Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY

Professional

Both

$2,348.00

Service Code	HCPCS 29904
Min. Negotiated Rate	$414.71
Max. Negotiated Rate	$12,622.63
Rate for Payer: Aetna Commercial	$851.15
Rate for Payer: BCBS Complete	$435.45
Rate for Payer: BCBS Trust/PPO	$12,622.63
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Cash Price	$1,878.40
Rate for Payer: Meridian Medicaid	$435.45
Rate for Payer: Priority Health Choice Medicaid	$414.71
Rate for Payer: Priority Health Cigna Priority Health	$1,643.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$984.03
Rate for Payer: Priority Health Narrow Network	$984.03
Rate for Payer: Priority Health SBD	$984.03
Rate for Payer: UMR Bronson Commercial	$1,080.08

PR ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT

Professional

Both

$1,999.00

Service Code	HCPCS 29846
Min. Negotiated Rate	$339.52
Max. Negotiated Rate	$1,401.05
Rate for Payer: Aetna Commercial	$696.33
Rate for Payer: BCBS Complete	$356.50
Rate for Payer: BCBS Trust/PPO	$1,401.05
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Meridian Medicaid	$356.50
Rate for Payer: Priority Health Choice Medicaid	$339.52
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$807.34
Rate for Payer: Priority Health Narrow Network	$807.34
Rate for Payer: Priority Health SBD	$807.34
Rate for Payer: UMR Bronson Commercial	$919.54

PR ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB

Professional

Both

$1,201.00

Service Code	HCPCS 23044
Min. Negotiated Rate	$367.00
Max. Negotiated Rate	$1,094.11
Rate for Payer: Aetna Commercial	$752.51
Rate for Payer: BCBS Complete	$385.35
Rate for Payer: BCBS Trust/PPO	$1,094.11
Rate for Payer: Cash Price	$960.80
Rate for Payer: Cash Price	$960.80
Rate for Payer: Meridian Medicaid	$385.35
Rate for Payer: Priority Health Choice Medicaid	$367.00
Rate for Payer: Priority Health Cigna Priority Health	$840.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$877.29
Rate for Payer: Priority Health Narrow Network	$877.29
Rate for Payer: Priority Health SBD	$877.29
Rate for Payer: UMR Bronson Commercial	$552.46

PR ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG

Professional

Both

$789.00

Service Code	HCPCS 23101
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$707.77
Rate for Payer: Aetna Commercial	$609.14
Rate for Payer: BCBS Complete	$314.23
Rate for Payer: BCBS Trust/PPO	$39.62
Rate for Payer: Cash Price	$631.20
Rate for Payer: Cash Price	$631.20
Rate for Payer: Meridian Medicaid	$314.23
Rate for Payer: Priority Health Choice Medicaid	$299.27
Rate for Payer: Priority Health Cigna Priority Health	$552.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$707.77
Rate for Payer: Priority Health Narrow Network	$707.77
Rate for Payer: Priority Health SBD	$707.77
Rate for Payer: UMR Bronson Commercial	$362.94

PR ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB

Professional

Both

$1,105.00

Service Code	HCPCS 27620
Min. Negotiated Rate	$238.79
Max. Negotiated Rate	$773.50
Rate for Payer: Aetna Commercial	$598.68
Rate for Payer: BCBS Complete	$305.06
Rate for Payer: BCBS Trust/PPO	$238.79
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Meridian Medicaid	$305.06
Rate for Payer: Priority Health Choice Medicaid	$290.53
Rate for Payer: Priority Health Cigna Priority Health	$773.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$682.22
Rate for Payer: Priority Health Narrow Network	$682.22
Rate for Payer: Priority Health SBD	$682.22
Rate for Payer: UMR Bronson Commercial	$508.30

PR ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX

Professional

Both

$2,023.00

Service Code	HCPCS 24006
Min. Negotiated Rate	$40.33
Max. Negotiated Rate	$1,416.10
Rate for Payer: Aetna Commercial	$949.53
Rate for Payer: BCBS Complete	$486.21
Rate for Payer: BCBS Trust/PPO	$40.33
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Meridian Medicaid	$486.21
Rate for Payer: Priority Health Choice Medicaid	$463.06
Rate for Payer: Priority Health Cigna Priority Health	$1,416.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,097.39
Rate for Payer: Priority Health Narrow Network	$1,097.39
Rate for Payer: Priority Health SBD	$1,097.39
Rate for Payer: UMR Bronson Commercial	$930.58

