Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

Facility

$2,257.00

Service Code	CPT 27829
Hospital Charge Code	27829
Min. Negotiated Rate	$703.35
Max. Negotiated Rate	$20,018.71
Rate for Payer: Aetna American Axle	$1,467.05
Rate for Payer: Aetna Commercial	$1,918.45
Rate for Payer: Aetna Medicare	$6,613.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,467.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,948.86
Rate for Payer: Amish Plain Church Group Commercial	$7,948.86
Rate for Payer: BCBS Complete	$3,652.66
Rate for Payer: BCBS MAPPO	$6,359.09
Rate for Payer: BCBS Trust/PPO	$5,471.85
Rate for Payer: BCN Medicare Advantage	$6,359.09
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Cofinity Commercial	$1,579.90
Rate for Payer: Cofinity Commercial	$1,941.02
Rate for Payer: Encore Health Key Benefits Commercial	$1,805.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,359.09
Rate for Payer: Healthscope Commercial	$2,031.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,579.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,692.75
Rate for Payer: Mclaren Medicaid	$3,478.42
Rate for Payer: Mclaren Medicare	$6,359.09
Rate for Payer: Meridian Medicaid	$3,652.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,677.04
Rate for Payer: MI Amish Medical Board Commercial	$7,312.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,918.45
Rate for Payer: PACE Medicare	$6,041.14
Rate for Payer: PACE SWMI	$6,359.09
Rate for Payer: PHP Commercial	$1,918.45
Rate for Payer: PHP Medicare Advantage	$6,359.09
Rate for Payer: Priority Health Choice Medicaid	$3,478.42
Rate for Payer: Priority Health Cigna Priority Health	$1,579.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,018.71
Rate for Payer: Priority Health Medicare	$6,359.09
Rate for Payer: Priority Health Narrow Network	$16,014.97
Rate for Payer: Priority Health SBD	$1,421.91
Rate for Payer: Railroad Medicare Medicare	$6,359.09
Rate for Payer: UHC All Payor (Choice/PPO)	$773.68
Rate for Payer: UHC Dual Complete DSNP	$6,359.09
Rate for Payer: UHC Exchange	$703.35
Rate for Payer: UHC Medicare Advantage	$6,549.86
Rate for Payer: UMR Bronson Commercial	$835.09
Rate for Payer: VA VA	$6,359.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,692.75

PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

Professional

Both

$2,257.00

Service Code	HCPCS 27829
Hospital Charge Code	27829
Min. Negotiated Rate	$457.52
Max. Negotiated Rate	$1,579.90
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: BCBS Complete	$480.40
Rate for Payer: BCBS Trust/PPO	$1,311.73
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Meridian Medicaid	$480.40
Rate for Payer: Priority Health Choice Medicaid	$457.52
Rate for Payer: Priority Health Cigna Priority Health	$1,579.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,089.72
Rate for Payer: Priority Health Narrow Network	$1,089.72
Rate for Payer: Priority Health SBD	$1,089.72
Rate for Payer: UMR Bronson Commercial	$1,038.22

PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

Facility

$2,257.00

Service Code	CPT 27829
Hospital Charge Code	27829
Min. Negotiated Rate	$993.08
Max. Negotiated Rate	$2,031.30
Rate for Payer: Aetna American Axle	$1,467.05
Rate for Payer: Aetna Commercial	$1,918.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,467.05
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Cofinity Commercial	$1,579.90
Rate for Payer: Cofinity Commercial	$1,941.02
Rate for Payer: Encore Health Key Benefits Commercial	$1,805.60
Rate for Payer: Healthscope Commercial	$2,031.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,579.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,692.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,918.45
Rate for Payer: PHP Commercial	$1,918.45
Rate for Payer: Priority Health Cigna Priority Health	$1,579.90
Rate for Payer: Priority Health SBD	$1,421.91
Rate for Payer: UMR Bronson Commercial	$993.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,692.75

PR OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION

Professional

Both

$2,257.00

Service Code	HCPCS 27829
Min. Negotiated Rate	$457.52
Max. Negotiated Rate	$1,579.90
Rate for Payer: Aetna Commercial	$942.40
Rate for Payer: BCBS Complete	$480.40
Rate for Payer: BCBS Trust/PPO	$1,311.73
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Cash Price	$1,805.60
Rate for Payer: Meridian Medicaid	$480.40
Rate for Payer: Priority Health Choice Medicaid	$457.52
Rate for Payer: Priority Health Cigna Priority Health	$1,579.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,089.72
Rate for Payer: Priority Health Narrow Network	$1,089.72
Rate for Payer: Priority Health SBD	$1,089.72
Rate for Payer: UMR Bronson Commercial	$1,038.22

