Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA

Professional

Both

$404.00

Service Code	HCPCS 26750
Min. Negotiated Rate	$127.80
Max. Negotiated Rate	$945.13
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: BCBS Complete	$134.19
Rate for Payer: BCBS Trust/PPO	$945.13
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Meridian Medicaid	$134.19
Rate for Payer: Priority Health Choice Medicaid	$127.80
Rate for Payer: Priority Health Cigna Priority Health	$282.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$299.24
Rate for Payer: Priority Health Narrow Network	$299.24
Rate for Payer: Priority Health SBD	$299.24
Rate for Payer: UMR Bronson Commercial	$185.84

PR CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ

Professional

Both

$739.00

Service Code	HCPCS 25600
Min. Negotiated Rate	$216.83
Max. Negotiated Rate	$579.96
Rate for Payer: Aetna Commercial	$422.71
Rate for Payer: BCBS Complete	$227.67
Rate for Payer: BCBS Trust/PPO	$579.96
Rate for Payer: Cash Price	$591.20
Rate for Payer: Cash Price	$591.20
Rate for Payer: Meridian Medicaid	$227.67
Rate for Payer: Priority Health Choice Medicaid	$216.83
Rate for Payer: Priority Health Cigna Priority Health	$517.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$510.13
Rate for Payer: Priority Health Narrow Network	$510.13
Rate for Payer: Priority Health SBD	$510.13
Rate for Payer: UMR Bronson Commercial	$339.94

PR CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF

Professional

Both

$1,361.00

Service Code	HCPCS 25605
Min. Negotiated Rate	$101.96
Max. Negotiated Rate	$952.70
Rate for Payer: Aetna Commercial	$681.17
Rate for Payer: BCBS Complete	$353.82
Rate for Payer: BCBS Trust/PPO	$101.96
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Cash Price	$1,088.80
Rate for Payer: Meridian Medicaid	$353.82
Rate for Payer: Priority Health Choice Medicaid	$336.97
Rate for Payer: Priority Health Cigna Priority Health	$952.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$798.15
Rate for Payer: Priority Health Narrow Network	$798.15
Rate for Payer: Priority Health SBD	$798.15
Rate for Payer: UMR Bronson Commercial	$626.06

PR CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING

Professional

Both

$1,026.00

Service Code	HCPCS 26432
Min. Negotiated Rate	$257.28
Max. Negotiated Rate	$849.20
Rate for Payer: Aetna Commercial	$712.43
Rate for Payer: BCBS Complete	$370.59
Rate for Payer: BCBS Trust/PPO	$257.28
Rate for Payer: Cash Price	$820.80
Rate for Payer: Cash Price	$820.80
Rate for Payer: Meridian Medicaid	$370.59
Rate for Payer: Priority Health Choice Medicaid	$352.94
Rate for Payer: Priority Health Cigna Priority Health	$718.20
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	$471.96

PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ

Professional

Both

$1,389.00

Service Code	HCPCS 27510
Min. Negotiated Rate	$442.19
Max. Negotiated Rate	$1,050.92
Rate for Payer: Aetna Commercial	$911.08
Rate for Payer: BCBS Complete	$464.30
Rate for Payer: BCBS Trust/PPO	$768.68
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Meridian Medicaid	$464.30
Rate for Payer: Priority Health Choice Medicaid	$442.19
Rate for Payer: Priority Health Cigna Priority Health	$972.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,050.92
Rate for Payer: Priority Health Narrow Network	$1,050.92
Rate for Payer: Priority Health SBD	$1,050.92
Rate for Payer: UMR Bronson Commercial	$638.94