PR ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB

Professional

Both

$1,998.00

Service Code	HCPCS 24000
Min. Negotiated Rate	$21.65
Max. Negotiated Rate	$1,398.60
Rate for Payer: Aetna Commercial	$635.11
Rate for Payer: BCBS Complete	$328.09
Rate for Payer: BCBS Trust/PPO	$21.65
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Meridian Medicaid	$328.09
Rate for Payer: Priority Health Choice Medicaid	$312.47
Rate for Payer: Priority Health Cigna Priority Health	$1,398.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$740.44
Rate for Payer: Priority Health Narrow Network	$740.44
Rate for Payer: Priority Health SBD	$740.44
Rate for Payer: UMR Bronson Commercial	$919.08

PR ARTHRT ELBOW W/JT EXPL W/WOBX W/O RMVL LOOSE/FB

Professional

Both

$1,322.00

Service Code	HCPCS 24101
Min. Negotiated Rate	$57.31
Max. Negotiated Rate	$925.40
Rate for Payer: Aetna Commercial	$670.06
Rate for Payer: BCBS Complete	$344.87
Rate for Payer: BCBS Trust/PPO	$57.31
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Cash Price	$1,057.60
Rate for Payer: Meridian Medicaid	$344.87
Rate for Payer: Priority Health Choice Medicaid	$328.45
Rate for Payer: Priority Health Cigna Priority Health	$925.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$781.29
Rate for Payer: Priority Health Narrow Network	$781.29
Rate for Payer: Priority Health SBD	$781.29
Rate for Payer: UMR Bronson Commercial	$608.12

PR ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT

Professional

Both

$1,265.00

Service Code	HCPCS 26070
Min. Negotiated Rate	$193.15
Max. Negotiated Rate	$885.50
Rate for Payer: Aetna Commercial	$428.74
Rate for Payer: BCBS Complete	$222.76
Rate for Payer: BCBS Trust/PPO	$193.15
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Meridian Medicaid	$222.76
Rate for Payer: Priority Health Choice Medicaid	$212.15
Rate for Payer: Priority Health Cigna Priority Health	$885.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$501.45
Rate for Payer: Priority Health Narrow Network	$501.45
Rate for Payer: Priority Health SBD	$501.45
Rate for Payer: UMR Bronson Commercial	$581.90

PR ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA

Professional

Both

$1,068.00

Service Code	HCPCS 26080
Min. Negotiated Rate	$132.87
Max. Negotiated Rate	$747.60
Rate for Payer: Aetna Commercial	$525.93
Rate for Payer: BCBS Complete	$274.87
Rate for Payer: BCBS Trust/PPO	$132.87
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cash Price	$854.40
Rate for Payer: Meridian Medicaid	$274.87
Rate for Payer: Priority Health Choice Medicaid	$261.78
Rate for Payer: Priority Health Cigna Priority Health	$747.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$618.90
Rate for Payer: Priority Health Narrow Network	$618.90
Rate for Payer: Priority Health SBD	$618.90
Rate for Payer: UMR Bronson Commercial	$491.28

PR ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA

Professional

Both

$562.00

Service Code	HCPCS 26075
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$526.48
Rate for Payer: Aetna Commercial	$447.37
Rate for Payer: BCBS Complete	$233.27
Rate for Payer: BCBS Trust/PPO	$120.56
Rate for Payer: Cash Price	$449.60
Rate for Payer: Cash Price	$449.60
Rate for Payer: Meridian Medicaid	$233.27
Rate for Payer: Priority Health Choice Medicaid	$222.16
Rate for Payer: Priority Health Cigna Priority Health	$393.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$526.48
Rate for Payer: Priority Health Narrow Network	$526.48
Rate for Payer: Priority Health SBD	$526.48
Rate for Payer: UMR Bronson Commercial	$258.52

