Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL

Professional

Both

$3,275.00

Service Code	HCPCS 35363
Min. Negotiated Rate	$1,012.60
Max. Negotiated Rate	$2,517.22
Rate for Payer: Aetna Commercial	$2,184.46
Rate for Payer: BCBS Complete	$1,063.23
Rate for Payer: BCBS Trust/PPO	$1,218.79
Rate for Payer: Cash Price	$2,620.00
Rate for Payer: Cash Price	$2,620.00
Rate for Payer: Mclaren Medicaid	$1,012.60
Rate for Payer: Meridian Medicaid	$1,063.23
Rate for Payer: Priority Health Choice Medicaid	$1,012.60
Rate for Payer: Priority Health Cigna Priority Health	$2,292.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,517.22
Rate for Payer: Priority Health Narrow Network	$2,517.22
Rate for Payer: Priority Health SBD	$2,517.22

PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL

Professional

Both

$1,717.00

Service Code	HCPCS 35371
Min. Negotiated Rate	$508.43
Max. Negotiated Rate	$1,266.58
Rate for Payer: Aetna Commercial	$1,096.85
Rate for Payer: BCBS Complete	$533.85
Rate for Payer: BCBS Trust/PPO	$666.19
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Mclaren Medicaid	$508.43
Rate for Payer: Meridian Medicaid	$533.85
Rate for Payer: Priority Health Choice Medicaid	$508.43
Rate for Payer: Priority Health Cigna Priority Health	$1,201.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,266.58
Rate for Payer: Priority Health Narrow Network	$1,266.58
Rate for Payer: Priority Health SBD	$1,266.58

PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL

Professional

Both

$3,699.00

Service Code	HCPCS 35372
Min. Negotiated Rate	$609.18
Max. Negotiated Rate	$2,589.30
Rate for Payer: Aetna Commercial	$1,311.71
Rate for Payer: BCBS Complete	$639.64
Rate for Payer: BCBS Trust/PPO	$1,194.49
Rate for Payer: Cash Price	$2,959.20
Rate for Payer: Cash Price	$2,959.20
Rate for Payer: Mclaren Medicaid	$609.18
Rate for Payer: Meridian Medicaid	$639.64
Rate for Payer: Priority Health Choice Medicaid	$609.18
Rate for Payer: Priority Health Cigna Priority Health	$2,589.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,515.55
Rate for Payer: Priority Health Narrow Network	$1,515.55
Rate for Payer: Priority Health SBD	$1,515.55

PR TEAEC W/WO PATCH GRAFT ILIAC

Professional

Both

$2,478.00

Service Code	HCPCS 35351
Min. Negotiated Rate	$801.73
Max. Negotiated Rate	$1,993.77
Rate for Payer: Aetna Commercial	$1,728.25
Rate for Payer: BCBS Complete	$841.82
Rate for Payer: BCBS Trust/PPO	$942.49
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Mclaren Medicaid	$801.73
Rate for Payer: Meridian Medicaid	$841.82
Rate for Payer: Priority Health Choice Medicaid	$801.73
Rate for Payer: Priority Health Cigna Priority Health	$1,734.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,993.77
Rate for Payer: Priority Health Narrow Network	$1,993.77
Rate for Payer: Priority Health SBD	$1,993.77

PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL

Professional

Both

$2,013.00

Service Code	HCPCS 35355
Min. Negotiated Rate	$641.34
Max. Negotiated Rate	$1,596.40
Rate for Payer: Aetna Commercial	$1,386.40
Rate for Payer: BCBS Complete	$673.41
Rate for Payer: BCBS Trust/PPO	$1,096.22
Rate for Payer: Cash Price	$1,610.40
Rate for Payer: Cash Price	$1,610.40
Rate for Payer: Mclaren Medicaid	$641.34
Rate for Payer: Meridian Medicaid	$673.41
Rate for Payer: Priority Health Choice Medicaid	$641.34
Rate for Payer: Priority Health Cigna Priority Health	$1,409.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,596.40
Rate for Payer: Priority Health Narrow Network	$1,596.40
Rate for Payer: Priority Health SBD	$1,596.40

PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL

Professional

Both

$4,420.00

Service Code	HCPCS 35341
Min. Negotiated Rate	$865.42
Max. Negotiated Rate	$3,094.00
Rate for Payer: Aetna Commercial	$1,840.86
Rate for Payer: BCBS Complete	$908.69
Rate for Payer: BCBS Trust/PPO	$1,030.71
Rate for Payer: Cash Price	$3,536.00
Rate for Payer: Cash Price	$3,536.00
Rate for Payer: Mclaren Medicaid	$865.42
Rate for Payer: Meridian Medicaid	$908.69
Rate for Payer: Priority Health Choice Medicaid	$865.42
Rate for Payer: Priority Health Cigna Priority Health	$3,094.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,146.98
Rate for Payer: Priority Health Narrow Network	$2,146.98
Rate for Payer: Priority Health SBD	$2,146.98

PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL

Professional

Both

$3,779.00

Service Code	HCPCS 35321
Min. Negotiated Rate	$561.89
Max. Negotiated Rate	$2,645.30
Rate for Payer: Aetna Commercial	$1,199.86
Rate for Payer: BCBS Complete	$589.98
Rate for Payer: BCBS Trust/PPO	$677.28
Rate for Payer: Cash Price	$3,023.20
Rate for Payer: Cash Price	$3,023.20
Rate for Payer: Mclaren Medicaid	$561.89
Rate for Payer: Meridian Medicaid	$589.98
Rate for Payer: Priority Health Choice Medicaid	$561.89
Rate for Payer: Priority Health Cigna Priority Health	$2,645.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,393.72
Rate for Payer: Priority Health Narrow Network	$1,393.72
Rate for Payer: Priority Health SBD	$1,393.72

PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC

Professional

Both

$2,790.00

Service Code	HCPCS 35311
Min. Negotiated Rate	$970.00
Max. Negotiated Rate	$2,421.48
Rate for Payer: Aetna Commercial	$2,093.18
Rate for Payer: BCBS Complete	$1,018.50
Rate for Payer: BCBS Trust/PPO	$1,646.71
Rate for Payer: Cash Price	$2,232.00
Rate for Payer: Cash Price	$2,232.00
Rate for Payer: Mclaren Medicaid	$970.00
Rate for Payer: Meridian Medicaid	$1,018.50
Rate for Payer: Priority Health Choice Medicaid	$970.00
Rate for Payer: Priority Health Cigna Priority Health	$1,953.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,421.48
Rate for Payer: Priority Health Narrow Network	$2,421.48
Rate for Payer: Priority Health SBD	$2,421.48

PR TEAM CONFERENCE NON-FACE-TO-FACE NONPHYSICIAN

Professional

Both

$58.00

Service Code	HCPCS 99368
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$852.68
Rate for Payer: Aetna Commercial	$36.09
Rate for Payer: BCBS Complete	$23.20
Rate for Payer: BCBS Trust/PPO	$852.68
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Priority Health Cigna Priority Health	$40.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.54
Rate for Payer: Priority Health Narrow Network	$44.54
Rate for Payer: Priority Health SBD	$44.54

PR TEAM CONFERENCE NON-FACE-TO-FACE PHYSICIAN

Professional

Both

$150.00

Service Code	HCPCS 99367
Min. Negotiated Rate	$55.68
Max. Negotiated Rate	$232.98
Rate for Payer: Aetna Commercial	$55.68
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS Trust/PPO	$232.98
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Priority Health Cigna Priority Health	$105.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.53
Rate for Payer: Priority Health Narrow Network	$68.53
Rate for Payer: Priority Health SBD	$68.53

PR TENDON GRAFT FROM A DISTANCE

Professional

Both

$1,091.00

Service Code	HCPCS 20924
Min. Negotiated Rate	$326.32
Max. Negotiated Rate	$11,952.59
Rate for Payer: Aetna Commercial	$672.54
Rate for Payer: BCBS Complete	$342.64
Rate for Payer: BCBS Trust/PPO	$11,952.59
Rate for Payer: Cash Price	$872.80
Rate for Payer: Cash Price	$872.80
Rate for Payer: Mclaren Medicaid	$326.32
Rate for Payer: Meridian Medicaid	$342.64
Rate for Payer: Priority Health Choice Medicaid	$326.32
Rate for Payer: Priority Health Cigna Priority Health	$763.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$775.17
Rate for Payer: Priority Health Narrow Network	$775.17
Rate for Payer: Priority Health SBD	$775.17

PR TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON

Professional

Both

$1,009.00

Service Code	HCPCS 24305
Min. Negotiated Rate	$148.45
Max. Negotiated Rate	$894.65
Rate for Payer: Aetna Commercial	$772.36
Rate for Payer: BCBS Complete	$396.31
Rate for Payer: BCBS Trust/PPO	$148.45
Rate for Payer: Cash Price	$807.20
Rate for Payer: Cash Price	$807.20
Rate for Payer: Mclaren Medicaid	$377.44
Rate for Payer: Meridian Medicaid	$396.31
Rate for Payer: Priority Health Choice Medicaid	$377.44
Rate for Payer: Priority Health Cigna Priority Health	$706.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$894.65
Rate for Payer: Priority Health Narrow Network	$894.65
Rate for Payer: Priority Health SBD	$894.65

