Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR INJECTION EPIDURAL BLOOD/CLOT PATCH

Professional

Both

$462.00

Service Code	HCPCS 62273
Min. Negotiated Rate	$71.78
Max. Negotiated Rate	$645.05
Rate for Payer: Aetna Commercial	$145.25
Rate for Payer: BCBS Complete	$75.37
Rate for Payer: BCBS Trust/PPO	$645.05
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cash Price	$369.60
Rate for Payer: Meridian Medicaid	$75.37
Rate for Payer: Priority Health Choice Medicaid	$71.78
Rate for Payer: Priority Health Cigna Priority Health	$323.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$189.11
Rate for Payer: Priority Health Narrow Network	$189.11
Rate for Payer: Priority Health SBD	$189.11
Rate for Payer: UMR Bronson Commercial	$212.52

PR INJECTION INTRALESIONAL >7 LESIONS

Professional

Both

$120.00

Service Code	HCPCS 11901
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$185.19
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: BCBS Complete	$30.20
Rate for Payer: BCBS Trust/PPO	$185.19
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Meridian Medicaid	$30.20
Rate for Payer: Priority Health Choice Medicaid	$28.76
Rate for Payer: Priority Health Cigna Priority Health	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.49
Rate for Payer: Priority Health Narrow Network	$55.49
Rate for Payer: Priority Health SBD	$55.49
Rate for Payer: UMR Bronson Commercial	$55.20

PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS

Professional

Both

$90.00

Service Code	HCPCS 11900
Min. Negotiated Rate	$18.96
Max. Negotiated Rate	$206.51
Rate for Payer: Aetna Commercial	$32.33
Rate for Payer: BCBS Complete	$19.91
Rate for Payer: BCBS Trust/PPO	$206.51
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Meridian Medicaid	$19.91
Rate for Payer: Priority Health Choice Medicaid	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$63.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.58
Rate for Payer: Priority Health Narrow Network	$36.58
Rate for Payer: Priority Health SBD	$36.58
Rate for Payer: UMR Bronson Commercial	$41.40

PR INJECTION KNEE ARTHROGRAPHY

Professional

Both

$280.00

Service Code	HCPCS 27370
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$196.00
Rate for Payer: BCBS Complete	$112.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Priority Health Cigna Priority Health	$196.00
Rate for Payer: UMR Bronson Commercial	$128.80

PR INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM

Professional

Both

$324.00

Service Code	HCPCS 19030
Min. Negotiated Rate	$13.78
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$82.84
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$13.78
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$226.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$92.90
Rate for Payer: Priority Health Narrow Network	$92.90
Rate for Payer: Priority Health SBD	$92.90
Rate for Payer: UMR Bronson Commercial	$149.04

PR INJECTION,ONABOTULINUMTOXINA

Professional

Both

$8.00

Service Code	HCPCS J0585
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCBS Trust/PPO	$6.35
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.60
Rate for Payer: UMR Bronson Commercial	$3.68

PR INJECTION PEYRONIE DISEASE

Professional

Both

$217.00

Service Code	HCPCS 54200
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$189.66
Rate for Payer: Aetna Commercial	$107.78
Rate for Payer: BCBS Complete	$59.04
Rate for Payer: BCBS Trust/PPO	$189.66
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Meridian Medicaid	$59.04
Rate for Payer: Priority Health Choice Medicaid	$56.23
Rate for Payer: Priority Health Cigna Priority Health	$151.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.87
Rate for Payer: Priority Health Narrow Network	$138.87
Rate for Payer: Priority Health SBD	$138.87
Rate for Payer: UMR Bronson Commercial	$99.82

PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED

Professional

Both

$600.00

Service Code	HCPCS 00671
Hospital Revenue Code	990
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$420.00
Rate for Payer: BCBS Complete	$240.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Priority Health Cigna Priority Health	$420.00
Rate for Payer: UMR Bronson Commercial	$276.00

PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY

Professional

Both

$281.00

Service Code	HCPCS 24220
Min. Negotiated Rate	$41.75
Max. Negotiated Rate	$196.70
Rate for Payer: Aetna Commercial	$90.48
Rate for Payer: BCBS Complete	$43.84
Rate for Payer: BCBS Trust/PPO	$70.79
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Meridian Medicaid	$43.84
Rate for Payer: Priority Health Choice Medicaid	$41.75
Rate for Payer: Priority Health Cigna Priority Health	$196.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.60
Rate for Payer: Priority Health Narrow Network	$100.60
Rate for Payer: Priority Health SBD	$100.60
Rate for Payer: UMR Bronson Commercial	$129.26

PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR

Professional

Both

$590.00

Service Code	HCPCS 62284
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$499.24
Rate for Payer: Aetna Commercial	$109.22
Rate for Payer: BCBS Complete	$55.02
Rate for Payer: BCBS Trust/PPO	$499.24
Rate for Payer: Cash Price	$472.00
Rate for Payer: Cash Price	$472.00
Rate for Payer: Meridian Medicaid	$55.02
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health	$413.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$140.99
Rate for Payer: Priority Health Narrow Network	$140.99
Rate for Payer: Priority Health SBD	$140.99
Rate for Payer: UMR Bronson Commercial	$271.40

PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR

Professional

Both

$1,412.00

Service Code	HCPCS 62290
Min. Negotiated Rate	$98.62
Max. Negotiated Rate	$988.40
Rate for Payer: Aetna Commercial	$210.47
Rate for Payer: BCBS Complete	$103.55
Rate for Payer: BCBS Trust/PPO	$675.17
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Meridian Medicaid	$103.55
Rate for Payer: Priority Health Choice Medicaid	$98.62
Rate for Payer: Priority Health Cigna Priority Health	$988.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$263.30
Rate for Payer: Priority Health Narrow Network	$263.30
Rate for Payer: Priority Health SBD	$263.30
Rate for Payer: UMR Bronson Commercial	$649.52

PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM

Professional

Both

$447.00

Service Code	HCPCS 36002
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$797.73
Rate for Payer: Aetna Commercial	$138.71
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCBS Trust/PPO	$797.73
Rate for Payer: Cash Price	$357.60
Rate for Payer: Cash Price	$357.60
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health	$312.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.77
Rate for Payer: Priority Health Narrow Network	$162.77
Rate for Payer: Priority Health SBD	$162.77
Rate for Payer: UMR Bronson Commercial	$205.62

PR INJECTION, REMDESIVIR, 1 MG

Professional

Both

$16.32

Service Code	HCPCS J0248
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$11.42
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: BCBS Complete	$6.53
Rate for Payer: BCBS Trust/PPO	$6.17
Rate for Payer: Cash Price	$13.06
Rate for Payer: Cash Price	$13.06
Rate for Payer: Priority Health Cigna Priority Health	$11.42
Rate for Payer: UMR Bronson Commercial	$7.51

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$331.00

Service Code	CPT 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$73.02
Max. Negotiated Rate	$1,115.78
Rate for Payer: Aetna American Axle	$215.15
Rate for Payer: Aetna Commercial	$281.35
Rate for Payer: Aetna Medicare	$368.61
Rate for Payer: Aetna New Business (MI Preferred)	$215.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.04
Rate for Payer: Amish Plain Church Group Commercial	$443.04
Rate for Payer: BCBS Complete	$203.58
Rate for Payer: BCBS MAPPO	$354.43
Rate for Payer: BCBS Trust/PPO	$294.85
Rate for Payer: BCN Medicare Advantage	$354.43
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cofinity Commercial	$231.70
Rate for Payer: Cofinity Commercial	$284.66
Rate for Payer: Encore Health Key Benefits Commercial	$264.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.43
Rate for Payer: Healthscope Commercial	$297.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$231.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$248.25
Rate for Payer: Mclaren Medicaid	$193.87
Rate for Payer: Mclaren Medicare	$354.43
Rate for Payer: Meridian Medicaid	$203.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.15
Rate for Payer: MI Amish Medical Board Commercial	$407.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.35
Rate for Payer: PACE Medicare	$336.71
Rate for Payer: PACE SWMI	$354.43
Rate for Payer: PHP Commercial	$281.35
Rate for Payer: PHP Medicare Advantage	$354.43
Rate for Payer: Priority Health Choice Medicaid	$193.87
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,115.78
Rate for Payer: Priority Health Medicare	$354.43
Rate for Payer: Priority Health Narrow Network	$892.62
Rate for Payer: Priority Health SBD	$208.53
Rate for Payer: Railroad Medicare Medicare	$354.43
Rate for Payer: UHC All Payor (Choice/PPO)	$80.32
Rate for Payer: UHC Dual Complete DSNP	$354.43
Rate for Payer: UHC Exchange	$73.02
Rate for Payer: UHC Medicare Advantage	$365.06
Rate for Payer: UMR Bronson Commercial	$122.47
Rate for Payer: VA VA	$354.43
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$248.25

