Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>

Professional

Both

$6,857.00

Service Code	HCPCS 27364
Min. Negotiated Rate	$912.28
Max. Negotiated Rate	$5,142.75
Rate for Payer: Aetna Commercial	$2,093.77
Rate for Payer: Aetna Medicare	$3,428.50
Rate for Payer: BCBS Complete	$957.89
Rate for Payer: BCN Commercial	$2,358.94
Rate for Payer: Cash Price	$5,485.60
Rate for Payer: Cash Price	$5,485.60
Rate for Payer: Mclaren Medicaid	$912.28
Rate for Payer: Meridian Medicaid	$957.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,142.75
Rate for Payer: Priority Health Choice Medicaid	$912.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,521.63
Rate for Payer: Priority Health Narrow/Tiered Network	$2,521.63
Rate for Payer: UHC Medicaid	$912.28
Rate for Payer: UHCCP Medicaid	$912.28

PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM

Professional

Both

$2,962.00

Service Code	HCPCS 25077
Min. Negotiated Rate	$529.73
Max. Negotiated Rate	$2,221.50
Rate for Payer: Aetna Commercial	$1,186.63
Rate for Payer: Aetna Medicare	$1,481.00
Rate for Payer: BCBS Complete	$556.22
Rate for Payer: BCN Commercial	$1,301.73
Rate for Payer: Cash Price	$2,369.60
Rate for Payer: Cash Price	$2,369.60
Rate for Payer: Mclaren Medicaid	$529.73
Rate for Payer: Meridian Medicaid	$556.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,221.50
Rate for Payer: Priority Health Choice Medicaid	$529.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,391.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,391.51
Rate for Payer: UHC Medicaid	$529.73
Rate for Payer: UHCCP Medicaid	$529.73

PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM

Professional

Both

$1,727.00

Service Code	HCPCS 21557
Min. Negotiated Rate	$562.75
Max. Negotiated Rate	$1,536.30
Rate for Payer: Aetna Commercial	$1,274.88
Rate for Payer: Aetna Medicare	$863.50
Rate for Payer: BCBS Complete	$590.89
Rate for Payer: BCN Commercial	$1,437.17
Rate for Payer: Cash Price	$1,381.60
Rate for Payer: Cash Price	$1,381.60
Rate for Payer: Mclaren Medicaid	$562.75
Rate for Payer: Meridian Medicaid	$590.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,295.25
Rate for Payer: Priority Health Choice Medicaid	$562.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,536.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,536.30
Rate for Payer: UHC Medicaid	$562.75
Rate for Payer: UHCCP Medicaid	$562.75

PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>

Professional

Both

$3,521.00

Service Code	HCPCS 21558
Min. Negotiated Rate	$778.94
Max. Negotiated Rate	$2,640.75
Rate for Payer: Aetna Commercial	$1,800.42
Rate for Payer: Aetna Medicare	$1,760.50
Rate for Payer: BCBS Complete	$817.89
Rate for Payer: BCN Commercial	$2,014.34
Rate for Payer: Cash Price	$2,816.80
Rate for Payer: Cash Price	$2,816.80
Rate for Payer: Mclaren Medicaid	$778.94
Rate for Payer: Meridian Medicaid	$817.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,640.75
Rate for Payer: Priority Health Choice Medicaid	$778.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,153.27
Rate for Payer: Priority Health Narrow/Tiered Network	$2,153.27
Rate for Payer: UHC Medicaid	$778.94
Rate for Payer: UHCCP Medicaid	$778.94

PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM

Professional

Both

$2,432.00

Service Code	HCPCS 26117
Min. Negotiated Rate	$442.83
Max. Negotiated Rate	$1,824.00
Rate for Payer: Aetna Commercial	$984.86
Rate for Payer: Aetna Medicare	$1,216.00
Rate for Payer: BCBS Complete	$464.97
Rate for Payer: BCN Commercial	$1,141.37
Rate for Payer: Cash Price	$1,945.60
Rate for Payer: Cash Price	$1,945.60
Rate for Payer: Mclaren Medicaid	$442.83
Rate for Payer: Meridian Medicaid	$464.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,824.00
Rate for Payer: Priority Health Choice Medicaid	$442.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,220.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,220.09
Rate for Payer: UHC Medicaid	$442.83
Rate for Payer: UHCCP Medicaid	$442.83

PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM

Professional

Both

$3,257.00

Service Code	HCPCS 27049
Min. Negotiated Rate	$823.88
Max. Negotiated Rate	$2,442.75
Rate for Payer: Aetna Commercial	$1,808.92
Rate for Payer: Aetna Medicare	$1,628.50
Rate for Payer: BCBS Complete	$865.07
Rate for Payer: BCN Commercial	$2,152.28
Rate for Payer: Cash Price	$2,605.60
Rate for Payer: Cash Price	$2,605.60
Rate for Payer: Mclaren Medicaid	$823.88
Rate for Payer: Meridian Medicaid	$865.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,442.75
Rate for Payer: Priority Health Choice Medicaid	$823.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,300.73
Rate for Payer: Priority Health Narrow/Tiered Network	$2,300.73
Rate for Payer: UHC Medicaid	$823.88
Rate for Payer: UHCCP Medicaid	$823.88

PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM

Professional

Both

$3,479.00

Service Code	HCPCS 27329
Min. Negotiated Rate	$616.00
Max. Negotiated Rate	$2,609.25
Rate for Payer: Aetna Commercial	$1,391.29
Rate for Payer: Aetna Medicare	$1,739.50
Rate for Payer: BCBS Complete	$646.80
Rate for Payer: BCN Commercial	$1,573.62
Rate for Payer: Cash Price	$2,783.20
Rate for Payer: Cash Price	$2,783.20
Rate for Payer: Mclaren Medicaid	$616.00
Rate for Payer: Meridian Medicaid	$646.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,609.25
Rate for Payer: Priority Health Choice Medicaid	$616.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,682.16
Rate for Payer: Priority Health Narrow/Tiered Network	$1,682.16
Rate for Payer: UHC Medicaid	$616.00
Rate for Payer: UHCCP Medicaid	$616.00

PR RAPID DESENSITIZATION PROCEDURE EACH HOUR

Professional

Both

$261.00

Service Code	HCPCS 95180
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$195.75
Rate for Payer: Aetna Commercial	$105.91
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS Complete	$58.15
Rate for Payer: BCN Commercial	$151.88
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Mclaren Medicaid	$55.38
Rate for Payer: Meridian Medicaid	$58.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.75
Rate for Payer: Priority Health Choice Medicaid	$55.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.96
Rate for Payer: Priority Health Narrow/Tiered Network	$142.96
Rate for Payer: UHC Medicaid	$55.38
Rate for Payer: UHCCP Medicaid	$55.38

PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY

Professional

Both

$877.00

Service Code	HCPCS 28313
Min. Negotiated Rate	$350.80
Max. Negotiated Rate	$657.75
Rate for Payer: Aetna Commercial	$475.12
Rate for Payer: Aetna Medicare	$438.50
Rate for Payer: BCBS Complete	$350.80
Rate for Payer: BCN Commercial	$555.25
Rate for Payer: Cash Price	$701.60
Rate for Payer: Cash Price	$701.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$657.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$593.54
Rate for Payer: Priority Health Narrow/Tiered Network	$593.54

PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD

Professional

Both

$7,412.00

Service Code	HCPCS 21175
Min. Negotiated Rate	$1,231.99
Max. Negotiated Rate	$5,559.00
Rate for Payer: Aetna Commercial	$2,954.27
Rate for Payer: Aetna Medicare	$3,706.00
Rate for Payer: BCBS Complete	$1,293.59
Rate for Payer: BCN Commercial	$3,634.18
Rate for Payer: Cash Price	$5,929.60
Rate for Payer: Cash Price	$5,929.60
Rate for Payer: Mclaren Medicaid	$1,231.99
Rate for Payer: Meridian Medicaid	$1,293.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,559.00
Rate for Payer: Priority Health Choice Medicaid	$1,231.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,536.26
Rate for Payer: Priority Health Narrow/Tiered Network	$3,536.26
Rate for Payer: UHC Medicaid	$1,231.99
Rate for Payer: UHCCP Medicaid	$1,231.99

PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT

Professional

Both

$1,252.00

Service Code	HCPCS 26545
Min. Negotiated Rate	$451.13
Max. Negotiated Rate	$1,183.36
Rate for Payer: Aetna Commercial	$969.02
Rate for Payer: Aetna Medicare	$626.00
Rate for Payer: BCBS Complete	$473.69
Rate for Payer: BCN Commercial	$1,107.01
Rate for Payer: Cash Price	$1,001.60
Rate for Payer: Cash Price	$1,001.60
Rate for Payer: Mclaren Medicaid	$451.13
Rate for Payer: Meridian Medicaid	$473.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$939.00
Rate for Payer: Priority Health Choice Medicaid	$451.13
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	$451.13
Rate for Payer: UHCCP Medicaid	$451.13