PR TENDON SHEATH INCISION

Professional

Both

$1,157.00

Service Code	HCPCS 26055
Min. Negotiated Rate	$163.86
Max. Negotiated Rate	$809.90
Rate for Payer: Aetna Commercial	$384.81
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCBS Trust/PPO	$163.86
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cash Price	$925.60
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health	$809.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$452.43
Rate for Payer: Priority Health Narrow Network	$452.43
Rate for Payer: Priority Health SBD	$452.43

PR TENDON SHEATH INCISION

Facility

$1,157.00

Service Code	CPT 26055
Hospital Charge Code	26055
Hospital Revenue Code	960
Min. Negotiated Rate	$728.91
Max. Negotiated Rate	$1,041.30
Rate for Payer: Aetna Commercial	$983.45
Rate for Payer: Aetna New Business (MI Preferred)	$752.05
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cofinity Commercial	$995.02
Rate for Payer: Cofinity Commercial	$809.90
Rate for Payer: Healthscope Commercial	$1,041.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$983.45
Rate for Payer: PHP Commercial	$983.45
Rate for Payer: Priority Health Cigna Priority Health	$809.90
Rate for Payer: Priority Health SBD	$728.91

PR TENDON SHEATH INCISION

Facility

$1,157.00

Service Code	CPT 26055
Hospital Charge Code	26055
Hospital Revenue Code	960
Min. Negotiated Rate	$294.04
Max. Negotiated Rate	$1,787.60
Rate for Payer: Aetna Commercial	$983.45
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Aetna New Business (MI Preferred)	$752.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$857.09
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cofinity Commercial	$809.90
Rate for Payer: Cofinity Commercial	$995.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Healthscope Commercial	$1,041.30
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$983.45
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Commercial	$983.45
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health Cigna Priority Health	$809.90
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health SBD	$728.91
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$323.44
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$294.04
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

PR TENDON SHEATH INCISION

Professional

Both

$1,157.00

Service Code	HCPCS 26055
Hospital Charge Code	26055
Min. Negotiated Rate	$163.86
Max. Negotiated Rate	$809.90
Rate for Payer: Aetna Commercial	$384.81
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCBS Trust/PPO	$163.86
Rate for Payer: Cash Price	$925.60
Rate for Payer: Cash Price	$925.60
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health	$809.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$452.43
Rate for Payer: Priority Health Narrow Network	$452.43
Rate for Payer: Priority Health SBD	$452.43

PR TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT

Professional

Both

$1,391.00

Service Code	HCPCS 26483
Min. Negotiated Rate	$563.60
Max. Negotiated Rate	$1,351.68
Rate for Payer: Aetna Commercial	$1,159.57
Rate for Payer: BCBS Complete	$591.78
Rate for Payer: BCBS Trust/PPO	$1,202.41
Rate for Payer: Cash Price	$1,112.80
Rate for Payer: Cash Price	$1,112.80
Rate for Payer: Mclaren Medicaid	$563.60
Rate for Payer: Meridian Medicaid	$591.78
Rate for Payer: Priority Health Choice Medicaid	$563.60
Rate for Payer: Priority Health Cigna Priority Health	$973.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,351.68
Rate for Payer: Priority Health Narrow Network	$1,351.68
Rate for Payer: Priority Health SBD	$1,351.68

PR TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE

Professional

Both

$1,071.00

Service Code	HCPCS 24340
Min. Negotiated Rate	$86.64
Max. Negotiated Rate	$926.31
Rate for Payer: Aetna Commercial	$824.71
Rate for Payer: BCBS Complete	$407.72
Rate for Payer: BCBS Trust/PPO	$86.64
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Mclaren Medicaid	$388.30
Rate for Payer: Meridian Medicaid	$407.72
Rate for Payer: Priority Health Choice Medicaid	$388.30
Rate for Payer: Priority Health Cigna Priority Health	$749.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$926.31
Rate for Payer: Priority Health Narrow Network	$926.31
Rate for Payer: Priority Health SBD	$926.31

PR TENODESIS DISTAL JOINT EACH

Professional

Both

$995.00

Service Code	HCPCS 26474
Min. Negotiated Rate	$423.23
Max. Negotiated Rate	$1,253.66
Rate for Payer: Aetna Commercial	$857.34
Rate for Payer: BCBS Complete	$444.39
Rate for Payer: BCBS Trust/PPO	$1,253.66
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cash Price	$796.00
Rate for Payer: Mclaren Medicaid	$423.23
Rate for Payer: Meridian Medicaid	$444.39
Rate for Payer: Priority Health Choice Medicaid	$423.23
Rate for Payer: Priority Health Cigna Priority Health	$696.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,016.20
Rate for Payer: Priority Health Narrow Network	$1,016.20
Rate for Payer: Priority Health SBD	$1,016.20

