Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

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: 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
Rate for Payer: UMR Bronson Commercial	$591.10

PR TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA

Professional

Both

$1,808.00

Service Code	HCPCS 26449
Min. Negotiated Rate	$455.82
Max. Negotiated Rate	$1,435.39
Rate for Payer: Aetna Commercial	$924.13
Rate for Payer: BCBS Complete	$478.61
Rate for Payer: BCBS Trust/PPO	$1,435.39
Rate for Payer: Cash Price	$1,446.40
Rate for Payer: Cash Price	$1,446.40
Rate for Payer: Meridian Medicaid	$478.61
Rate for Payer: Priority Health Choice Medicaid	$455.82
Rate for Payer: Priority Health Cigna Priority Health	$1,265.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,079.52
Rate for Payer: Priority Health Narrow Network	$1,079.52
Rate for Payer: Priority Health SBD	$1,079.52
Rate for Payer: UMR Bronson Commercial	$831.68

PR TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON

Professional

Both

$780.00

Service Code	HCPCS 28226
Min. Negotiated Rate	$260.29
Max. Negotiated Rate	$1,180.75
Rate for Payer: Aetna Commercial	$526.36
Rate for Payer: BCBS Complete	$273.30
Rate for Payer: BCBS Trust/PPO	$1,180.75
Rate for Payer: Cash Price	$624.00
Rate for Payer: Cash Price	$624.00
Rate for Payer: Meridian Medicaid	$273.30
Rate for Payer: Priority Health Choice Medicaid	$260.29
Rate for Payer: Priority Health Cigna Priority Health	$546.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$615.84
Rate for Payer: Priority Health Narrow Network	$615.84
Rate for Payer: Priority Health SBD	$615.84
Rate for Payer: UMR Bronson Commercial	$358.80

PR TENOLYSIS EXTENSOR FOOT SINGLE TENDON

Professional

Both

$637.00

Service Code	HCPCS 28225
Min. Negotiated Rate	$171.25
Max. Negotiated Rate	$1,072.98
Rate for Payer: Aetna Commercial	$349.34
Rate for Payer: BCBS Complete	$179.81
Rate for Payer: BCBS Trust/PPO	$1,072.98
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cash Price	$509.60
Rate for Payer: Meridian Medicaid	$179.81
Rate for Payer: Priority Health Choice Medicaid	$171.25
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$402.39
Rate for Payer: Priority Health Narrow Network	$402.39
Rate for Payer: Priority Health SBD	$402.39
Rate for Payer: UMR Bronson Commercial	$293.02

PR TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH

Professional

Both

$1,205.00

Service Code	HCPCS 26445
Min. Negotiated Rate	$391.49
Max. Negotiated Rate	$1,045.51
Rate for Payer: Aetna Commercial	$805.18
Rate for Payer: BCBS Complete	$411.06
Rate for Payer: BCBS Trust/PPO	$1,045.51
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Meridian Medicaid	$411.06
Rate for Payer: Priority Health Choice Medicaid	$391.49
Rate for Payer: Priority Health Cigna Priority Health	$843.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$946.23
Rate for Payer: Priority Health Narrow Network	$946.23
Rate for Payer: Priority Health SBD	$946.23
Rate for Payer: UMR Bronson Commercial	$554.30

PR TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS

Professional

Both

$821.00

Service Code	HCPCS 28222
Min. Negotiated Rate	$238.99
Max. Negotiated Rate	$1,051.85
Rate for Payer: Aetna Commercial	$475.18
Rate for Payer: BCBS Complete	$250.94
Rate for Payer: BCBS Trust/PPO	$1,051.85
Rate for Payer: Cash Price	$656.80
Rate for Payer: Cash Price	$656.80
Rate for Payer: Meridian Medicaid	$250.94
Rate for Payer: Priority Health Choice Medicaid	$238.99
Rate for Payer: Priority Health Cigna Priority Health	$574.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$554.56
Rate for Payer: Priority Health Narrow Network	$554.56
Rate for Payer: Priority Health SBD	$554.56
Rate for Payer: UMR Bronson Commercial	$377.66

PR TENOLYSIS FLEXOR FOOT SINGLE TENDON

Professional

Both

$969.00

Service Code	HCPCS 28220
Min. Negotiated Rate	$197.24
Max. Negotiated Rate	$1,218.26
Rate for Payer: Aetna Commercial	$400.31
Rate for Payer: BCBS Complete	$207.10
Rate for Payer: BCBS Trust/PPO	$1,218.26
Rate for Payer: Cash Price	$775.20
Rate for Payer: Cash Price	$775.20
Rate for Payer: Meridian Medicaid	$207.10
Rate for Payer: Priority Health Choice Medicaid	$197.24
Rate for Payer: Priority Health Cigna Priority Health	$678.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$463.68
Rate for Payer: Priority Health Narrow Network	$463.68
Rate for Payer: Priority Health SBD	$463.68
Rate for Payer: UMR Bronson Commercial	$445.74