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS

Professional

Both

$3,673.00

Service Code	HCPCS 26542
Min. Negotiated Rate	$444.32
Max. Negotiated Rate	$2,754.75
Rate for Payer: Aetna Commercial	$954.95
Rate for Payer: Aetna Medicare	$1,836.50
Rate for Payer: BCBS Complete	$466.54
Rate for Payer: BCN Commercial	$1,091.58
Rate for Payer: Cash Price	$2,938.40
Rate for Payer: Cash Price	$2,938.40
Rate for Payer: Mclaren Medicaid	$444.32
Rate for Payer: Meridian Medicaid	$466.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,754.75
Rate for Payer: Priority Health Choice Medicaid	$444.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,166.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,166.87
Rate for Payer: UHC Medicaid	$444.32
Rate for Payer: UHCCP Medicaid	$444.32

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF

Professional

Both

$2,451.00

Service Code	HCPCS 26541
Min. Negotiated Rate	$509.92
Max. Negotiated Rate	$1,838.25
Rate for Payer: Aetna Commercial	$1,106.28
Rate for Payer: Aetna Medicare	$1,225.50
Rate for Payer: BCBS Complete	$535.42
Rate for Payer: BCN Commercial	$1,264.37
Rate for Payer: Cash Price	$1,960.80
Rate for Payer: Cash Price	$1,960.80
Rate for Payer: Mclaren Medicaid	$509.92
Rate for Payer: Meridian Medicaid	$535.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,838.25
Rate for Payer: Priority Health Choice Medicaid	$509.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,351.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,351.58
Rate for Payer: UHC Medicaid	$509.92
Rate for Payer: UHCCP Medicaid	$509.92

PR RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC

Professional

Both

$1,800.00

Service Code	HCPCS 21181
Min. Negotiated Rate	$428.98
Max. Negotiated Rate	$1,350.00
Rate for Payer: Aetna Commercial	$983.15
Rate for Payer: Aetna Medicare	$900.00
Rate for Payer: BCBS Complete	$450.43
Rate for Payer: BCN Commercial	$1,121.95
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Mclaren Medicaid	$428.98
Rate for Payer: Meridian Medicaid	$450.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,350.00
Rate for Payer: Priority Health Choice Medicaid	$428.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,199.34
Rate for Payer: Priority Health Narrow/Tiered Network	$1,199.34
Rate for Payer: UHC Medicaid	$428.98
Rate for Payer: UHCCP Medicaid	$428.98

PR RCNSTJ DISLC PATELLA W/PATELLECTOMY

Professional

Both

$1,565.00

Service Code	HCPCS 27424
Min. Negotiated Rate	$449.00
Max. Negotiated Rate	$1,224.35
Rate for Payer: Aetna Commercial	$999.14
Rate for Payer: Aetna Medicare	$782.50
Rate for Payer: BCBS Complete	$471.45
Rate for Payer: BCN Commercial	$1,145.36
Rate for Payer: Cash Price	$1,252.00
Rate for Payer: Cash Price	$1,252.00
Rate for Payer: Mclaren Medicaid	$449.00
Rate for Payer: Meridian Medicaid	$471.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,173.75
Rate for Payer: Priority Health Choice Medicaid	$449.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,224.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,224.35
Rate for Payer: UHC Medicaid	$449.00
Rate for Payer: UHCCP Medicaid	$449.00

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Professional

Both

$2,382.00

Service Code	HCPCS 27422
Hospital Charge Code	27422
Min. Negotiated Rate	$445.60
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna Commercial	$992.84
Rate for Payer: Aetna Medicare	$1,191.00
Rate for Payer: BCBS Complete	$467.88
Rate for Payer: BCN Commercial	$1,135.89
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Mclaren Medicaid	$445.60
Rate for Payer: Meridian Medicaid	$467.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,786.50
Rate for Payer: Priority Health Choice Medicaid	$445.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,214.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,214.23
Rate for Payer: UHC Medicaid	$445.60
Rate for Payer: UHCCP Medicaid	$445.60