PR CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ

Professional

Both

$1,078.00

Service Code	HCPCS 27508
Min. Negotiated Rate	$326.53
Max. Negotiated Rate	$773.63
Rate for Payer: Aetna Commercial	$663.27
Rate for Payer: BCBS Complete	$342.86
Rate for Payer: BCBS Trust/PPO	$738.04
Rate for Payer: Cash Price	$862.40
Rate for Payer: Cash Price	$862.40
Rate for Payer: Meridian Medicaid	$342.86
Rate for Payer: Priority Health Choice Medicaid	$326.53
Rate for Payer: Priority Health Cigna Priority Health	$754.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.63
Rate for Payer: Priority Health Narrow Network	$773.63
Rate for Payer: Priority Health SBD	$773.63
Rate for Payer: UMR Bronson Commercial	$495.88

PR CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ

Professional

Both

$1,346.00

Service Code	HCPCS 27232
Min. Negotiated Rate	$467.75
Max. Negotiated Rate	$1,113.73
Rate for Payer: Aetna Commercial	$995.08
Rate for Payer: BCBS Complete	$491.14
Rate for Payer: BCBS Trust/PPO	$835.77
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Meridian Medicaid	$491.14
Rate for Payer: Priority Health Choice Medicaid	$467.75
Rate for Payer: Priority Health Cigna Priority Health	$942.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,113.73
Rate for Payer: Priority Health Narrow Network	$1,113.73
Rate for Payer: Priority Health SBD	$1,113.73
Rate for Payer: UMR Bronson Commercial	$619.16

PR CLTX FEM FX PROX END NCK W/O MANJ

Professional

Both

$979.00

Service Code	HCPCS 27230
Min. Negotiated Rate	$313.75
Max. Negotiated Rate	$806.71
Rate for Payer: Aetna Commercial	$634.41
Rate for Payer: BCBS Complete	$329.44
Rate for Payer: BCBS Trust/PPO	$806.71
Rate for Payer: Cash Price	$783.20
Rate for Payer: Cash Price	$783.20
Rate for Payer: Meridian Medicaid	$329.44
Rate for Payer: Priority Health Choice Medicaid	$313.75
Rate for Payer: Priority Health Cigna Priority Health	$685.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$741.46
Rate for Payer: Priority Health Narrow Network	$741.46
Rate for Payer: Priority Health SBD	$741.46
Rate for Payer: UMR Bronson Commercial	$450.34

PR CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ

Professional

Both

$1,796.00

Service Code	HCPCS 27502
Min. Negotiated Rate	$486.71
Max. Negotiated Rate	$1,257.20
Rate for Payer: Aetna Commercial	$1,013.42
Rate for Payer: BCBS Complete	$511.05
Rate for Payer: BCBS Trust/PPO	$878.56
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Meridian Medicaid	$511.05
Rate for Payer: Priority Health Choice Medicaid	$486.71
Rate for Payer: Priority Health Cigna Priority Health	$1,257.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,161.72
Rate for Payer: Priority Health Narrow Network	$1,161.72
Rate for Payer: Priority Health SBD	$1,161.72
Rate for Payer: UMR Bronson Commercial	$826.16

PR CLTX FX GRT TOE PHLX/PHLG W/MANJ

Professional

Both

$224.00

Service Code	HCPCS 28495
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$413.04
Rate for Payer: Aetna Commercial	$192.97
Rate for Payer: BCBS Complete	$103.33
Rate for Payer: BCBS Trust/PPO	$413.04
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Meridian Medicaid	$103.33
Rate for Payer: Priority Health Choice Medicaid	$98.41
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$229.79
Rate for Payer: Priority Health Narrow Network	$229.79
Rate for Payer: Priority Health SBD	$229.79
Rate for Payer: UMR Bronson Commercial	$103.04

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Facility

$297.00

Service Code	CPT 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$130.68
Max. Negotiated Rate	$267.30
Rate for Payer: Aetna American Axle	$193.05
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: Aetna New Business (MI Preferred)	$193.05
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$207.90
Rate for Payer: Cofinity Commercial	$255.42
Rate for Payer: Encore Health Key Benefits Commercial	$237.60
Rate for Payer: Healthscope Commercial	$267.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$207.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$222.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: PHP Commercial	$252.45
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health SBD	$187.11
Rate for Payer: UMR Bronson Commercial	$130.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$222.75

