Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR

Professional

Both

$1,938.00

Service Code	HCPCS 24587
Min. Negotiated Rate	$435.85
Max. Negotiated Rate	$1,674.15
Rate for Payer: Aetna Commercial	$1,453.71
Rate for Payer: Aetna Medicare	$969.00
Rate for Payer: BCBS Complete	$740.95
Rate for Payer: BCBS Trust/PPO	$435.85
Rate for Payer: BCN Commercial	$1,596.02
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Meridian Medicaid	$740.95
Rate for Payer: Priority Health Choice Medicaid	$705.67
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,674.15
Rate for Payer: Priority Health Narrow Network	$1,674.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,252.48
Rate for Payer: UHC Exchange	$1,252.48
Rate for Payer: UHCCP Medicaid	$705.67

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Professional

Both

$3,192.00

Service Code	HCPCS 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$333.89
Max. Negotiated Rate	$2,074.80
Rate for Payer: Aetna Commercial	$1,179.32
Rate for Payer: Aetna Medicare	$1,596.00
Rate for Payer: BCBS Complete	$604.31
Rate for Payer: BCBS Trust/PPO	$333.89
Rate for Payer: BCN Commercial	$1,298.41
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Meridian Medicaid	$604.31
Rate for Payer: Priority Health Choice Medicaid	$575.53
Rate for Payer: Priority Health Cigna Priority Health	$2,074.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,363.23
Rate for Payer: Priority Health Narrow Network	$1,363.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,008.70
Rate for Payer: UHC Exchange	$1,008.70
Rate for Payer: UHCCP Medicaid	$575.53

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Facility

$3,192.00

Service Code	CPT 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$2,074.80
Max. Negotiated Rate	$19,540.31
Rate for Payer: Aetna Commercial	$2,872.80
Rate for Payer: Aetna Medicare	$12,606.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,758.31
Rate for Payer: Amish Plain Church Group Commercial	$15,758.31
Rate for Payer: ASR ASR	$3,096.24
Rate for Payer: ASR Commercial	$3,096.24
Rate for Payer: BCBS Complete	$7,095.02
Rate for Payer: BCBS MAPPO	$12,606.65
Rate for Payer: BCBS Trust/PPO	$2,613.93
Rate for Payer: BCN Commercial	$2,474.76
Rate for Payer: BCN Medicare Advantage	$12,606.65
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cofinity Commercial	$3,000.48
Rate for Payer: Encore Health Key Benefits Commercial	$2,553.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,606.65
Rate for Payer: Healthscope Commercial	$3,192.00
Rate for Payer: Healthscope Whirlpool	$3,096.24
Rate for Payer: Humana Choice PPO Medicare	$12,606.65
Rate for Payer: Mclaren Commercial	$2,872.80
Rate for Payer: Mclaren Medicaid	$6,757.16
Rate for Payer: Mclaren Medicare	$12,606.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,236.98
Rate for Payer: Meridian Medicaid	$7,095.02
Rate for Payer: MI Amish Medical Board Commercial	$14,497.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,713.20
Rate for Payer: Nomi Health Commercial	$2,617.44
Rate for Payer: PACE Medicare	$11,976.32
Rate for Payer: PACE SWMI	$12,606.65
Rate for Payer: PHP Commercial	$13,867.32
Rate for Payer: PHP Medicaid	$6,757.16
Rate for Payer: PHP Medicare Advantage	$12,606.65
Rate for Payer: Priority Health Choice Medicaid	$6,757.16
Rate for Payer: Priority Health Cigna Priority Health	$2,074.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,796.83
Rate for Payer: Priority Health Medicare	$12,606.65
Rate for Payer: Priority Health Narrow Network	$2,237.59
Rate for Payer: Railroad Medicare Medicare	$12,606.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,808.96
Rate for Payer: UHC Dual Complete DSNP	$12,606.65
Rate for Payer: UHC Exchange	$19,540.31
Rate for Payer: UHC Medicare Advantage	$12,606.65
Rate for Payer: UHCCP DNSP	$12,606.65
Rate for Payer: UHCCP Medicaid	$6,757.16
Rate for Payer: VA VA	$12,606.65