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$331.00

Service Code	HCPCS 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$751.77
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$751.77
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.63
Rate for Payer: Priority Health Narrow Network	$118.63
Rate for Payer: Priority Health SBD	$118.63
Rate for Payer: UMR Bronson Commercial	$152.26

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$331.00

Service Code	HCPCS 36471
Min. Negotiated Rate	$47.50
Max. Negotiated Rate	$751.77
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: BCBS Complete	$49.88
Rate for Payer: BCBS Trust/PPO	$751.77
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cash Price	$264.80
Rate for Payer: Meridian Medicaid	$49.88
Rate for Payer: Priority Health Choice Medicaid	$47.50
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.63
Rate for Payer: Priority Health Narrow Network	$118.63
Rate for Payer: Priority Health SBD	$118.63
Rate for Payer: UMR Bronson Commercial	$152.26

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Facility

$331.00

Service Code	CPT 36471
Hospital Charge Code	36471
Min. Negotiated Rate	$145.64
Max. Negotiated Rate	$297.90
Rate for Payer: Aetna American Axle	$215.15
Rate for Payer: Aetna Commercial	$281.35
Rate for Payer: Aetna New Business (MI Preferred)	$215.15
Rate for Payer: Cash Price	$264.80
Rate for Payer: Cofinity Commercial	$231.70
Rate for Payer: Cofinity Commercial	$284.66
Rate for Payer: Encore Health Key Benefits Commercial	$264.80
Rate for Payer: Healthscope Commercial	$297.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$231.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$248.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$281.35
Rate for Payer: PHP Commercial	$281.35
Rate for Payer: Priority Health Cigna Priority Health	$231.70
Rate for Payer: Priority Health SBD	$208.53
Rate for Payer: UMR Bronson Commercial	$145.64
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$248.25

PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

Professional

Both

$265.00

Service Code	HCPCS 36470
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$701.05
Rate for Payer: Aetna Commercial	$51.69
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCBS Trust/PPO	$701.05
Rate for Payer: Cash Price	$212.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Cigna Priority Health	$185.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.64
Rate for Payer: Priority Health Narrow Network	$60.64
Rate for Payer: Priority Health SBD	$60.64
Rate for Payer: UMR Bronson Commercial	$121.90

PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS

Professional

Both

$342.00

Service Code	HCPCS 46500
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$3,628.89
Rate for Payer: Aetna Commercial	$245.44
Rate for Payer: BCBS Complete	$123.90
Rate for Payer: BCBS Trust/PPO	$3,628.89
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Meridian Medicaid	$123.90
Rate for Payer: Priority Health Choice Medicaid	$118.00
Rate for Payer: Priority Health Cigna Priority Health	$239.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$326.32
Rate for Payer: Priority Health Narrow Network	$326.32
Rate for Payer: Priority Health SBD	$326.32
Rate for Payer: UMR Bronson Commercial	$157.32