PR TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO

Professional

Both

$1,750.00

Service Code	HCPCS 26442
Min. Negotiated Rate	$640.49
Max. Negotiated Rate	$1,535.02
Rate for Payer: Aetna Commercial	$1,311.01
Rate for Payer: BCBS Complete	$672.51
Rate for Payer: BCBS Trust/PPO	$688.90
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Meridian Medicaid	$672.51
Rate for Payer: Priority Health Choice Medicaid	$640.49
Rate for Payer: Priority Health Cigna Priority Health	$1,225.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,535.02
Rate for Payer: Priority Health Narrow Network	$1,535.02
Rate for Payer: Priority Health SBD	$1,535.02
Rate for Payer: UMR Bronson Commercial	$805.00

PR TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON

Professional

Both

$1,166.00

Service Code	HCPCS 26440
Min. Negotiated Rate	$421.31
Max. Negotiated Rate	$1,014.15
Rate for Payer: Aetna Commercial	$863.93
Rate for Payer: BCBS Complete	$442.38
Rate for Payer: BCBS Trust/PPO	$497.66
Rate for Payer: Cash Price	$932.80
Rate for Payer: Cash Price	$932.80
Rate for Payer: Meridian Medicaid	$442.38
Rate for Payer: Priority Health Choice Medicaid	$421.31
Rate for Payer: Priority Health Cigna Priority Health	$816.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,014.15
Rate for Payer: Priority Health Narrow Network	$1,014.15
Rate for Payer: Priority Health SBD	$1,014.15
Rate for Payer: UMR Bronson Commercial	$536.36

PR TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH

Professional

Both

$1,275.00

Service Code	HCPCS 27680
Min. Negotiated Rate	$272.64
Max. Negotiated Rate	$3,794.78
Rate for Payer: Aetna Commercial	$557.39
Rate for Payer: BCBS Complete	$286.27
Rate for Payer: BCBS Trust/PPO	$3,794.78
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Cash Price	$1,020.00
Rate for Payer: Meridian Medicaid	$286.27
Rate for Payer: Priority Health Choice Medicaid	$272.64
Rate for Payer: Priority Health Cigna Priority Health	$892.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$641.88
Rate for Payer: Priority Health Narrow Network	$641.88
Rate for Payer: Priority Health SBD	$641.88
Rate for Payer: UMR Bronson Commercial	$586.50

PR TENOLYSIS TRICEPS

Professional

Both

$1,391.00

Service Code	HCPCS 24332
Min. Negotiated Rate	$227.17
Max. Negotiated Rate	$973.70
Rate for Payer: Aetna Commercial	$819.67
Rate for Payer: BCBS Complete	$421.13
Rate for Payer: BCBS Trust/PPO	$227.17
Rate for Payer: Cash Price	$1,112.80
Rate for Payer: Cash Price	$1,112.80
Rate for Payer: Meridian Medicaid	$421.13
Rate for Payer: Priority Health Choice Medicaid	$401.08
Rate for Payer: Priority Health Cigna Priority Health	$973.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$951.34
Rate for Payer: Priority Health Narrow Network	$951.34
Rate for Payer: Priority Health SBD	$951.34
Rate for Payer: UMR Bronson Commercial	$639.86

PR TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX

Professional

Both

$2,823.00

Service Code	HCPCS 27006
Min. Negotiated Rate	$146.80
Max. Negotiated Rate	$1,976.10
Rate for Payer: Aetna Commercial	$958.69
Rate for Payer: BCBS Complete	$485.10
Rate for Payer: BCBS Trust/PPO	$146.80
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Meridian Medicaid	$485.10
Rate for Payer: Priority Health Choice Medicaid	$462.00
Rate for Payer: Priority Health Cigna Priority Health	$1,976.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,093.29
Rate for Payer: Priority Health Narrow Network	$1,093.29
Rate for Payer: Priority Health SBD	$1,093.29
Rate for Payer: UMR Bronson Commercial	$1,298.58

PR TENOTOMY ADDUCTOR HIP OPEN

Professional

Both

$1,037.00

Service Code	HCPCS 27001
Min. Negotiated Rate	$350.81
Max. Negotiated Rate	$834.92
Rate for Payer: Aetna Commercial	$723.30
Rate for Payer: BCBS Complete	$368.35
Rate for Payer: BCBS Trust/PPO	$781.36
Rate for Payer: Cash Price	$829.60
Rate for Payer: Cash Price	$829.60
Rate for Payer: Meridian Medicaid	$368.35
Rate for Payer: Priority Health Choice Medicaid	$350.81
Rate for Payer: Priority Health Cigna Priority Health	$725.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$834.92
Rate for Payer: Priority Health Narrow Network	$834.92
Rate for Payer: Priority Health SBD	$834.92
Rate for Payer: UMR Bronson Commercial	$477.02