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Facility

$3,192.00

Service Code	CPT 23615
Hospital Charge Code	23615
Min. Negotiated Rate	$2,074.80
Max. Negotiated Rate	$3,192.00
Rate for Payer: Aetna Commercial	$2,872.80
Rate for Payer: ASR ASR	$3,096.24
Rate for Payer: ASR Commercial	$3,096.24
Rate for Payer: BCBS Trust/PPO	$2,601.16
Rate for Payer: BCN Commercial	$2,474.76
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cofinity Commercial	$3,000.48
Rate for Payer: Encore Health Key Benefits Commercial	$2,553.60
Rate for Payer: Healthscope Commercial	$3,192.00
Rate for Payer: Healthscope Whirlpool	$3,096.24
Rate for Payer: Mclaren Commercial	$2,872.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,713.20
Rate for Payer: Nomi Health Commercial	$2,617.44
Rate for Payer: Priority Health Cigna Priority Health	$2,074.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,808.96

PR OPTX PROX HUMERAL FX W/INT FIXJ RPR TUBEROSITY

Professional

Both

$3,192.00

Service Code	HCPCS 23615
Min. Negotiated Rate	$333.89
Max. Negotiated Rate	$2,074.80
Rate for Payer: Aetna Commercial	$1,179.32
Rate for Payer: Aetna Medicare	$1,596.00
Rate for Payer: BCBS Complete	$604.31
Rate for Payer: BCBS Trust/PPO	$333.89
Rate for Payer: BCN Commercial	$1,298.41
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Meridian Medicaid	$604.31
Rate for Payer: Priority Health Choice Medicaid	$575.53
Rate for Payer: Priority Health Cigna Priority Health	$2,074.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,363.23
Rate for Payer: Priority Health Narrow Network	$1,363.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,008.70
Rate for Payer: UHC Exchange	$1,008.70
Rate for Payer: UHCCP Medicaid	$575.53

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

Professional

Both

$2,377.00

Service Code	HCPCS 23616
Min. Negotiated Rate	$496.07
Max. Negotiated Rate	$1,897.54
Rate for Payer: Aetna Commercial	$1,651.81
Rate for Payer: Aetna Medicare	$1,188.50
Rate for Payer: BCBS Complete	$838.47
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: BCN Commercial	$1,809.09
Rate for Payer: Cash Price	$1,901.60
Rate for Payer: Cash Price	$1,901.60
Rate for Payer: Meridian Medicaid	$838.47
Rate for Payer: Priority Health Choice Medicaid	$798.54
Rate for Payer: Priority Health Cigna Priority Health	$1,545.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,897.54
Rate for Payer: Priority Health Narrow Network	$1,897.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,456.88
Rate for Payer: UHC Exchange	$1,456.88
Rate for Payer: UHCCP Medicaid	$798.54

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

Professional

Both

$3,098.00

Service Code	HCPCS 27226
Min. Negotiated Rate	$558.94
Max. Negotiated Rate	$2,013.70
Rate for Payer: Aetna Commercial	$1,412.38
Rate for Payer: Aetna Medicare	$1,549.00
Rate for Payer: BCBS Complete	$716.13
Rate for Payer: BCBS Trust/PPO	$558.94
Rate for Payer: BCN Commercial	$1,546.66
Rate for Payer: Cash Price	$2,478.40
Rate for Payer: Cash Price	$2,478.40
Rate for Payer: Meridian Medicaid	$716.13
Rate for Payer: Priority Health Choice Medicaid	$682.03
Rate for Payer: Priority Health Cigna Priority Health	$2,013.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,625.30
Rate for Payer: Priority Health Narrow Network	$1,625.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,206.72
Rate for Payer: UHC Exchange	$1,206.72
Rate for Payer: UHCCP Medicaid	$682.03