PR OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE

Professional

Both

$3,844.00

Service Code	HCPCS 27514
Min. Negotiated Rate	$619.40
Max. Negotiated Rate	$2,690.80
Rate for Payer: Aetna Commercial	$1,295.18
Rate for Payer: BCBS Complete	$650.37
Rate for Payer: BCBS Trust/PPO	$1,253.66
Rate for Payer: Cash Price	$3,075.20
Rate for Payer: Cash Price	$3,075.20
Rate for Payer: Meridian Medicaid	$650.37
Rate for Payer: Priority Health Choice Medicaid	$619.40
Rate for Payer: Priority Health Cigna Priority Health	$2,690.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,476.29
Rate for Payer: Priority Health Narrow Network	$1,476.29
Rate for Payer: Priority Health SBD	$1,476.29
Rate for Payer: UMR Bronson Commercial	$1,768.24

PR OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD

Professional

Both

$3,842.00

Service Code	HCPCS 27269
Min. Negotiated Rate	$794.49
Max. Negotiated Rate	$4,086.40
Rate for Payer: Aetna Commercial	$1,661.80
Rate for Payer: BCBS Complete	$834.21
Rate for Payer: BCBS Trust/PPO	$4,086.40
Rate for Payer: Cash Price	$3,073.60
Rate for Payer: Cash Price	$3,073.60
Rate for Payer: Meridian Medicaid	$834.21
Rate for Payer: Priority Health Choice Medicaid	$794.49
Rate for Payer: Priority Health Cigna Priority Health	$2,689.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,894.01
Rate for Payer: Priority Health Narrow Network	$1,894.01
Rate for Payer: Priority Health SBD	$1,894.01
Rate for Payer: UMR Bronson Commercial	$1,767.32

PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN

Professional

Both

$3,773.00

Service Code	HCPCS 27511
Min. Negotiated Rate	$638.79
Max. Negotiated Rate	$2,641.10
Rate for Payer: Aetna Commercial	$1,335.40
Rate for Payer: BCBS Complete	$670.73
Rate for Payer: BCBS Trust/PPO	$1,679.99
Rate for Payer: Cash Price	$3,018.40
Rate for Payer: Cash Price	$3,018.40
Rate for Payer: Meridian Medicaid	$670.73
Rate for Payer: Priority Health Choice Medicaid	$638.79
Rate for Payer: Priority Health Cigna Priority Health	$2,641.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,522.76
Rate for Payer: Priority Health Narrow Network	$1,522.76
Rate for Payer: Priority Health SBD	$1,522.76
Rate for Payer: UMR Bronson Commercial	$1,735.58

PR OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN

Professional

Both

$4,311.00

Service Code	HCPCS 27513
Min. Negotiated Rate	$790.02
Max. Negotiated Rate	$3,017.70
Rate for Payer: Aetna Commercial	$1,659.27
Rate for Payer: BCBS Complete	$829.52
Rate for Payer: BCBS Trust/PPO	$1,854.86
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Meridian Medicaid	$829.52
Rate for Payer: Priority Health Choice Medicaid	$790.02
Rate for Payer: Priority Health Cigna Priority Health	$3,017.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,886.34
Rate for Payer: Priority Health Narrow Network	$1,886.34
Rate for Payer: Priority Health SBD	$1,886.34
Rate for Payer: UMR Bronson Commercial	$1,983.06

PR OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES

Professional

Both

$1,408.00

Service Code	HCPCS 28505
Min. Negotiated Rate	$320.57
Max. Negotiated Rate	$1,403.69
Rate for Payer: Aetna Commercial	$658.49
Rate for Payer: BCBS Complete	$336.60
Rate for Payer: BCBS Trust/PPO	$1,403.69
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Meridian Medicaid	$336.60
Rate for Payer: Priority Health Choice Medicaid	$320.57
Rate for Payer: Priority Health Cigna Priority Health	$985.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$756.27
Rate for Payer: Priority Health Narrow Network	$756.27
Rate for Payer: Priority Health SBD	$756.27
Rate for Payer: UMR Bronson Commercial	$647.68