PR TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX

Professional

Both

$819.00

Service Code	HCPCS 27000
Min. Negotiated Rate	$252.83
Max. Negotiated Rate	$635.54
Rate for Payer: Aetna Commercial	$541.57
Rate for Payer: BCBS Complete	$265.47
Rate for Payer: BCBS Trust/PPO	$635.54
Rate for Payer: Cash Price	$655.20
Rate for Payer: Cash Price	$655.20
Rate for Payer: Meridian Medicaid	$265.47
Rate for Payer: Priority Health Choice Medicaid	$252.83
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$604.11
Rate for Payer: Priority Health Narrow Network	$604.11
Rate for Payer: Priority Health SBD	$604.11
Rate for Payer: UMR Bronson Commercial	$376.74

PR TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS

Professional

Both

$1,248.00

Service Code	HCPCS 24357
Min. Negotiated Rate	$270.94
Max. Negotiated Rate	$873.60
Rate for Payer: Aetna Commercial	$554.57
Rate for Payer: BCBS Complete	$284.49
Rate for Payer: BCBS Trust/PPO	$296.90
Rate for Payer: Cash Price	$998.40
Rate for Payer: Cash Price	$998.40
Rate for Payer: Meridian Medicaid	$284.49
Rate for Payer: Priority Health Choice Medicaid	$270.94
Rate for Payer: Priority Health Cigna Priority Health	$873.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$644.96
Rate for Payer: Priority Health Narrow Network	$644.96
Rate for Payer: Priority Health SBD	$644.96
Rate for Payer: UMR Bronson Commercial	$574.08

PR TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON

Professional

Both

$972.00

Service Code	HCPCS 26460
Min. Negotiated Rate	$293.73
Max. Negotiated Rate	$1,932.52
Rate for Payer: Aetna Commercial	$582.66
Rate for Payer: BCBS Complete	$308.42
Rate for Payer: BCBS Trust/PPO	$1,932.52
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cash Price	$777.60
Rate for Payer: Meridian Medicaid	$308.42
Rate for Payer: Priority Health Choice Medicaid	$293.73
Rate for Payer: Priority Health Cigna Priority Health	$680.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$700.61
Rate for Payer: Priority Health Narrow Network	$700.61
Rate for Payer: Priority Health SBD	$700.61
Rate for Payer: UMR Bronson Commercial	$447.12

PR TENOTOMY FLEXOR FINGER OPEN EACH TENDON

Professional

Both

$972.00

Service Code	HCPCS 26455
Min. Negotiated Rate	$299.90
Max. Negotiated Rate	$1,822.64
Rate for Payer: Aetna Commercial	$593.34
Rate for Payer: BCBS Complete	$314.90
Rate for Payer: BCBS Trust/PPO	$1,822.64
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cash Price	$777.60
Rate for Payer: Meridian Medicaid	$314.90
Rate for Payer: Priority Health Choice Medicaid	$299.90
Rate for Payer: Priority Health Cigna Priority Health	$680.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$721.04
Rate for Payer: Priority Health Narrow Network	$721.04
Rate for Payer: Priority Health SBD	$721.04
Rate for Payer: UMR Bronson Commercial	$447.12

PR TENOTOMY FLEXOR PALM OPEN EACH TENDON

Professional

Both

$1,105.00

Service Code	HCPCS 26450
Min. Negotiated Rate	$301.82
Max. Negotiated Rate	$1,515.16
Rate for Payer: Aetna Commercial	$597.83
Rate for Payer: BCBS Complete	$316.91
Rate for Payer: BCBS Trust/PPO	$1,515.16
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Meridian Medicaid	$316.91
Rate for Payer: Priority Health Choice Medicaid	$301.82
Rate for Payer: Priority Health Cigna Priority Health	$773.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$725.13
Rate for Payer: Priority Health Narrow Network	$725.13
Rate for Payer: Priority Health SBD	$725.13
Rate for Payer: UMR Bronson Commercial	$508.30

PR TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE

Professional

Both

$1,383.00

Service Code	HCPCS 27005
Min. Negotiated Rate	$466.04
Max. Negotiated Rate	$1,100.96
Rate for Payer: Aetna Commercial	$959.38
Rate for Payer: BCBS Complete	$489.34
Rate for Payer: BCBS Trust/PPO	$801.96
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Meridian Medicaid	$489.34
Rate for Payer: Priority Health Choice Medicaid	$466.04
Rate for Payer: Priority Health Cigna Priority Health	$968.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,100.96
Rate for Payer: Priority Health Narrow Network	$1,100.96
Rate for Payer: Priority Health SBD	$1,100.96
Rate for Payer: UMR Bronson Commercial	$636.18