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Facility

$2,382.00

Service Code	CPT 27422
Hospital Charge Code	27422
Hospital Revenue Code	960
Min. Negotiated Rate	$1,657.87
Max. Negotiated Rate	$2,143.80
Rate for Payer: Aetna Commercial	$2,024.70
Rate for Payer: BCBS Trust/PPO	$1,967.29
Rate for Payer: BCN Commercial	$1,967.29
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cofinity Commercial	$2,048.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,905.60
Rate for Payer: Healthscope Commercial	$2,143.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,786.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,024.70
Rate for Payer: Nomi Health Commercial	$1,953.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,786.50
Rate for Payer: PHP Commercial	$2,024.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,072.34
Rate for Payer: Priority Health Narrow/Tiered Network	$1,657.87
Rate for Payer: UHC Core	$1,988.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,786.50

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Facility

$2,382.00

Service Code	CPT 27422
Hospital Charge Code	27422
Hospital Revenue Code	960
Min. Negotiated Rate	$419.95
Max. Negotiated Rate	$2,143.80
Rate for Payer: Aetna Commercial	$2,024.70
Rate for Payer: Aetna Medicare	$619.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$744.38
Rate for Payer: Amish Plain Church Group Commercial	$744.38
Rate for Payer: BCBS Complete	$440.91
Rate for Payer: BCBS MAPPO	$595.50
Rate for Payer: BCBS Trust/PPO	$1,958.24
Rate for Payer: BCN Commercial	$1,958.24
Rate for Payer: BCN Medicare Advantage	$595.50
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cofinity Commercial	$2,048.52
Rate for Payer: Encore Health Key Benefits Commercial	$1,905.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$595.50
Rate for Payer: Healthscope Commercial	$2,143.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,786.50
Rate for Payer: Mclaren Medicaid	$419.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$625.27
Rate for Payer: Meridian Medicaid	$440.91
Rate for Payer: MI Amish Medical Board Commercial	$684.83
Rate for Payer: Molina Medicare/Medicaid	$655.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,024.70
Rate for Payer: Nomi Health Commercial	$1,953.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,786.50
Rate for Payer: PACE Senior Care Partners	$565.73
Rate for Payer: PACE SWMI	$595.50
Rate for Payer: PHP Commercial	$2,024.70
Rate for Payer: PHP Medicare Advantage	$595.50
Rate for Payer: Priority Health Choice Medicaid	$419.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,072.34
Rate for Payer: Priority Health Medicare	$601.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,657.87
Rate for Payer: Railroad Medicare Medicare	$595.50
Rate for Payer: UHC Core	$1,988.97
Rate for Payer: UHC Exchange	$595.50
Rate for Payer: UHC Medicaid	$419.95
Rate for Payer: UHC Medicare Advantage	$595.50
Rate for Payer: UHCCP Medicaid	$419.95
Rate for Payer: VA VA	$595.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,786.50

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Professional

Both

$2,382.00

Service Code	HCPCS 27422
Min. Negotiated Rate	$445.60
Max. Negotiated Rate	$1,786.50
Rate for Payer: Aetna Commercial	$992.84
Rate for Payer: Aetna Medicare	$1,191.00
Rate for Payer: BCBS Complete	$467.88
Rate for Payer: BCN Commercial	$1,135.89
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Cash Price	$1,905.60
Rate for Payer: Mclaren Medicaid	$445.60
Rate for Payer: Meridian Medicaid	$467.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,786.50
Rate for Payer: Priority Health Choice Medicaid	$445.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,214.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,214.23
Rate for Payer: UHC Medicaid	$445.60
Rate for Payer: UHCCP Medicaid	$445.60

PR RCNSTJ DISLOCATING PATELLA

Professional

Both

$2,405.00

Service Code	HCPCS 27420
Min. Negotiated Rate	$449.64
Max. Negotiated Rate	$1,803.75
Rate for Payer: Aetna Commercial	$992.16
Rate for Payer: Aetna Medicare	$1,202.50
Rate for Payer: BCBS Complete	$472.12
Rate for Payer: BCN Commercial	$1,140.37
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Cash Price	$1,924.00
Rate for Payer: Mclaren Medicaid	$449.64
Rate for Payer: Meridian Medicaid	$472.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,803.75
Rate for Payer: Priority Health Choice Medicaid	$449.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,219.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,219.02
Rate for Payer: UHC Medicaid	$449.64
Rate for Payer: UHCCP Medicaid	$449.64

PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT

Professional

Both

$3,111.00

Service Code	HCPCS 24344
Min. Negotiated Rate	$657.11
Max. Negotiated Rate	$2,333.25
Rate for Payer: Aetna Commercial	$1,457.34
Rate for Payer: Aetna Medicare	$1,555.50
Rate for Payer: BCBS Complete	$689.97
Rate for Payer: BCN Commercial	$1,682.18
Rate for Payer: Cash Price	$2,488.80
Rate for Payer: Cash Price	$2,488.80
Rate for Payer: Mclaren Medicaid	$657.11
Rate for Payer: Meridian Medicaid	$689.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,333.25
Rate for Payer: Priority Health Choice Medicaid	$657.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,798.20
Rate for Payer: Priority Health Narrow/Tiered Network	$1,798.20
Rate for Payer: UHC Medicaid	$657.11
Rate for Payer: UHCCP Medicaid	$657.11

PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF

Professional

Both

$3,435.00

Service Code	HCPCS 24346
Min. Negotiated Rate	$657.11
Max. Negotiated Rate	$2,576.25
Rate for Payer: Aetna Commercial	$1,470.76
Rate for Payer: Aetna Medicare	$1,717.50
Rate for Payer: BCBS Complete	$689.97
Rate for Payer: BCN Commercial	$1,682.18
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Mclaren Medicaid	$657.11
Rate for Payer: Meridian Medicaid	$689.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,576.25
Rate for Payer: Priority Health Choice Medicaid	$657.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,798.20
Rate for Payer: Priority Health Narrow/Tiered Network	$1,798.20
Rate for Payer: UHC Medicaid	$657.11
Rate for Payer: UHCCP Medicaid	$657.11

PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT

Professional

Both

$6,655.00

Service Code	HCPCS 21194
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$4,991.25
Rate for Payer: Aetna Commercial	$1,893.04
Rate for Payer: Aetna Medicare	$3,327.50
Rate for Payer: BCBS Complete	$856.80
Rate for Payer: BCN Commercial	$2,130.36
Rate for Payer: Cash Price	$5,324.00
Rate for Payer: Cash Price	$5,324.00
Rate for Payer: Mclaren Medicaid	$816.00
Rate for Payer: Meridian Medicaid	$856.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,991.25
Rate for Payer: Priority Health Choice Medicaid	$816.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,277.29
Rate for Payer: Priority Health Narrow/Tiered Network	$2,277.29
Rate for Payer: UHC Medicaid	$816.00
Rate for Payer: UHCCP Medicaid	$816.00

PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE

Professional

Both

$3,614.00

Service Code	HCPCS 21244
Min. Negotiated Rate	$572.33
Max. Negotiated Rate	$2,710.50
Rate for Payer: Aetna Commercial	$1,342.79
Rate for Payer: Aetna Medicare	$1,807.00
Rate for Payer: BCBS Complete	$600.95
Rate for Payer: BCN Commercial	$1,506.40
Rate for Payer: Cash Price	$2,891.20
Rate for Payer: Cash Price	$2,891.20
Rate for Payer: Mclaren Medicaid	$572.33
Rate for Payer: Meridian Medicaid	$600.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,710.50
Rate for Payer: Priority Health Choice Medicaid	$572.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,610.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,610.29
Rate for Payer: UHC Medicaid	$572.33
Rate for Payer: UHCCP Medicaid	$572.33

PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE

Professional

Both

$1,791.00

Service Code	HCPCS 26587
Min. Negotiated Rate	$619.40
Max. Negotiated Rate	$1,699.72
Rate for Payer: Aetna Commercial	$1,391.35
Rate for Payer: Aetna Medicare	$895.50
Rate for Payer: BCBS Complete	$650.37
Rate for Payer: BCN Commercial	$1,590.05
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Cash Price	$1,432.80
Rate for Payer: Mclaren Medicaid	$619.40
Rate for Payer: Meridian Medicaid	$650.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,343.25
Rate for Payer: Priority Health Choice Medicaid	$619.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,699.72
Rate for Payer: Priority Health Narrow/Tiered Network	$1,699.72
Rate for Payer: UHC Medicaid	$619.40
Rate for Payer: UHCCP Medicaid	$619.40

Know your out-of-pocket cost for care.

All Charges