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Professional

Both

$297.00

Service Code	HCPCS 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$1,548.98
Rate for Payer: Aetna Commercial	$160.73
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$1,548.98
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.04
Rate for Payer: Priority Health Narrow Network	$194.04
Rate for Payer: Priority Health SBD	$194.04
Rate for Payer: UMR Bronson Commercial	$136.62

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Professional

Both

$297.00

Service Code	HCPCS 28490
Min. Negotiated Rate	$82.43
Max. Negotiated Rate	$1,548.98
Rate for Payer: Aetna Commercial	$160.73
Rate for Payer: BCBS Complete	$86.55
Rate for Payer: BCBS Trust/PPO	$1,548.98
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Meridian Medicaid	$86.55
Rate for Payer: Priority Health Choice Medicaid	$82.43
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.04
Rate for Payer: Priority Health Narrow Network	$194.04
Rate for Payer: Priority Health SBD	$194.04
Rate for Payer: UMR Bronson Commercial	$136.62

PR CLTX FX GRT TOE PHLX/PHLG W/O MANJ

Facility

$297.00

Service Code	CPT 28490
Hospital Charge Code	28490
Min. Negotiated Rate	$109.89
Max. Negotiated Rate	$659.87
Rate for Payer: Aetna American Axle	$193.05
Rate for Payer: Aetna Commercial	$252.45
Rate for Payer: Aetna Medicare	$218.00
Rate for Payer: Aetna New Business (MI Preferred)	$193.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$262.02
Rate for Payer: Amish Plain Church Group Commercial	$262.02
Rate for Payer: BCBS Complete	$120.41
Rate for Payer: BCBS MAPPO	$209.62
Rate for Payer: BCBS Trust/PPO	$115.30
Rate for Payer: BCN Medicare Advantage	$209.62
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cofinity Commercial	$255.42
Rate for Payer: Cofinity Commercial	$207.90
Rate for Payer: Encore Health Key Benefits Commercial	$237.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$209.62
Rate for Payer: Healthscope Commercial	$267.30
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$207.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$222.75
Rate for Payer: Mclaren Medicaid	$114.66
Rate for Payer: Mclaren Medicare	$209.62
Rate for Payer: Meridian Medicaid	$120.41
Rate for Payer: Meridian Wellcare - Medicare Advantage	$220.10
Rate for Payer: MI Amish Medical Board Commercial	$241.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$252.45
Rate for Payer: PACE Medicare	$199.14
Rate for Payer: PACE SWMI	$209.62
Rate for Payer: PHP Commercial	$252.45
Rate for Payer: PHP Medicare Advantage	$209.62
Rate for Payer: Priority Health Choice Medicaid	$114.66
Rate for Payer: Priority Health Cigna Priority Health	$207.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$659.87
Rate for Payer: Priority Health Medicare	$209.62
Rate for Payer: Priority Health Narrow Network	$527.90
Rate for Payer: Priority Health SBD	$187.11
Rate for Payer: Railroad Medicare Medicare	$209.62
Rate for Payer: UHC All Payor (Choice/PPO)	$139.39
Rate for Payer: UHC Dual Complete DSNP	$209.62
Rate for Payer: UHC Exchange	$126.72
Rate for Payer: UHC Medicare Advantage	$215.91
Rate for Payer: UMR Bronson Commercial	$109.89
Rate for Payer: VA VA	$209.62
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$222.75

PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ

Professional

Both

$363.00

Service Code	HCPCS 28515
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$423.70
Rate for Payer: Aetna Commercial	$184.71
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCBS Trust/PPO	$423.70
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health	$254.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.62
Rate for Payer: Priority Health Narrow Network	$221.62
Rate for Payer: Priority Health SBD	$221.62
Rate for Payer: UMR Bronson Commercial	$166.98