PR OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE

Professional

Both

$604.00

Service Code	HCPCS 28525
Min. Negotiated Rate	$263.91
Max. Negotiated Rate	$619.93
Rate for Payer: Aetna Commercial	$533.40
Rate for Payer: BCBS Complete	$277.11
Rate for Payer: BCBS Trust/PPO	$576.38
Rate for Payer: Cash Price	$483.20
Rate for Payer: Cash Price	$483.20
Rate for Payer: Meridian Medicaid	$277.11
Rate for Payer: Priority Health Choice Medicaid	$263.91
Rate for Payer: Priority Health Cigna Priority Health	$422.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$619.93
Rate for Payer: Priority Health Narrow Network	$619.93
Rate for Payer: Priority Health SBD	$619.93
Rate for Payer: UMR Bronson Commercial	$277.84

PR OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT

Professional

Both

$1,149.00

Service Code	HCPCS 21407
Min. Negotiated Rate	$411.52
Max. Negotiated Rate	$3,350.93
Rate for Payer: Aetna Commercial	$848.33
Rate for Payer: BCBS Complete	$432.10
Rate for Payer: BCBS Trust/PPO	$3,350.93
Rate for Payer: Cash Price	$919.20
Rate for Payer: Cash Price	$919.20
Rate for Payer: Meridian Medicaid	$432.10
Rate for Payer: Priority Health Choice Medicaid	$411.52
Rate for Payer: Priority Health Cigna Priority Health	$804.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$987.60
Rate for Payer: Priority Health Narrow Network	$987.60
Rate for Payer: Priority Health SBD	$987.60
Rate for Payer: UMR Bronson Commercial	$528.54

PR OPEN TX HUMERAL EPICONDYLAR FRACTURE

Professional

Both

$2,388.00

Service Code	HCPCS 24575
Min. Negotiated Rate	$402.56
Max. Negotiated Rate	$1,671.60
Rate for Payer: Aetna Commercial	$974.52
Rate for Payer: BCBS Complete	$499.63
Rate for Payer: BCBS Trust/PPO	$402.56
Rate for Payer: Cash Price	$1,910.40
Rate for Payer: Cash Price	$1,910.40
Rate for Payer: Meridian Medicaid	$499.63
Rate for Payer: Priority Health Choice Medicaid	$475.84
Rate for Payer: Priority Health Cigna Priority Health	$1,671.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,128.54
Rate for Payer: Priority Health Narrow Network	$1,128.54
Rate for Payer: Priority Health SBD	$1,128.54
Rate for Payer: UMR Bronson Commercial	$1,098.48

PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN

Professional

Both

$2,985.00

Service Code	HCPCS 24545
Min. Negotiated Rate	$314.34
Max. Negotiated Rate	$2,089.50
Rate for Payer: Aetna Commercial	$1,239.12
Rate for Payer: BCBS Complete	$629.35
Rate for Payer: BCBS Trust/PPO	$314.34
Rate for Payer: Cash Price	$2,388.00
Rate for Payer: Cash Price	$2,388.00
Rate for Payer: Meridian Medicaid	$629.35
Rate for Payer: Priority Health Choice Medicaid	$599.38
Rate for Payer: Priority Health Cigna Priority Health	$2,089.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,422.67
Rate for Payer: Priority Health Narrow Network	$1,422.67
Rate for Payer: Priority Health SBD	$1,422.67
Rate for Payer: UMR Bronson Commercial	$1,373.10

PR OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN

Professional

Both

$3,904.00

Service Code	HCPCS 24546
Min. Negotiated Rate	$387.77
Max. Negotiated Rate	$2,732.80
Rate for Payer: Aetna Commercial	$1,384.52
Rate for Payer: BCBS Complete	$701.59
Rate for Payer: BCBS Trust/PPO	$387.77
Rate for Payer: Cash Price	$3,123.20
Rate for Payer: Cash Price	$3,123.20
Rate for Payer: Meridian Medicaid	$701.59
Rate for Payer: Priority Health Choice Medicaid	$668.18
Rate for Payer: Priority Health Cigna Priority Health	$2,732.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,589.14
Rate for Payer: Priority Health Narrow Network	$1,589.14
Rate for Payer: Priority Health SBD	$1,589.14
Rate for Payer: UMR Bronson Commercial	$1,795.84

