Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RPR INCPLT/PRTL AV CANAL W/WO AV VALVE RPR

Professional

Both

$7,774.00

Service Code	HCPCS 33660
Min. Negotiated Rate	$1,046.04
Max. Negotiated Rate	$5,830.50
Rate for Payer: Aetna Commercial	$2,358.28
Rate for Payer: Aetna Medicare	$3,887.00
Rate for Payer: BCBS Complete	$1,098.34
Rate for Payer: BCN Commercial	$2,582.53
Rate for Payer: Cash Price	$6,219.20
Rate for Payer: Cash Price	$6,219.20
Rate for Payer: Mclaren Medicaid	$1,046.04
Rate for Payer: Meridian Medicaid	$1,098.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,830.50
Rate for Payer: Priority Health Choice Medicaid	$1,046.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,777.18
Rate for Payer: Priority Health Narrow/Tiered Network	$2,777.18
Rate for Payer: UHC Medicaid	$1,046.04
Rate for Payer: UHCCP Medicaid	$1,046.04

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,685.00

Service Code	HCPCS 49525
Min. Negotiated Rate	$353.58
Max. Negotiated Rate	$1,263.75
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: Aetna Medicare	$842.50
Rate for Payer: BCBS Complete	$371.26
Rate for Payer: BCN Commercial	$870.97
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Mclaren Medicaid	$353.58
Rate for Payer: Meridian Medicaid	$371.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,263.75
Rate for Payer: Priority Health Choice Medicaid	$353.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,061.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,061.22
Rate for Payer: UHC Medicaid	$353.58
Rate for Payer: UHCCP Medicaid	$353.58

PR RPR INGUN HERNIA SLIDING ANY AGE

Professional

Both

$1,685.00

Service Code	HCPCS 49525
Hospital Charge Code	49525
Min. Negotiated Rate	$353.58
Max. Negotiated Rate	$1,263.75
Rate for Payer: Aetna Commercial	$773.33
Rate for Payer: Aetna Medicare	$842.50
Rate for Payer: BCBS Complete	$371.26
Rate for Payer: BCN Commercial	$870.97
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Mclaren Medicaid	$353.58
Rate for Payer: Meridian Medicaid	$371.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,263.75
Rate for Payer: Priority Health Choice Medicaid	$353.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,061.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,061.22
Rate for Payer: UHC Medicaid	$353.58
Rate for Payer: UHCCP Medicaid	$353.58

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,685.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$1,172.76
Max. Negotiated Rate	$1,516.50
Rate for Payer: Aetna Commercial	$1,432.25
Rate for Payer: BCBS Trust/PPO	$1,391.64
Rate for Payer: BCN Commercial	$1,391.64
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Cofinity Commercial	$1,449.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,348.00
Rate for Payer: Healthscope Commercial	$1,516.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,263.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,432.25
Rate for Payer: Nomi Health Commercial	$1,381.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,263.75
Rate for Payer: PHP Commercial	$1,432.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,465.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,172.76
Rate for Payer: UHC Core	$1,406.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,263.75

PR RPR INGUN HERNIA SLIDING ANY AGE

Facility

$1,685.00

Service Code	CPT 49525
Hospital Charge Code	49525
Hospital Revenue Code	960
Min. Negotiated Rate	$297.07
Max. Negotiated Rate	$1,516.50
Rate for Payer: Aetna Commercial	$1,432.25
Rate for Payer: Aetna Medicare	$438.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$526.56
Rate for Payer: Amish Plain Church Group Commercial	$526.56
Rate for Payer: BCBS Complete	$311.89
Rate for Payer: BCBS MAPPO	$421.25
Rate for Payer: BCBS Trust/PPO	$1,385.24
Rate for Payer: BCN Commercial	$1,385.24
Rate for Payer: BCN Medicare Advantage	$421.25
Rate for Payer: Cash Price	$1,348.00
Rate for Payer: Cofinity Commercial	$1,449.10
Rate for Payer: Encore Health Key Benefits Commercial	$1,348.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$421.25
Rate for Payer: Healthscope Commercial	$1,516.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,263.75
Rate for Payer: Mclaren Medicaid	$297.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$442.31
Rate for Payer: Meridian Medicaid	$311.89
Rate for Payer: MI Amish Medical Board Commercial	$484.44
Rate for Payer: Molina Medicare/Medicaid	$463.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,432.25
Rate for Payer: Nomi Health Commercial	$1,381.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,263.75
Rate for Payer: PACE Senior Care Partners	$400.19
Rate for Payer: PACE SWMI	$421.25
Rate for Payer: PHP Commercial	$1,432.25
Rate for Payer: PHP Medicare Advantage	$421.25
Rate for Payer: Priority Health Choice Medicaid	$297.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,465.95
Rate for Payer: Priority Health Medicare	$425.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,172.76
Rate for Payer: Railroad Medicare Medicare	$421.25
Rate for Payer: UHC Core	$1,406.97
Rate for Payer: UHC Exchange	$421.25
Rate for Payer: UHC Medicaid	$297.07
Rate for Payer: UHC Medicare Advantage	$421.25
Rate for Payer: UHCCP Medicaid	$297.07
Rate for Payer: VA VA	$421.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,263.75

PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM

Professional

Both

$956.00

Service Code	HCPCS 12046
Min. Negotiated Rate	$199.79
Max. Negotiated Rate	$717.00
Rate for Payer: Aetna Commercial	$343.64
Rate for Payer: Aetna Medicare	$478.00
Rate for Payer: BCBS Complete	$209.78
Rate for Payer: BCN Commercial	$480.06
Rate for Payer: Cash Price	$764.80
Rate for Payer: Cash Price	$764.80
Rate for Payer: Mclaren Medicaid	$199.79
Rate for Payer: Meridian Medicaid	$209.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$717.00
Rate for Payer: Priority Health Choice Medicaid	$199.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.37
Rate for Payer: Priority Health Narrow/Tiered Network	$439.37
Rate for Payer: UHC Medicaid	$199.79
Rate for Payer: UHCCP Medicaid	$199.79

PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG

Professional

Both

$222.00

Service Code	HCPCS 41250
Min. Negotiated Rate	$106.29
Max. Negotiated Rate	$283.96
Rate for Payer: Aetna Commercial	$203.77
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Complete	$111.60
Rate for Payer: BCN Commercial	$233.06
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Mclaren Medicaid	$106.29
Rate for Payer: Meridian Medicaid	$111.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50
Rate for Payer: Priority Health Choice Medicaid	$106.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$283.96
Rate for Payer: Priority Health Narrow/Tiered Network	$283.96
Rate for Payer: UHC Medicaid	$106.29
Rate for Payer: UHCCP Medicaid	$106.29

PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX

Professional

Both

$1,117.00

Service Code	HCPCS 41252
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$837.75
Rate for Payer: Aetna Commercial	$276.83
Rate for Payer: Aetna Medicare	$558.50
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCN Commercial	$315.23
Rate for Payer: Cash Price	$893.60
Rate for Payer: Cash Price	$893.60
Rate for Payer: Mclaren Medicaid	$124.61
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$837.75
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$384.07
Rate for Payer: Priority Health Narrow/Tiered Network	$384.07
Rate for Payer: UHC Medicaid	$124.61
Rate for Payer: UHCCP Medicaid	$124.61

PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH

Professional

Both

$3,511.00

Service Code	HCPCS 49606
Min. Negotiated Rate	$676.06
Max. Negotiated Rate	$2,633.25
Rate for Payer: Aetna Commercial	$1,535.48
Rate for Payer: Aetna Medicare	$1,755.50
Rate for Payer: BCBS Complete	$709.86
Rate for Payer: BCN Commercial	$1,709.07
Rate for Payer: Cash Price	$2,808.80
Rate for Payer: Cash Price	$2,808.80
Rate for Payer: Mclaren Medicaid	$676.06
Rate for Payer: Meridian Medicaid	$709.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,633.25
Rate for Payer: Priority Health Choice Medicaid	$676.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,082.39
Rate for Payer: Priority Health Narrow/Tiered Network	$2,082.39
Rate for Payer: UHC Medicaid	$676.06
Rate for Payer: UHCCP Medicaid	$676.06

PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH

Professional

Both

$9,393.00

Service Code	HCPCS 49605
Min. Negotiated Rate	$2,864.00
Max. Negotiated Rate	$8,938.76
Rate for Payer: Aetna Commercial	$6,672.97
Rate for Payer: Aetna Medicare	$4,696.50
Rate for Payer: BCBS Complete	$3,007.20
Rate for Payer: BCN Commercial	$7,336.25
Rate for Payer: Cash Price	$7,514.40
Rate for Payer: Cash Price	$7,514.40
Rate for Payer: Mclaren Medicaid	$2,864.00
Rate for Payer: Meridian Medicaid	$3,007.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,044.75
Rate for Payer: Priority Health Choice Medicaid	$2,864.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8,938.76
Rate for Payer: Priority Health Narrow/Tiered Network	$8,938.76
Rate for Payer: UHC Medicaid	$2,864.00
Rate for Payer: UHCCP Medicaid	$2,864.00

PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX

Professional

Both

$781.00

Service Code	HCPCS 40654
Min. Negotiated Rate	$251.98
Max. Negotiated Rate	$790.60
Rate for Payer: Aetna Commercial	$555.88
Rate for Payer: Aetna Medicare	$390.50
Rate for Payer: BCBS Complete	$264.58
Rate for Payer: BCN Commercial	$648.87
Rate for Payer: Cash Price	$624.80
Rate for Payer: Cash Price	$624.80
Rate for Payer: Mclaren Medicaid	$251.98
Rate for Payer: Meridian Medicaid	$264.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$585.75
Rate for Payer: Priority Health Choice Medicaid	$251.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$790.60
Rate for Payer: Priority Health Narrow/Tiered Network	$790.60
Rate for Payer: UHC Medicaid	$251.98
Rate for Payer: UHCCP Medicaid	$251.98

PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK

Professional

Both

$1,224.00

Service Code	HCPCS 46715
Min. Negotiated Rate	$353.37
Max. Negotiated Rate	$1,028.45
Rate for Payer: Aetna Commercial	$747.32
Rate for Payer: Aetna Medicare	$612.00
Rate for Payer: BCBS Complete	$371.04
Rate for Payer: BCN Commercial	$844.08
Rate for Payer: Cash Price	$979.20
Rate for Payer: Cash Price	$979.20
Rate for Payer: Mclaren Medicaid	$353.37
Rate for Payer: Meridian Medicaid	$371.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$918.00
Rate for Payer: Priority Health Choice Medicaid	$353.37
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	$353.37
Rate for Payer: UHCCP Medicaid	$353.37

PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA

Professional

Both

$3,082.00

Service Code	HCPCS 46716
Min. Negotiated Rate	$774.89
Max. Negotiated Rate	$2,311.50
Rate for Payer: Aetna Commercial	$1,651.96
Rate for Payer: Aetna Medicare	$1,541.00
Rate for Payer: BCBS Complete	$813.63
Rate for Payer: BCN Commercial	$1,873.40
Rate for Payer: Cash Price	$2,465.60
Rate for Payer: Cash Price	$2,465.60
Rate for Payer: Mclaren Medicaid	$774.89
Rate for Payer: Meridian Medicaid	$813.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,311.50
Rate for Payer: Priority Health Choice Medicaid	$774.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,282.63
Rate for Payer: Priority Health Narrow/Tiered Network	$2,282.63
Rate for Payer: UHC Medicaid	$774.89
Rate for Payer: UHCCP Medicaid	$774.89

PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ

Professional

Both

$10,586.00

Service Code	HCPCS 39503
Min. Negotiated Rate	$3,413.33
Max. Negotiated Rate	$9,172.31
Rate for Payer: Aetna Commercial	$5,982.65
Rate for Payer: Aetna Medicare	$5,293.00
Rate for Payer: BCBS Complete	$3,584.00
Rate for Payer: BCN Commercial	$8,529.42
Rate for Payer: Cash Price	$8,468.80
Rate for Payer: Cash Price	$8,468.80
Rate for Payer: Mclaren Medicaid	$3,413.33
Rate for Payer: Meridian Medicaid	$3,584.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,939.50
Rate for Payer: Priority Health Choice Medicaid	$3,413.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9,172.31
Rate for Payer: Priority Health Narrow/Tiered Network	$9,172.31
Rate for Payer: UHC Medicaid	$3,413.33
Rate for Payer: UHCCP Medicaid	$3,413.33

PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$1,200.00

Service Code	HCPCS 53449
Min. Negotiated Rate	$356.78
Max. Negotiated Rate	$1,003.56
Rate for Payer: Aetna Commercial	$786.57
Rate for Payer: Aetna Medicare	$600.00
Rate for Payer: BCBS Complete	$374.62
Rate for Payer: BCN Commercial	$921.26
Rate for Payer: Cash Price	$960.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Mclaren Medicaid	$356.78
Rate for Payer: Meridian Medicaid	$374.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$900.00
Rate for Payer: Priority Health Choice Medicaid	$356.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,003.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,003.56
Rate for Payer: UHC Medicaid	$356.78
Rate for Payer: UHCCP Medicaid	$356.78

PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE

Professional

Both

$3,981.00

Service Code	HCPCS 27472
Min. Negotiated Rate	$737.19
Max. Negotiated Rate	$2,985.75
Rate for Payer: Aetna Commercial	$1,690.24
Rate for Payer: Aetna Medicare	$1,990.50
Rate for Payer: BCBS Complete	$774.05
Rate for Payer: BCN Commercial	$1,913.24
Rate for Payer: Cash Price	$3,184.80
Rate for Payer: Cash Price	$3,184.80
Rate for Payer: Mclaren Medicaid	$737.19
Rate for Payer: Meridian Medicaid	$774.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,985.75
Rate for Payer: Priority Health Choice Medicaid	$737.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,045.20
Rate for Payer: Priority Health Narrow/Tiered Network	$2,045.20
Rate for Payer: UHC Medicaid	$737.19
Rate for Payer: UHCCP Medicaid	$737.19

PR RPR NON/MAL FEMUR DSTL H/N W/O GRF

Professional

Both

$3,015.00

Service Code	HCPCS 27470
Min. Negotiated Rate	$692.04
Max. Negotiated Rate	$2,261.25
Rate for Payer: Aetna Commercial	$1,574.91
Rate for Payer: Aetna Medicare	$1,507.50
Rate for Payer: BCBS Complete	$726.64
Rate for Payer: BCN Commercial	$1,787.25
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Cash Price	$2,412.00
Rate for Payer: Mclaren Medicaid	$692.04
Rate for Payer: Meridian Medicaid	$726.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,261.25
Rate for Payer: Priority Health Choice Medicaid	$692.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,910.53
Rate for Payer: Priority Health Narrow/Tiered Network	$1,910.53
Rate for Payer: UHC Medicaid	$692.04
Rate for Payer: UHCCP Medicaid	$692.04

PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH

Professional

Both

$5,584.00

Service Code	HCPCS 27725
Min. Negotiated Rate	$716.53
Max. Negotiated Rate	$4,188.00
Rate for Payer: Aetna Commercial	$1,621.26
Rate for Payer: Aetna Medicare	$2,792.00
Rate for Payer: BCBS Complete	$752.36
Rate for Payer: BCN Commercial	$1,845.02
Rate for Payer: Cash Price	$4,467.20
Rate for Payer: Cash Price	$4,467.20
Rate for Payer: Mclaren Medicaid	$716.53
Rate for Payer: Meridian Medicaid	$752.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,188.00
Rate for Payer: Priority Health Choice Medicaid	$716.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,972.28
Rate for Payer: Priority Health Narrow/Tiered Network	$1,972.28
Rate for Payer: UHC Medicaid	$716.53
Rate for Payer: UHCCP Medicaid	$716.53

PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT

Professional

Both

$4,914.00

Service Code	HCPCS 27724
Min. Negotiated Rate	$723.56
Max. Negotiated Rate	$3,685.50
Rate for Payer: Aetna Commercial	$1,683.13
Rate for Payer: Aetna Medicare	$2,457.00
Rate for Payer: BCBS Complete	$759.74
Rate for Payer: BCN Commercial	$1,892.33
Rate for Payer: Cash Price	$3,931.20
Rate for Payer: Cash Price	$3,931.20
Rate for Payer: Mclaren Medicaid	$723.56
Rate for Payer: Meridian Medicaid	$759.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,685.50
Rate for Payer: Priority Health Choice Medicaid	$723.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,022.85
Rate for Payer: Priority Health Narrow/Tiered Network	$2,022.85
Rate for Payer: UHC Medicaid	$723.56
Rate for Payer: UHCCP Medicaid	$723.56

PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT

Professional

Both

$1,355.00

Service Code	HCPCS 28322
Min. Negotiated Rate	$344.63
Max. Negotiated Rate	$1,016.25
Rate for Payer: Aetna Commercial	$766.29
Rate for Payer: Aetna Medicare	$677.50
Rate for Payer: BCBS Complete	$361.86
Rate for Payer: BCN Commercial	$877.44
Rate for Payer: Cash Price	$1,084.00
Rate for Payer: Cash Price	$1,084.00
Rate for Payer: Mclaren Medicaid	$344.63
Rate for Payer: Meridian Medicaid	$361.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,016.25
Rate for Payer: Priority Health Choice Medicaid	$344.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$937.97
Rate for Payer: Priority Health Narrow/Tiered Network	$937.97
Rate for Payer: UHC Medicaid	$344.63
Rate for Payer: UHCCP Medicaid	$344.63

PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS

Professional

Both

$7,236.00

Service Code	HCPCS 33496
Min. Negotiated Rate	$1,011.75
Max. Negotiated Rate	$5,427.00
Rate for Payer: Aetna Commercial	$2,234.49
Rate for Payer: Aetna Medicare	$3,618.00
Rate for Payer: BCBS Complete	$1,062.34
Rate for Payer: BCN Commercial	$2,446.58
Rate for Payer: Cash Price	$5,788.80
Rate for Payer: Cash Price	$5,788.80
Rate for Payer: Mclaren Medicaid	$1,011.75
Rate for Payer: Meridian Medicaid	$1,062.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,427.00
Rate for Payer: Priority Health Choice Medicaid	$1,011.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,630.98
Rate for Payer: Priority Health Narrow/Tiered Network	$2,630.98
Rate for Payer: UHC Medicaid	$1,011.75
Rate for Payer: UHCCP Medicaid	$1,011.75

PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT

Professional

Both

$3,338.00

Service Code	HCPCS 25405
Min. Negotiated Rate	$598.96
Max. Negotiated Rate	$2,503.50
Rate for Payer: Aetna Commercial	$1,384.02
Rate for Payer: Aetna Medicare	$1,669.00
Rate for Payer: BCBS Complete	$628.91
Rate for Payer: BCN Commercial	$1,577.10
Rate for Payer: Cash Price	$2,670.40
Rate for Payer: Cash Price	$2,670.40
Rate for Payer: Mclaren Medicaid	$598.96
Rate for Payer: Meridian Medicaid	$628.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,503.50
Rate for Payer: Priority Health Choice Medicaid	$598.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,685.88
Rate for Payer: Priority Health Narrow/Tiered Network	$1,685.88
Rate for Payer: UHC Medicaid	$598.96
Rate for Payer: UHCCP Medicaid	$598.96

PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF

Professional

Both

$3,373.00

Service Code	HCPCS 25415
Min. Negotiated Rate	$571.05
Max. Negotiated Rate	$2,529.75
Rate for Payer: Aetna Commercial	$1,294.84
Rate for Payer: Aetna Medicare	$1,686.50
Rate for Payer: BCBS Complete	$599.60
Rate for Payer: BCN Commercial	$1,471.04
Rate for Payer: Cash Price	$2,698.40
Rate for Payer: Cash Price	$2,698.40
Rate for Payer: Mclaren Medicaid	$571.05
Rate for Payer: Meridian Medicaid	$599.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,529.75
Rate for Payer: Priority Health Choice Medicaid	$571.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,572.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,572.50
Rate for Payer: UHC Medicaid	$571.05
Rate for Payer: UHCCP Medicaid	$571.05

PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT

Professional

Both

$2,712.00

Service Code	HCPCS 25400
Min. Negotiated Rate	$470.09
Max. Negotiated Rate	$2,034.00
Rate for Payer: Aetna Commercial	$1,071.92
Rate for Payer: Aetna Medicare	$1,356.00
Rate for Payer: BCBS Complete	$493.59
Rate for Payer: BCN Commercial	$1,223.54
Rate for Payer: Cash Price	$2,169.60
Rate for Payer: Cash Price	$2,169.60
Rate for Payer: Mclaren Medicaid	$470.09
Rate for Payer: Meridian Medicaid	$493.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,034.00
Rate for Payer: Priority Health Choice Medicaid	$470.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,307.92
Rate for Payer: Priority Health Narrow/Tiered Network	$1,307.92
Rate for Payer: UHC Medicaid	$470.09
Rate for Payer: UHCCP Medicaid	$470.09

PR RPR NON-UNION MTCRPL/PHALANX

Professional

Both

$2,172.00

Service Code	HCPCS 26546
Min. Negotiated Rate	$633.46
Max. Negotiated Rate	$1,689.07
Rate for Payer: Aetna Commercial	$1,364.30
Rate for Payer: Aetna Medicare	$1,086.00
Rate for Payer: BCBS Complete	$665.13
Rate for Payer: BCN Commercial	$1,580.09
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Cash Price	$1,737.60
Rate for Payer: Mclaren Medicaid	$633.46
Rate for Payer: Meridian Medicaid	$665.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,629.00
Rate for Payer: Priority Health Choice Medicaid	$633.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,689.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,689.07
Rate for Payer: UHC Medicaid	$633.46
Rate for Payer: UHCCP Medicaid	$633.46

Know your out-of-pocket cost for care.

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