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

Professional

Both

$2,540.00

Service Code	HCPCS 25575
Min. Negotiated Rate	$590.86
Max. Negotiated Rate	$1,676.82
Rate for Payer: Aetna Commercial	$1,204.50
Rate for Payer: Aetna Medicare	$1,270.00
Rate for Payer: BCBS Complete	$620.40
Rate for Payer: BCBS Trust/PPO	$1,676.82
Rate for Payer: BCN Commercial	$1,331.16
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Cash Price	$2,032.00
Rate for Payer: Meridian Medicaid	$620.40
Rate for Payer: Priority Health Choice Medicaid	$590.86
Rate for Payer: Priority Health Cigna Priority Health	$1,651.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,398.35
Rate for Payer: Priority Health Narrow Network	$1,398.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,022.52
Rate for Payer: UHC Exchange	$1,022.52
Rate for Payer: UHCCP Medicaid	$590.86

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

Professional

Both

$1,870.00

Service Code	HCPCS 25574
Min. Negotiated Rate	$444.11
Max. Negotiated Rate	$4,249.65
Rate for Payer: Aetna Commercial	$898.86
Rate for Payer: Aetna Medicare	$935.00
Rate for Payer: BCBS Complete	$466.32
Rate for Payer: BCBS Trust/PPO	$4,249.65
Rate for Payer: BCN Commercial	$998.86
Rate for Payer: Cash Price	$1,496.00
Rate for Payer: Cash Price	$1,496.00
Rate for Payer: Meridian Medicaid	$466.32
Rate for Payer: Priority Health Choice Medicaid	$444.11
Rate for Payer: Priority Health Cigna Priority Health	$1,215.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,049.27
Rate for Payer: Priority Health Narrow Network	$1,049.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$757.03
Rate for Payer: UHC Exchange	$757.03
Rate for Payer: UHCCP Medicaid	$444.11

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

Professional

Both

$5,711.00

Service Code	HCPCS 22318
Min. Negotiated Rate	$33.96
Max. Negotiated Rate	$3,712.15
Rate for Payer: Aetna Commercial	$2,196.46
Rate for Payer: Aetna Medicare	$2,855.50
Rate for Payer: BCBS Complete	$1,130.56
Rate for Payer: BCBS Trust/PPO	$33.96
Rate for Payer: BCN Commercial	$2,682.29
Rate for Payer: Cash Price	$4,568.80
Rate for Payer: Cash Price	$4,568.80
Rate for Payer: Meridian Medicaid	$1,130.56
Rate for Payer: Priority Health Choice Medicaid	$1,076.72
Rate for Payer: Priority Health Cigna Priority Health	$3,712.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,565.68
Rate for Payer: Priority Health Narrow Network	$2,565.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,878.31
Rate for Payer: UHC Exchange	$1,878.31
Rate for Payer: UHCCP Medicaid	$1,076.72

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

Professional

Both

$10,742.00

Service Code	HCPCS 22319
Min. Negotiated Rate	$1,196.21
Max. Negotiated Rate	$6,982.30
Rate for Payer: Aetna Commercial	$2,450.58
Rate for Payer: Aetna Medicare	$5,371.00
Rate for Payer: BCBS Complete	$1,256.02
Rate for Payer: BCBS Trust/PPO	$5,215.40
Rate for Payer: BCN Commercial	$2,704.34
Rate for Payer: Cash Price	$8,593.60
Rate for Payer: Cash Price	$8,593.60
Rate for Payer: Meridian Medicaid	$1,256.02
Rate for Payer: Priority Health Choice Medicaid	$1,196.21
Rate for Payer: Priority Health Cigna Priority Health	$6,982.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,844.53
Rate for Payer: Priority Health Narrow Network	$2,844.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,085.40
Rate for Payer: UHC Exchange	$2,085.40
Rate for Payer: UHCCP Medicaid	$1,196.21

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR

Professional

Both

$4,067.00

Service Code	HCPCS 22326
Min. Negotiated Rate	$984.70
Max. Negotiated Rate	$2,643.55
Rate for Payer: Aetna Commercial	$2,012.34
Rate for Payer: Aetna Medicare	$2,033.50
Rate for Payer: BCBS Complete	$1,033.94
Rate for Payer: BCBS Trust/PPO	$1,741.59
Rate for Payer: BCN Commercial	$2,452.00
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Cash Price	$3,253.60
Rate for Payer: Meridian Medicaid	$1,033.94
Rate for Payer: Priority Health Choice Medicaid	$984.70
Rate for Payer: Priority Health Cigna Priority Health	$2,643.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,340.25
Rate for Payer: Priority Health Narrow Network	$2,340.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,705.43
Rate for Payer: UHC Exchange	$1,705.43
Rate for Payer: UHCCP Medicaid	$984.70