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Facility

$118.00

Service Code	CPT 20552
Hospital Charge Code	20552
Hospital Revenue Code	521
Min. Negotiated Rate	$36.02
Max. Negotiated Rate	$828.79
Rate for Payer: Aetna American Axle	$76.70
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna Medicare	$273.80
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.09
Rate for Payer: Amish Plain Church Group Commercial	$329.09
Rate for Payer: BCBS Complete	$151.22
Rate for Payer: BCBS MAPPO	$263.27
Rate for Payer: BCBS Trust/PPO	$290.76
Rate for Payer: BCN Medicare Advantage	$263.27
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Encore Health Key Benefits Commercial	$94.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.27
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$82.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$88.50
Rate for Payer: Mclaren Medicaid	$144.01
Rate for Payer: Mclaren Medicare	$263.27
Rate for Payer: Meridian Medicaid	$151.22
Rate for Payer: Meridian Wellcare - Medicare Advantage	$276.43
Rate for Payer: MI Amish Medical Board Commercial	$302.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PACE Medicare	$250.11
Rate for Payer: PACE SWMI	$263.27
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: PHP Medicare Advantage	$263.27
Rate for Payer: Priority Health Choice Medicaid	$144.01
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$828.79
Rate for Payer: Priority Health Medicare	$263.27
Rate for Payer: Priority Health Narrow Network	$663.03
Rate for Payer: Priority Health SBD	$74.34
Rate for Payer: Railroad Medicare Medicare	$263.27
Rate for Payer: UHC All Payor (Choice/PPO)	$39.62
Rate for Payer: UHC Dual Complete DSNP	$263.27
Rate for Payer: UHC Exchange	$36.02
Rate for Payer: UHC Medicare Advantage	$271.17
Rate for Payer: UMR Bronson Commercial	$43.66
Rate for Payer: VA VA	$263.27
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$88.50

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Facility

$118.00

Service Code	CPT 20552
Hospital Charge Code	20552
Hospital Revenue Code	521
Min. Negotiated Rate	$51.92
Max. Negotiated Rate	$106.20
Rate for Payer: Aetna American Axle	$76.70
Rate for Payer: Aetna Commercial	$100.30
Rate for Payer: Aetna New Business (MI Preferred)	$76.70
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cofinity Commercial	$101.48
Rate for Payer: Cofinity Commercial	$82.60
Rate for Payer: Encore Health Key Benefits Commercial	$94.40
Rate for Payer: Healthscope Commercial	$106.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$82.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$88.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$100.30
Rate for Payer: PHP Commercial	$100.30
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health SBD	$74.34
Rate for Payer: UMR Bronson Commercial	$51.92
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$88.50

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$118.00

Service Code	HCPCS 20552
Hospital Charge Code	20552
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$82.60
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: BCBS Complete	$24.60
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Meridian Medicaid	$24.60
Rate for Payer: Priority Health Choice Medicaid	$23.43
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.18
Rate for Payer: Priority Health Narrow Network	$56.18
Rate for Payer: Priority Health SBD	$56.18
Rate for Payer: UMR Bronson Commercial	$54.28

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$118.00

Service Code	HCPCS 20552
Min. Negotiated Rate	$23.43
Max. Negotiated Rate	$82.60
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: BCBS Complete	$24.60
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$94.40
Rate for Payer: Cash Price	$94.40
Rate for Payer: Meridian Medicaid	$24.60
Rate for Payer: Priority Health Choice Medicaid	$23.43
Rate for Payer: Priority Health Cigna Priority Health	$82.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.18
Rate for Payer: Priority Health Narrow Network	$56.18
Rate for Payer: Priority Health SBD	$56.18
Rate for Payer: UMR Bronson Commercial	$54.28

PR INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES

Professional

Both

$139.00

Service Code	HCPCS 20553
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$97.30
Rate for Payer: Aetna Commercial	$57.07
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$37.50
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$97.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.35
Rate for Payer: Priority Health Narrow Network	$64.35
Rate for Payer: Priority Health SBD	$64.35
Rate for Payer: UMR Bronson Commercial	$63.94

PR INJECTION SINGLE TENDON ORIGIN/INSERTION

Professional

Both

$92.00

Service Code	HCPCS 20551
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$64.40
Rate for Payer: Aetna Commercial	$52.78
Rate for Payer: BCBS Complete	$25.72
Rate for Payer: BCBS Trust/PPO	$24.96
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Meridian Medicaid	$25.72
Rate for Payer: Priority Health Choice Medicaid	$24.50
Rate for Payer: Priority Health Cigna Priority Health	$64.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.24
Rate for Payer: Priority Health Narrow Network	$59.24
Rate for Payer: Priority Health SBD	$59.24
Rate for Payer: UMR Bronson Commercial	$42.32

Know your out-of-pocket cost for care.

All Charges