PR ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB

Professional

Both

$1,230.00

Service Code	HCPCS 23107
Min. Negotiated Rate	$24.83
Max. Negotiated Rate	$1,020.28
Rate for Payer: Aetna Commercial	$882.97
Rate for Payer: BCBS Complete	$453.34
Rate for Payer: BCBS Trust/PPO	$24.83
Rate for Payer: Cash Price	$984.00
Rate for Payer: Cash Price	$984.00
Rate for Payer: Meridian Medicaid	$453.34
Rate for Payer: Priority Health Choice Medicaid	$431.75
Rate for Payer: Priority Health Cigna Priority Health	$861.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,020.28
Rate for Payer: Priority Health Narrow Network	$1,020.28
Rate for Payer: Priority Health SBD	$1,020.28
Rate for Payer: UMR Bronson Commercial	$565.80

PR ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX

Professional

Both

$981.00

Service Code	HCPCS 23106
Min. Negotiated Rate	$151.62
Max. Negotiated Rate	$778.23
Rate for Payer: Aetna Commercial	$668.25
Rate for Payer: BCBS Complete	$344.64
Rate for Payer: BCBS Trust/PPO	$151.62
Rate for Payer: Cash Price	$784.80
Rate for Payer: Cash Price	$784.80
Rate for Payer: Meridian Medicaid	$344.64
Rate for Payer: Priority Health Choice Medicaid	$328.23
Rate for Payer: Priority Health Cigna Priority Health	$686.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$778.23
Rate for Payer: Priority Health Narrow Network	$778.23
Rate for Payer: Priority Health SBD	$778.23
Rate for Payer: UMR Bronson Commercial	$451.26

PR ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY

Professional

Both

$1,112.00

Service Code	HCPCS 23105
Min. Negotiated Rate	$85.58
Max. Negotiated Rate	$986.06
Rate for Payer: Aetna Commercial	$855.39
Rate for Payer: BCBS Complete	$437.68
Rate for Payer: BCBS Trust/PPO	$85.58
Rate for Payer: Cash Price	$889.60
Rate for Payer: Cash Price	$889.60
Rate for Payer: Meridian Medicaid	$437.68
Rate for Payer: Priority Health Choice Medicaid	$416.84
Rate for Payer: Priority Health Cigna Priority Health	$778.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$986.06
Rate for Payer: Priority Health Narrow Network	$986.06
Rate for Payer: Priority Health SBD	$986.06
Rate for Payer: UMR Bronson Commercial	$511.52

PR ARTHRT KNE W/EXPL DRG/RMVL FB

Facility

$2,638.00

Service Code	CPT 27310
Hospital Charge Code	27310
Min. Negotiated Rate	$1,160.72
Max. Negotiated Rate	$2,374.20
Rate for Payer: Aetna American Axle	$1,714.70
Rate for Payer: Aetna Commercial	$2,242.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,714.70
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Cofinity Commercial	$1,846.60
Rate for Payer: Cofinity Commercial	$2,268.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,110.40
Rate for Payer: Healthscope Commercial	$2,374.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,846.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,978.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,242.30
Rate for Payer: PHP Commercial	$2,242.30
Rate for Payer: Priority Health Cigna Priority Health	$1,846.60
Rate for Payer: Priority Health SBD	$1,661.94
Rate for Payer: UMR Bronson Commercial	$1,160.72
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,978.50

PR ARTHRT KNE W/EXPL DRG/RMVL FB

Professional

Both

$2,638.00

Service Code	HCPCS 27310
Hospital Charge Code	27310
Min. Negotiated Rate	$474.78
Max. Negotiated Rate	$2,115.84
Rate for Payer: Aetna Commercial	$976.42
Rate for Payer: BCBS Complete	$498.52
Rate for Payer: BCBS Trust/PPO	$2,115.84
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Meridian Medicaid	$498.52
Rate for Payer: Priority Health Choice Medicaid	$474.78
Rate for Payer: Priority Health Cigna Priority Health	$1,846.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,128.03
Rate for Payer: Priority Health Narrow Network	$1,128.03
Rate for Payer: Priority Health SBD	$1,128.03
Rate for Payer: UMR Bronson Commercial	$1,213.48