PR OPEN TX ILIAC SPINE UNI/BIL

Professional

Both

$2,582.00

Service Code	HCPCS G0412
Min. Negotiated Rate	$467.11
Max. Negotiated Rate	$2,061.43
Rate for Payer: Aetna Commercial	$725.83
Rate for Payer: BCBS Complete	$490.47
Rate for Payer: BCBS Trust/PPO	$2,061.43
Rate for Payer: Cash Price	$2,065.60
Rate for Payer: Cash Price	$2,065.60
Rate for Payer: Meridian Medicaid	$490.47
Rate for Payer: Priority Health Choice Medicaid	$467.11
Rate for Payer: Priority Health Cigna Priority Health	$1,807.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,110.16
Rate for Payer: Priority Health Narrow Network	$1,110.16
Rate for Payer: Priority Health SBD	$1,110.16
Rate for Payer: UMR Bronson Commercial	$1,187.72

PR OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE

Professional

Both

$2,695.00

Service Code	HCPCS 27540
Min. Negotiated Rate	$246.72
Max. Negotiated Rate	$1,886.50
Rate for Payer: Aetna Commercial	$1,086.55
Rate for Payer: BCBS Complete	$552.20
Rate for Payer: BCBS Trust/PPO	$246.72
Rate for Payer: Cash Price	$2,156.00
Rate for Payer: Cash Price	$2,156.00
Rate for Payer: Meridian Medicaid	$552.20
Rate for Payer: Priority Health Choice Medicaid	$525.90
Rate for Payer: Priority Health Cigna Priority Health	$1,886.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,253.13
Rate for Payer: Priority Health Narrow Network	$1,253.13
Rate for Payer: Priority Health SBD	$1,253.13
Rate for Payer: UMR Bronson Commercial	$1,239.70

PR OPEN TX INTERPHALANGEAL JOINT DISLOCATION

Professional

Both

$1,510.00

Service Code	HCPCS 26785
Min. Negotiated Rate	$101.43
Max. Negotiated Rate	$1,057.00
Rate for Payer: Aetna Commercial	$725.42
Rate for Payer: BCBS Complete	$375.51
Rate for Payer: BCBS Trust/PPO	$101.43
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Cash Price	$1,208.00
Rate for Payer: Meridian Medicaid	$375.51
Rate for Payer: Priority Health Choice Medicaid	$357.63
Rate for Payer: Priority Health Cigna Priority Health	$1,057.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$849.20
Rate for Payer: Priority Health Narrow Network	$849.20
Rate for Payer: Priority Health SBD	$849.20
Rate for Payer: UMR Bronson Commercial	$694.60

PR OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR

Professional

Both

$2,108.00

Service Code	HCPCS 27557
Min. Negotiated Rate	$669.46
Max. Negotiated Rate	$1,595.79
Rate for Payer: Aetna Commercial	$1,401.09
Rate for Payer: BCBS Complete	$702.93
Rate for Payer: BCBS Trust/PPO	$843.70
Rate for Payer: Cash Price	$1,686.40
Rate for Payer: Cash Price	$1,686.40
Rate for Payer: Meridian Medicaid	$702.93
Rate for Payer: Priority Health Choice Medicaid	$669.46
Rate for Payer: Priority Health Cigna Priority Health	$1,475.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,595.79
Rate for Payer: Priority Health Narrow Network	$1,595.79
Rate for Payer: Priority Health SBD	$1,595.79
Rate for Payer: UMR Bronson Commercial	$969.68

PR OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR

Professional

Both

$1,740.00

Service Code	HCPCS 27556
Min. Negotiated Rate	$488.15
Max. Negotiated Rate	$1,341.99
Rate for Payer: Aetna Commercial	$1,174.25
Rate for Payer: BCBS Complete	$591.11
Rate for Payer: BCBS Trust/PPO	$488.15
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Cash Price	$1,392.00
Rate for Payer: Meridian Medicaid	$591.11
Rate for Payer: Priority Health Choice Medicaid	$562.96
Rate for Payer: Priority Health Cigna Priority Health	$1,218.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,341.99
Rate for Payer: Priority Health Narrow Network	$1,341.99
Rate for Payer: Priority Health SBD	$1,341.99
Rate for Payer: UMR Bronson Commercial	$800.40