PR TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON

Professional

Both

$888.00

Service Code	HCPCS 24310
Min. Negotiated Rate	$182.79
Max. Negotiated Rate	$736.35
Rate for Payer: Aetna Commercial	$632.34
Rate for Payer: BCBS Complete	$324.96
Rate for Payer: BCBS Trust/PPO	$182.79
Rate for Payer: Cash Price	$710.40
Rate for Payer: Cash Price	$710.40
Rate for Payer: Meridian Medicaid	$324.96
Rate for Payer: Priority Health Choice Medicaid	$309.49
Rate for Payer: Priority Health Cigna Priority Health	$621.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$736.35
Rate for Payer: Priority Health Narrow Network	$736.35
Rate for Payer: Priority Health SBD	$736.35
Rate for Payer: UMR Bronson Commercial	$408.48

PR TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON

Professional

Both

$651.00

Service Code	HCPCS 28234
Min. Negotiated Rate	$174.66
Max. Negotiated Rate	$2,375.77
Rate for Payer: Aetna Commercial	$349.37
Rate for Payer: BCBS Complete	$183.39
Rate for Payer: BCBS Trust/PPO	$2,375.77
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Meridian Medicaid	$183.39
Rate for Payer: Priority Health Choice Medicaid	$174.66
Rate for Payer: Priority Health Cigna Priority Health	$455.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.04
Rate for Payer: Priority Health Narrow Network	$409.04
Rate for Payer: Priority Health SBD	$409.04
Rate for Payer: UMR Bronson Commercial	$299.46

PR TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG

Professional

Both

$1,130.00

Service Code	HCPCS 27391
Min. Negotiated Rate	$377.01
Max. Negotiated Rate	$924.00
Rate for Payer: Aetna Commercial	$733.56
Rate for Payer: BCBS Complete	$395.86
Rate for Payer: BCBS Trust/PPO	$924.00
Rate for Payer: Cash Price	$904.00
Rate for Payer: Cash Price	$904.00
Rate for Payer: Meridian Medicaid	$395.86
Rate for Payer: Priority Health Choice Medicaid	$377.01
Rate for Payer: Priority Health Cigna Priority Health	$791.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$896.70
Rate for Payer: Priority Health Narrow Network	$896.70
Rate for Payer: Priority Health SBD	$896.70
Rate for Payer: UMR Bronson Commercial	$519.80

PR TENOTOMY PERCUTANEOUS TOE SINGLE TENDON

Professional

Both

$386.00

Service Code	HCPCS 28010
Min. Negotiated Rate	$134.62
Max. Negotiated Rate	$3,603.53
Rate for Payer: Aetna Commercial	$272.02
Rate for Payer: BCBS Complete	$141.35
Rate for Payer: BCBS Trust/PPO	$3,603.53
Rate for Payer: Cash Price	$308.80
Rate for Payer: Cash Price	$308.80
Rate for Payer: Meridian Medicaid	$141.35
Rate for Payer: Priority Health Choice Medicaid	$134.62
Rate for Payer: Priority Health Cigna Priority Health	$270.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$316.09
Rate for Payer: Priority Health Narrow Network	$316.09
Rate for Payer: Priority Health SBD	$316.09
Rate for Payer: UMR Bronson Commercial	$177.56

PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES

Professional

Both

$850.00

Service Code	HCPCS 27606
Min. Negotiated Rate	$173.38
Max. Negotiated Rate	$852.15
Rate for Payer: Aetna Commercial	$365.88
Rate for Payer: BCBS Complete	$182.05
Rate for Payer: BCBS Trust/PPO	$852.15
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Meridian Medicaid	$182.05
Rate for Payer: Priority Health Choice Medicaid	$173.38
Rate for Payer: Priority Health Cigna Priority Health	$595.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$414.14
Rate for Payer: Priority Health Narrow Network	$414.14
Rate for Payer: Priority Health SBD	$414.14
Rate for Payer: UMR Bronson Commercial	$391.00

PR TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES

Professional

Both

$747.00

Service Code	HCPCS 27605
Min. Negotiated Rate	$117.58
Max. Negotiated Rate	$832.60
Rate for Payer: Aetna Commercial	$244.41
Rate for Payer: BCBS Complete	$123.46
Rate for Payer: BCBS Trust/PPO	$832.60
Rate for Payer: Cash Price	$597.60
Rate for Payer: Cash Price	$597.60
Rate for Payer: Meridian Medicaid	$123.46
Rate for Payer: Priority Health Choice Medicaid	$117.58
Rate for Payer: Priority Health Cigna Priority Health	$522.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$278.81
Rate for Payer: Priority Health Narrow Network	$278.81
Rate for Payer: Priority Health SBD	$278.81
Rate for Payer: UMR Bronson Commercial	$343.62

Know your out-of-pocket cost for care.

All Charges