PR ARTHRT KNE W/EXPL DRG/RMVL FB

Facility

$2,638.00

Service Code	CPT 27310
Hospital Charge Code	27310
Min. Negotiated Rate	$729.87
Max. Negotiated Rate	$9,057.42
Rate for Payer: Aetna American Axle	$1,714.70
Rate for Payer: Aetna Commercial	$2,242.30
Rate for Payer: Aetna Medicare	$2,992.24
Rate for Payer: Aetna New Business (MI Preferred)	$1,714.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,596.44
Rate for Payer: Amish Plain Church Group Commercial	$3,596.44
Rate for Payer: BCBS Complete	$1,652.63
Rate for Payer: BCBS MAPPO	$2,877.15
Rate for Payer: BCBS Trust/PPO	$2,262.55
Rate for Payer: BCN Medicare Advantage	$2,877.15
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Cofinity Commercial	$1,846.60
Rate for Payer: Cofinity Commercial	$2,268.68
Rate for Payer: Encore Health Key Benefits Commercial	$2,110.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,877.15
Rate for Payer: Healthscope Commercial	$2,374.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,846.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,978.50
Rate for Payer: Mclaren Medicaid	$1,573.80
Rate for Payer: Mclaren Medicare	$2,877.15
Rate for Payer: Meridian Medicaid	$1,652.63
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,021.01
Rate for Payer: MI Amish Medical Board Commercial	$3,308.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,242.30
Rate for Payer: PACE Medicare	$2,733.29
Rate for Payer: PACE SWMI	$2,877.15
Rate for Payer: PHP Commercial	$2,242.30
Rate for Payer: PHP Medicare Advantage	$2,877.15
Rate for Payer: Priority Health Choice Medicaid	$1,573.80
Rate for Payer: Priority Health Cigna Priority Health	$1,846.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,057.42
Rate for Payer: Priority Health Medicare	$2,877.15
Rate for Payer: Priority Health Narrow Network	$7,245.94
Rate for Payer: Priority Health SBD	$1,661.94
Rate for Payer: Railroad Medicare Medicare	$2,877.15
Rate for Payer: UHC All Payor (Choice/PPO)	$802.86
Rate for Payer: UHC Dual Complete DSNP	$2,877.15
Rate for Payer: UHC Exchange	$729.87
Rate for Payer: UHC Medicare Advantage	$2,963.46
Rate for Payer: UMR Bronson Commercial	$976.06
Rate for Payer: VA VA	$2,877.15
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,978.50

PR ARTHRT KNE W/EXPL DRG/RMVL FB

Professional

Both

$2,638.00

Service Code	HCPCS 27310
Min. Negotiated Rate	$474.78
Max. Negotiated Rate	$2,115.84
Rate for Payer: Aetna Commercial	$976.42
Rate for Payer: BCBS Complete	$498.52
Rate for Payer: BCBS Trust/PPO	$2,115.84
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Cash Price	$2,110.40
Rate for Payer: Meridian Medicaid	$498.52
Rate for Payer: Priority Health Choice Medicaid	$474.78
Rate for Payer: Priority Health Cigna Priority Health	$1,846.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,128.03
Rate for Payer: Priority Health Narrow Network	$1,128.03
Rate for Payer: Priority Health SBD	$1,128.03
Rate for Payer: UMR Bronson Commercial	$1,213.48

PR ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB

Professional

Both

$1,715.00

Service Code	HCPCS 27331
Min. Negotiated Rate	$311.19
Max. Negotiated Rate	$1,200.50
Rate for Payer: Aetna Commercial	$634.56
Rate for Payer: BCBS Complete	$326.75
Rate for Payer: BCBS Trust/PPO	$1,191.32
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Meridian Medicaid	$326.75
Rate for Payer: Priority Health Choice Medicaid	$311.19
Rate for Payer: Priority Health Cigna Priority Health	$1,200.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$738.40
Rate for Payer: Priority Health Narrow Network	$738.40
Rate for Payer: Priority Health SBD	$738.40
Rate for Payer: UMR Bronson Commercial	$788.90

PR ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT

Professional

Both

$490.00

Service Code	HCPCS 28052
Min. Negotiated Rate	$165.08
Max. Negotiated Rate	$1,658.33
Rate for Payer: Aetna Commercial	$374.25
Rate for Payer: BCBS Complete	$173.33
Rate for Payer: BCBS Trust/PPO	$1,658.33
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Meridian Medicaid	$173.33
Rate for Payer: Priority Health Choice Medicaid	$165.08
Rate for Payer: Priority Health Cigna Priority Health	$343.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$387.07
Rate for Payer: Priority Health Narrow Network	$387.07
Rate for Payer: Priority Health SBD	$387.07
Rate for Payer: UMR Bronson Commercial	$225.40

