclaren Medicaid	$1,154.03
Rate for Payer: Meridian Medicaid	$1,211.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,298.00
Rate for Payer: Priority Health Choice Medicaid	$1,154.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,989.55
Rate for Payer: Priority Health Narrow/Tiered Network	$2,989.55
Rate for Payer: UHC Medicaid	$1,154.03
Rate for Payer: UHCCP Medicaid	$1,154.03

Know your out-of-pocket cost for care.

All Charges