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA

Professional

Both

$1,171.00

Service Code	HCPCS 22328
Min. Negotiated Rate	$180.84
Max. Negotiated Rate	$950.50
Rate for Payer: Aetna Commercial	$380.05
Rate for Payer: Aetna Medicare	$585.50
Rate for Payer: BCBS Complete	$189.88
Rate for Payer: BCBS Trust/PPO	$950.50
Rate for Payer: BCN Commercial	$453.59
Rate for Payer: Cash Price	$936.80
Rate for Payer: Cash Price	$936.80
Rate for Payer: Meridian Medicaid	$189.88
Rate for Payer: Priority Health Choice Medicaid	$180.84
Rate for Payer: Priority Health Cigna Priority Health	$761.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$428.46
Rate for Payer: Priority Health Narrow Network	$428.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$339.14
Rate for Payer: UHC Exchange	$339.14
Rate for Payer: UHCCP Medicaid	$180.84

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM

Professional

Both

$3,741.00

Service Code	HCPCS 22325
Min. Negotiated Rate	$966.38
Max. Negotiated Rate	$17,177.60
Rate for Payer: Aetna Commercial	$1,958.38
Rate for Payer: Aetna Medicare	$1,870.50
Rate for Payer: BCBS Complete	$1,014.70
Rate for Payer: BCBS Trust/PPO	$17,177.60
Rate for Payer: BCN Commercial	$2,172.66
Rate for Payer: Cash Price	$2,992.80
Rate for Payer: Cash Price	$2,992.80
Rate for Payer: Meridian Medicaid	$1,014.70
Rate for Payer: Priority Health Choice Medicaid	$966.38
Rate for Payer: Priority Health Cigna Priority Health	$2,431.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,287.32
Rate for Payer: Priority Health Narrow Network	$2,287.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,640.10
Rate for Payer: UHC Exchange	$1,640.10
Rate for Payer: UHCCP Medicaid	$966.38

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH

Professional

Both

$3,905.00

Service Code	HCPCS 22327
Min. Negotiated Rate	$950.50
Max. Negotiated Rate	$2,538.25
Rate for Payer: Aetna Commercial	$2,041.44
Rate for Payer: Aetna Medicare	$1,952.50
Rate for Payer: BCBS Complete	$1,053.84
Rate for Payer: BCBS Trust/PPO	$950.50
Rate for Payer: BCN Commercial	$2,264.04
Rate for Payer: Cash Price	$3,124.00
Rate for Payer: Cash Price	$3,124.00
Rate for Payer: Meridian Medicaid	$1,053.84
Rate for Payer: Priority Health Choice Medicaid	$1,003.66
Rate for Payer: Priority Health Cigna Priority Health	$2,538.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,383.51
Rate for Payer: Priority Health Narrow Network	$2,383.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,688.17
Rate for Payer: UHC Exchange	$1,688.17
Rate for Payer: UHCCP Medicaid	$1,003.66

PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC

Professional

Both

$2,579.00

Service Code	HCPCS 25525
Min. Negotiated Rate	$517.59
Max. Negotiated Rate	$1,676.35
Rate for Payer: Aetna Commercial	$1,049.63
Rate for Payer: Aetna Medicare	$1,289.50
Rate for Payer: BCBS Complete	$543.47
Rate for Payer: BCBS Trust/PPO	$1,471.84
Rate for Payer: BCN Commercial	$1,166.47
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Cash Price	$2,063.20
Rate for Payer: Meridian Medicaid	$543.47
Rate for Payer: Priority Health Choice Medicaid	$517.59
Rate for Payer: Priority Health Cigna Priority Health	$1,676.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,225.33
Rate for Payer: Priority Health Narrow Network	$1,225.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$900.82
Rate for Payer: UHC Exchange	$900.82
Rate for Payer: UHCCP Medicaid	$517.59

PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC

Professional

Both

$2,975.00

Service Code	HCPCS 25526
Min. Negotiated Rate	$623.88
Max. Negotiated Rate	$1,933.75
Rate for Payer: Aetna Commercial	$1,274.50
Rate for Payer: Aetna Medicare	$1,487.50
Rate for Payer: BCBS Complete	$655.07
Rate for Payer: BCBS Trust/PPO	$1,261.05
Rate for Payer: BCN Commercial	$1,406.91
Rate for Payer: Cash Price	$2,380.00
Rate for Payer: Cash Price	$2,380.00
Rate for Payer: Meridian Medicaid	$655.07
Rate for Payer: Priority Health Choice Medicaid	$623.88
Rate for Payer: Priority Health Cigna Priority Health	$1,933.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,478.24
Rate for Payer: Priority Health Narrow Network	$1,478.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,115.22
Rate for Payer: UHC Exchange	$1,115.22
Rate for Payer: UHCCP Medicaid	$623.88

PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ

Professional

Both

$2,939.00

Service Code	HCPCS 23670
Min. Negotiated Rate	$196.12
Max. Negotiated Rate	$1,910.35
Rate for Payer: Aetna Commercial	$1,162.77
Rate for Payer: Aetna Medicare	$1,469.50
Rate for Payer: BCBS Complete	$597.60
Rate for Payer: BCBS Trust/PPO	$196.12
Rate for Payer: BCN Commercial	$1,279.85
Rate for Payer: Cash Price	$2,351.20
Rate for Payer: Cash Price	$2,351.20
Rate for Payer: Meridian Medicaid	$597.60
Rate for Payer: Priority Health Choice Medicaid	$569.14
Rate for Payer: Priority Health Cigna Priority Health	$1,910.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,346.95
Rate for Payer: Priority Health Narrow Network	$1,346.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$986.95
Rate for Payer: UHC Exchange	$986.95
Rate for Payer: UHCCP Medicaid	$569.14

PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ

Professional

Both

$1,655.00

Service Code	HCPCS 23680
Min. Negotiated Rate	$228.81
Max. Negotiated Rate	$1,419.72
Rate for Payer: Aetna Commercial	$1,237.80
Rate for Payer: Aetna Medicare	$827.50
Rate for Payer: BCBS Complete	$636.29
Rate for Payer: BCBS Trust/PPO	$228.81
Rate for Payer: BCN Commercial	$1,365.86
Rate for Payer: Cash Price	$1,324.00
Rate for Payer: Cash Price	$1,324.00
Rate for Payer: Meridian Medicaid	$636.29
Rate for Payer: Priority Health Choice Medicaid	$605.99
Rate for Payer: Priority Health Cigna Priority Health	$1,075.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,419.72
Rate for Payer: Priority Health Narrow Network	$1,419.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,055.52
Rate for Payer: UHC Exchange	$1,055.52
Rate for Payer: UHCCP Medicaid	$605.99

PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN

Professional

Both

$1,647.00

Service Code	HCPCS 27178
Min. Negotiated Rate	$600.23
Max. Negotiated Rate	$1,421.75
Rate for Payer: Aetna Commercial	$1,230.99
Rate for Payer: Aetna Medicare	$823.50
Rate for Payer: BCBS Complete	$630.24
Rate for Payer: BCBS Trust/PPO	$969.43
Rate for Payer: BCN Commercial	$1,355.11
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Meridian Medicaid	$630.24
Rate for Payer: Priority Health Choice Medicaid	$600.23
Rate for Payer: Priority Health Cigna Priority Health	$1,070.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,421.75
Rate for Payer: Priority Health Narrow Network	$1,421.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,043.58
Rate for Payer: UHC Exchange	$1,043.58
Rate for Payer: UHCCP Medicaid	$600.23

PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ

Professional

Both

$2,351.00

Service Code	HCPCS 27181
Min. Negotiated Rate	$381.43
Max. Negotiated Rate	$1,722.49
Rate for Payer: Aetna Commercial	$1,496.07
Rate for Payer: Aetna Medicare	$1,175.50
Rate for Payer: BCBS Complete	$763.10
Rate for Payer: BCBS Trust/PPO	$381.43
Rate for Payer: BCN Commercial	$1,640.49
Rate for Payer: Cash Price	$1,880.80
Rate for Payer: Cash Price	$1,880.80
Rate for Payer: Meridian Medicaid	$763.10
Rate for Payer: Priority Health Choice Medicaid	$726.76
Rate for Payer: Priority Health Cigna Priority Health	$1,528.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,722.49
Rate for Payer: Priority Health Narrow Network	$1,722.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,285.27
Rate for Payer: UHC Exchange	$1,285.27
Rate for Payer: UHCCP Medicaid	$726.76

PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT

Professional

Both

$1,991.00

Service Code	HCPCS 27177
Min. Negotiated Rate	$723.77
Max. Negotiated Rate	$1,715.37
Rate for Payer: Aetna Commercial	$1,490.05
Rate for Payer: Aetna Medicare	$995.50
Rate for Payer: BCBS Complete	$759.96
Rate for Payer: BCBS Trust/PPO	$1,238.86
Rate for Payer: BCN Commercial	$1,635.11
Rate for Payer: Cash Price	$1,592.80
Rate for Payer: Cash Price	$1,592.80
Rate for Payer: Meridian Medicaid	$759.96
Rate for Payer: Priority Health Choice Medicaid	$723.77
Rate for Payer: Priority Health Cigna Priority Health	$1,294.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,715.37
Rate for Payer: Priority Health Narrow Network	$1,715.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,282.03
Rate for Payer: UHC Exchange	$1,282.03
Rate for Payer: UHCCP Medicaid	$723.77

PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM

Professional

Both

$1,986.00

Service Code	HCPCS 27258
Min. Negotiated Rate	$720.37
Max. Negotiated Rate	$2,598.71
Rate for Payer: Aetna Commercial	$1,486.20
Rate for Payer: Aetna Medicare	$993.00
Rate for Payer: BCBS Complete	$756.39
Rate for Payer: BCBS Trust/PPO	$2,598.71
Rate for Payer: BCN Commercial	$1,628.28
Rate for Payer: Cash Price	$1,588.80
Rate for Payer: Cash Price	$1,588.80
Rate for Payer: Meridian Medicaid	$756.39
Rate for Payer: Priority Health Choice Medicaid	$720.37
Rate for Payer: Priority Health Cigna Priority Health	$1,290.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,708.24
Rate for Payer: Priority Health Narrow Network	$1,708.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,279.74
Rate for Payer: UHC Exchange	$1,279.74
Rate for Payer: UHCCP Medicaid	$720.37

PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

Professional

Both

$2,138.00

Service Code	HCPCS 23532
Min. Negotiated Rate	$411.73
Max. Negotiated Rate	$1,389.70
Rate for Payer: Aetna Commercial	$835.21
Rate for Payer: Aetna Medicare	$1,069.00
Rate for Payer: BCBS Complete	$432.32
Rate for Payer: BCBS Trust/PPO	$525.66
Rate for Payer: BCN Commercial	$926.54
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Meridian Medicaid	$432.32
Rate for Payer: Priority Health Choice Medicaid	$411.73
Rate for Payer: Priority Health Cigna Priority Health	$1,389.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$973.96
Rate for Payer: Priority Health Narrow Network	$973.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$704.15
Rate for Payer: UHC Exchange	$704.15
Rate for Payer: UHCCP Medicaid	$411.73

PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ

Professional

Both

$3,097.00

Service Code	HCPCS 27536
Min. Negotiated Rate	$769.57
Max. Negotiated Rate	$2,013.05
Rate for Payer: Aetna Commercial	$1,583.28
Rate for Payer: Aetna Medicare	$1,548.50
Rate for Payer: BCBS Complete	$808.05
Rate for Payer: BCBS Trust/PPO	$803.02
Rate for Payer: BCN Commercial	$1,737.25
Rate for Payer: Cash Price	$2,477.60
Rate for Payer: Cash Price	$2,477.60
Rate for Payer: Meridian Medicaid	$808.05
Rate for Payer: Priority Health Choice Medicaid	$769.57
Rate for Payer: Priority Health Cigna Priority Health	$2,013.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,823.75
Rate for Payer: Priority Health Narrow Network	$1,823.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,376.75
Rate for Payer: UHC Exchange	$1,376.75
Rate for Payer: UHCCP Medicaid	$769.57

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