PR ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH

Professional

Both

$2,126.00

Service Code	HCPCS 27612
Min. Negotiated Rate	$369.98
Max. Negotiated Rate	$2,976.66
Rate for Payer: Aetna Commercial	$742.06
Rate for Payer: BCBS Complete	$388.48
Rate for Payer: BCBS Trust/PPO	$2,976.66
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Cash Price	$1,700.80
Rate for Payer: Meridian Medicaid	$388.48
Rate for Payer: Priority Health Choice Medicaid	$369.98
Rate for Payer: Priority Health Cigna Priority Health	$1,488.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$868.61
Rate for Payer: Priority Health Narrow Network	$868.61
Rate for Payer: Priority Health SBD	$868.61
Rate for Payer: UMR Bronson Commercial	$977.96

PR ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB

Professional

Both

$1,851.00

Service Code	HCPCS 25040
Min. Negotiated Rate	$363.38
Max. Negotiated Rate	$1,295.70
Rate for Payer: Aetna Commercial	$746.44
Rate for Payer: BCBS Complete	$381.55
Rate for Payer: BCBS Trust/PPO	$1,197.13
Rate for Payer: Cash Price	$1,480.80
Rate for Payer: Cash Price	$1,480.80
Rate for Payer: Meridian Medicaid	$381.55
Rate for Payer: Priority Health Choice Medicaid	$363.38
Rate for Payer: Priority Health Cigna Priority Health	$1,295.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$863.51
Rate for Payer: Priority Health Narrow Network	$863.51
Rate for Payer: Priority Health SBD	$863.51
Rate for Payer: UMR Bronson Commercial	$851.46

PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT

Professional

Both

$2,342.00

Service Code	HCPCS 27332
Min. Negotiated Rate	$419.82
Max. Negotiated Rate	$1,639.40
Rate for Payer: Aetna Commercial	$860.52
Rate for Payer: BCBS Complete	$440.81
Rate for Payer: BCBS Trust/PPO	$1,236.22
Rate for Payer: Cash Price	$1,873.60
Rate for Payer: Cash Price	$1,873.60
Rate for Payer: Meridian Medicaid	$440.81
Rate for Payer: Priority Health Choice Medicaid	$419.82
Rate for Payer: Priority Health Cigna Priority Health	$1,639.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$996.28
Rate for Payer: Priority Health Narrow Network	$996.28
Rate for Payer: Priority Health SBD	$996.28
Rate for Payer: UMR Bronson Commercial	$1,077.32

PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT

Professional

Both

$719.00

Service Code	HCPCS 28024
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$678.87
Rate for Payer: Aetna Commercial	$400.11
Rate for Payer: BCBS Complete	$209.12
Rate for Payer: BCBS Trust/PPO	$678.87
Rate for Payer: Cash Price	$575.20
Rate for Payer: Cash Price	$575.20
Rate for Payer: Meridian Medicaid	$209.12
Rate for Payer: Priority Health Choice Medicaid	$199.16
Rate for Payer: Priority Health Cigna Priority Health	$503.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$466.74
Rate for Payer: Priority Health Narrow Network	$466.74
Rate for Payer: Priority Health SBD	$466.74
Rate for Payer: UMR Bronson Commercial	$330.74

PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT

Professional

Both

$820.00

Service Code	HCPCS 28022
Min. Negotiated Rate	$211.51
Max. Negotiated Rate	$574.00
Rate for Payer: Aetna Commercial	$430.37
Rate for Payer: BCBS Complete	$222.09
Rate for Payer: BCBS Trust/PPO	$383.55
Rate for Payer: Cash Price	$656.00
Rate for Payer: Cash Price	$656.00
Rate for Payer: Meridian Medicaid	$222.09
Rate for Payer: Priority Health Choice Medicaid	$211.51
Rate for Payer: Priority Health Cigna Priority Health	$574.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$498.40
Rate for Payer: Priority Health Narrow Network	$498.40
Rate for Payer: Priority Health SBD	$498.40
Rate for Payer: UMR Bronson Commercial	$377.20

Know your out-of-pocket cost for care.

All Charges