PR TENODESIS LONG TENDON BICEPS

Professional

Both

$2,311.00

Service Code	HCPCS 23430
Min. Negotiated Rate	$106.55
Max. Negotiated Rate	$1,617.70
Rate for Payer: Aetna Commercial	$992.48
Rate for Payer: BCBS Complete	$506.12
Rate for Payer: BCBS Trust/PPO	$106.55
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Mclaren Medicaid	$482.02
Rate for Payer: Meridian Medicaid	$506.12
Rate for Payer: Priority Health Choice Medicaid	$482.02
Rate for Payer: Priority Health Cigna Priority Health	$1,617.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,145.39
Rate for Payer: Priority Health Narrow Network	$1,145.39
Rate for Payer: Priority Health SBD	$1,145.39

PR TENODESIS LONG TENDON BICEPS

Facility

$2,311.00

Service Code	CPT 23430
Hospital Charge Code	23430
Min. Negotiated Rate	$741.00
Max. Negotiated Rate	$19,834.21
Rate for Payer: Aetna Commercial	$1,964.35
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$2,909.12
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cofinity Commercial	$1,617.70
Rate for Payer: Cofinity Commercial	$1,987.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Healthscope Commercial	$2,079.90
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,964.35
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Commercial	$1,964.35
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Cigna Priority Health	$1,617.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,834.21
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Priority Health Narrow Network	$15,867.37
Rate for Payer: Priority Health SBD	$1,455.93
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$815.10
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$741.00
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

PR TENODESIS LONG TENDON BICEPS

Facility

$2,311.00

Service Code	CPT 23430
Hospital Charge Code	23430
Min. Negotiated Rate	$1,455.93
Max. Negotiated Rate	$2,079.90
Rate for Payer: Aetna Commercial	$1,964.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,502.15
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cofinity Commercial	$1,617.70
Rate for Payer: Cofinity Commercial	$1,987.46
Rate for Payer: Healthscope Commercial	$2,079.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,964.35
Rate for Payer: PHP Commercial	$1,964.35
Rate for Payer: Priority Health Cigna Priority Health	$1,617.70
Rate for Payer: Priority Health SBD	$1,455.93

PR TENODESIS LONG TENDON BICEPS

Professional

Both

$2,311.00

Service Code	HCPCS 23430
Hospital Charge Code	23430
Min. Negotiated Rate	$106.55
Max. Negotiated Rate	$1,617.70
Rate for Payer: Aetna Commercial	$992.48
Rate for Payer: BCBS Complete	$506.12
Rate for Payer: BCBS Trust/PPO	$106.55
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Mclaren Medicaid	$482.02
Rate for Payer: Meridian Medicaid	$506.12
Rate for Payer: Priority Health Choice Medicaid	$482.02
Rate for Payer: Priority Health Cigna Priority Health	$1,617.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,145.39
Rate for Payer: Priority Health Narrow Network	$1,145.39
Rate for Payer: Priority Health SBD	$1,145.39

PR TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH

Professional

Both

$1,944.00

Service Code	HCPCS 26471
Min. Negotiated Rate	$428.13
Max. Negotiated Rate	$1,867.54
Rate for Payer: Aetna Commercial	$869.56
Rate for Payer: BCBS Complete	$449.54
Rate for Payer: BCBS Trust/PPO	$1,867.54
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Mclaren Medicaid	$428.13
Rate for Payer: Meridian Medicaid	$449.54
Rate for Payer: Priority Health Choice Medicaid	$428.13
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,027.43
Rate for Payer: Priority Health Narrow Network	$1,027.43
Rate for Payer: Priority Health SBD	$1,027.43

PR TENODESIS WRIST EXTENSORS FINGERS

Professional

Both

$1,285.00

Service Code	HCPCS 25301
Min. Negotiated Rate	$232.45
Max. Negotiated Rate	$993.72
Rate for Payer: Aetna Commercial	$858.14
Rate for Payer: BCBS Complete	$439.48
Rate for Payer: BCBS Trust/PPO	$232.45
Rate for Payer: Cash Price	$1,028.00
Rate for Payer: Cash Price	$1,028.00
Rate for Payer: Mclaren Medicaid	$418.55
Rate for Payer: Meridian Medicaid	$439.48
Rate for Payer: Priority Health Choice Medicaid	$418.55
Rate for Payer: Priority Health Cigna Priority Health	$899.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$993.72
Rate for Payer: Priority Health Narrow Network	$993.72
Rate for Payer: Priority Health SBD	$993.72

Know your out-of-pocket cost for care.

All Charges