PR CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ

Professional

Both

$286.00

Service Code	HCPCS 28510
Min. Negotiated Rate	$79.88
Max. Negotiated Rate	$1,955.77
Rate for Payer: Aetna Commercial	$155.55
Rate for Payer: BCBS Complete	$83.87
Rate for Payer: BCBS Trust/PPO	$1,955.77
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Meridian Medicaid	$83.87
Rate for Payer: Priority Health Choice Medicaid	$79.88
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$186.39
Rate for Payer: Priority Health Narrow Network	$186.39
Rate for Payer: Priority Health SBD	$186.39
Rate for Payer: UMR Bronson Commercial	$131.56

PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ

Professional

Both

$855.00

Service Code	HCPCS 27824
Min. Negotiated Rate	$202.56
Max. Negotiated Rate	$3,163.99
Rate for Payer: Aetna Commercial	$405.52
Rate for Payer: BCBS Complete	$212.69
Rate for Payer: BCBS Trust/PPO	$3,163.99
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Meridian Medicaid	$212.69
Rate for Payer: Priority Health Choice Medicaid	$202.56
Rate for Payer: Priority Health Cigna Priority Health	$598.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$478.99
Rate for Payer: Priority Health Narrow Network	$478.99
Rate for Payer: Priority Health SBD	$478.99
Rate for Payer: UMR Bronson Commercial	$393.30

PR CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ

Professional

Both

$1,900.00

Service Code	HCPCS 27825
Min. Negotiated Rate	$322.27
Max. Negotiated Rate	$3,467.23
Rate for Payer: Aetna Commercial	$656.96
Rate for Payer: BCBS Complete	$338.38
Rate for Payer: BCBS Trust/PPO	$3,467.23
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Cash Price	$1,520.00
Rate for Payer: Meridian Medicaid	$338.38
Rate for Payer: Priority Health Choice Medicaid	$322.27
Rate for Payer: Priority Health Cigna Priority Health	$1,330.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$764.44
Rate for Payer: Priority Health Narrow Network	$764.44
Rate for Payer: Priority Health SBD	$764.44
Rate for Payer: UMR Bronson Commercial	$874.00

PR CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ

Professional

Both

$674.00

Service Code	HCPCS 23620
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$471.80
Rate for Payer: Aetna Commercial	$342.23
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCBS Trust/PPO	$193.36
Rate for Payer: Cash Price	$539.20
Rate for Payer: Cash Price	$539.20
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health	$471.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$409.55
Rate for Payer: Priority Health Narrow Network	$409.55
Rate for Payer: Priority Health SBD	$409.55
Rate for Payer: UMR Bronson Commercial	$310.04

PR CLTX GREATER HUMRL TUBEROSITY FX W/MANIPULATION

Professional

Both

$647.00

Service Code	HCPCS 23625
Min. Negotiated Rate	$234.51
Max. Negotiated Rate	$557.12
Rate for Payer: Aetna Commercial	$465.59
Rate for Payer: BCBS Complete	$246.24
Rate for Payer: BCBS Trust/PPO	$234.57
Rate for Payer: Cash Price	$517.60
Rate for Payer: Cash Price	$517.60
Rate for Payer: Meridian Medicaid	$246.24
Rate for Payer: Priority Health Choice Medicaid	$234.51
Rate for Payer: Priority Health Cigna Priority Health	$452.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$557.12
Rate for Payer: Priority Health Narrow Network	$557.12
Rate for Payer: Priority Health SBD	$557.12
Rate for Payer: UMR Bronson Commercial	$297.62