PR OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION

Professional

Both

$5,245.00

Service Code	HCPCS 27558
Min. Negotiated Rate	$760.62
Max. Negotiated Rate	$3,671.50
Rate for Payer: Aetna Commercial	$1,597.29
Rate for Payer: BCBS Complete	$798.65
Rate for Payer: BCBS Trust/PPO	$1,509.88
Rate for Payer: Cash Price	$4,196.00
Rate for Payer: Cash Price	$4,196.00
Rate for Payer: Meridian Medicaid	$798.65
Rate for Payer: Priority Health Choice Medicaid	$760.62
Rate for Payer: Priority Health Cigna Priority Health	$3,671.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,814.85
Rate for Payer: Priority Health Narrow Network	$1,814.85
Rate for Payer: Priority Health SBD	$1,814.85
Rate for Payer: UMR Bronson Commercial	$2,412.70

PR OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION

Professional

Both

$3,334.00

Service Code	HCPCS 21462
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$2,333.80
Rate for Payer: Aetna Commercial	$1,544.26
Rate for Payer: BCBS Complete	$778.30
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$2,667.20
Rate for Payer: Cash Price	$2,667.20
Rate for Payer: Meridian Medicaid	$778.30
Rate for Payer: Priority Health Choice Medicaid	$741.24
Rate for Payer: Priority Health Cigna Priority Health	$2,333.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,792.89
Rate for Payer: Priority Health Narrow Network	$1,792.89
Rate for Payer: Priority Health SBD	$1,792.89
Rate for Payer: UMR Bronson Commercial	$1,533.64

PR OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION

Professional

Both

$4,108.00

Service Code	HCPCS 21461
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$2,875.60
Rate for Payer: Aetna Commercial	$1,379.62
Rate for Payer: BCBS Complete	$713.90
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Meridian Medicaid	$713.90
Rate for Payer: Priority Health Choice Medicaid	$679.90
Rate for Payer: Priority Health Cigna Priority Health	$2,875.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,623.86
Rate for Payer: Priority Health Narrow Network	$1,623.86
Rate for Payer: Priority Health SBD	$1,623.86
Rate for Payer: UMR Bronson Commercial	$1,889.68

PR OPEN TX METACARPAL FRACTURE SINGLE EA BONE

Professional

Both

$1,887.00

Service Code	HCPCS 26615
Min. Negotiated Rate	$53.49
Max. Negotiated Rate	$1,320.90
Rate for Payer: Aetna Commercial	$765.08
Rate for Payer: BCBS Complete	$394.30
Rate for Payer: BCBS Trust/PPO	$53.49
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Cash Price	$1,509.60
Rate for Payer: Meridian Medicaid	$394.30
Rate for Payer: Priority Health Choice Medicaid	$375.52
Rate for Payer: Priority Health Cigna Priority Health	$1,320.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$890.06
Rate for Payer: Priority Health Narrow Network	$890.06
Rate for Payer: Priority Health SBD	$890.06
Rate for Payer: UMR Bronson Commercial	$868.02

PR OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION

Professional

Both

$1,017.00

Service Code	HCPCS 28645
Min. Negotiated Rate	$314.60
Max. Negotiated Rate	$821.51
Rate for Payer: Aetna Commercial	$643.68
Rate for Payer: BCBS Complete	$330.33
Rate for Payer: BCBS Trust/PPO	$821.51
Rate for Payer: Cash Price	$813.60
Rate for Payer: Cash Price	$813.60
Rate for Payer: Meridian Medicaid	$330.33
Rate for Payer: Priority Health Choice Medicaid	$314.60
Rate for Payer: Priority Health Cigna Priority Health	$711.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$738.91
Rate for Payer: Priority Health Narrow Network	$738.91
Rate for Payer: Priority Health SBD	$738.91
Rate for Payer: UMR Bronson Commercial	$467.82

PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW

Professional

Both

$3,376.00

Service Code	HCPCS 24635
Min. Negotiated Rate	$438.99
Max. Negotiated Rate	$2,363.20
Rate for Payer: Aetna Commercial	$899.81
Rate for Payer: BCBS Complete	$460.94
Rate for Payer: BCBS Trust/PPO	$1,028.60
Rate for Payer: Cash Price	$2,700.80
Rate for Payer: Cash Price	$2,700.80
Rate for Payer: Meridian Medicaid	$460.94
Rate for Payer: Priority Health Choice Medicaid	$438.99
Rate for Payer: Priority Health Cigna Priority Health	$2,363.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,043.76
Rate for Payer: Priority Health Narrow Network	$1,043.76
Rate for Payer: Priority Health SBD	$1,043.76
Rate for Payer: UMR Bronson Commercial	$1,552.96

Know your out-of-pocket cost for care.

All Charges