PR CLTX GREATER TROCHANTERIC FX W/O MANJ

Professional

Both

$878.00

Service Code	HCPCS 27246
Min. Negotiated Rate	$253.90
Max. Negotiated Rate	$1,725.43
Rate for Payer: Aetna Commercial	$514.65
Rate for Payer: BCBS Complete	$266.60
Rate for Payer: BCBS Trust/PPO	$1,725.43
Rate for Payer: Cash Price	$702.40
Rate for Payer: Cash Price	$702.40
Rate for Payer: Meridian Medicaid	$266.60
Rate for Payer: Priority Health Choice Medicaid	$253.90
Rate for Payer: Priority Health Cigna Priority Health	$614.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$601.03
Rate for Payer: Priority Health Narrow Network	$601.03
Rate for Payer: Priority Health SBD	$601.03
Rate for Payer: UMR Bronson Commercial	$403.88

PR CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA

Professional

Both

$1,920.00

Service Code	HCPCS 27252
Min. Negotiated Rate	$483.51
Max. Negotiated Rate	$2,221.50
Rate for Payer: Aetna Commercial	$1,012.43
Rate for Payer: BCBS Complete	$507.69
Rate for Payer: BCBS Trust/PPO	$2,221.50
Rate for Payer: Cash Price	$1,536.00
Rate for Payer: Cash Price	$1,536.00
Rate for Payer: Meridian Medicaid	$507.69
Rate for Payer: Priority Health Choice Medicaid	$483.51
Rate for Payer: Priority Health Cigna Priority Health	$1,344.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,157.64
Rate for Payer: Priority Health Narrow Network	$1,157.64
Rate for Payer: Priority Health SBD	$1,157.64
Rate for Payer: UMR Bronson Commercial	$883.20

PR CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA

Professional

Both

$724.00

Service Code	HCPCS 27250
Min. Negotiated Rate	$114.38
Max. Negotiated Rate	$2,156.52
Rate for Payer: Aetna Commercial	$245.86
Rate for Payer: BCBS Complete	$120.10
Rate for Payer: BCBS Trust/PPO	$2,156.52
Rate for Payer: Cash Price	$579.20
Rate for Payer: Cash Price	$579.20
Rate for Payer: Meridian Medicaid	$120.10
Rate for Payer: Priority Health Choice Medicaid	$114.38
Rate for Payer: Priority Health Cigna Priority Health	$506.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$274.21
Rate for Payer: Priority Health Narrow Network	$274.21
Rate for Payer: Priority Health SBD	$274.21
Rate for Payer: UMR Bronson Commercial	$333.04

PR CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ

Professional

Both

$666.00

Service Code	HCPCS 24576
Min. Negotiated Rate	$129.43
Max. Negotiated Rate	$492.78
Rate for Payer: Aetna Commercial	$412.52
Rate for Payer: BCBS Complete	$220.30
Rate for Payer: BCBS Trust/PPO	$129.43
Rate for Payer: Cash Price	$532.80
Rate for Payer: Cash Price	$532.80
Rate for Payer: Meridian Medicaid	$220.30
Rate for Payer: Priority Health Choice Medicaid	$209.81
Rate for Payer: Priority Health Cigna Priority Health	$466.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$492.78
Rate for Payer: Priority Health Narrow Network	$492.78
Rate for Payer: Priority Health SBD	$492.78
Rate for Payer: UMR Bronson Commercial	$306.36

PR CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ

Professional

Both

$804.00

Service Code	HCPCS 24560
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$562.80
Rate for Payer: Aetna Commercial	$391.16
Rate for Payer: BCBS Complete	$206.65
Rate for Payer: BCBS Trust/PPO	$112.00
Rate for Payer: Cash Price	$643.20
Rate for Payer: Cash Price	$643.20
Rate for Payer: Meridian Medicaid	$206.65
Rate for Payer: Priority Health Choice Medicaid	$196.81
Rate for Payer: Priority Health Cigna Priority Health	$562.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$464.69
Rate for Payer: Priority Health Narrow Network	$464.69
Rate for Payer: Priority Health SBD	$464.69
Rate for Payer: UMR Bronson Commercial	$369.84

Know your out-of-pocket cost for care.

All Charges