Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC DEVELOPMENTAL TESTING

Facility

$379.19

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$246.47
Max. Negotiated Rate	$379.19
Rate for Payer: Aetna Commercial	$341.27
Rate for Payer: ASR ASR	$367.81
Rate for Payer: ASR Commercial	$367.81
Rate for Payer: BCBS Trust/PPO	$309.00
Rate for Payer: BCN Commercial	$293.99
Rate for Payer: Cash Price	$303.35
Rate for Payer: Cofinity Commercial	$356.44
Rate for Payer: Encore Health Key Benefits Commercial	$303.35
Rate for Payer: Healthscope Commercial	$379.19
Rate for Payer: Healthscope Whirlpool	$367.81
Rate for Payer: Mclaren Commercial	$341.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.31
Rate for Payer: Nomi Health Commercial	$310.94
Rate for Payer: Priority Health Cigna Priority Health	$246.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$333.69

HC DEVELOPMENTAL TESTING

Facility

$379.19

Service Code	CPT 96110
Hospital Charge Code	51000057
Hospital Revenue Code	761
Min. Negotiated Rate	$151.68
Max. Negotiated Rate	$379.19
Rate for Payer: Aetna Commercial	$341.27
Rate for Payer: Aetna Medicare	$189.60
Rate for Payer: ASR ASR	$367.81
Rate for Payer: ASR Commercial	$367.81
Rate for Payer: BCBS Complete	$151.68
Rate for Payer: BCBS Trust/PPO	$310.52
Rate for Payer: BCN Commercial	$293.99
Rate for Payer: Cash Price	$303.35
Rate for Payer: Cofinity Commercial	$356.44
Rate for Payer: Encore Health Key Benefits Commercial	$303.35
Rate for Payer: Healthscope Commercial	$379.19
Rate for Payer: Healthscope Whirlpool	$367.81
Rate for Payer: Mclaren Commercial	$341.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$322.31
Rate for Payer: Nomi Health Commercial	$310.94
Rate for Payer: Priority Health Cigna Priority Health	$246.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$332.25
Rate for Payer: Priority Health Narrow Network	$265.81
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$333.69

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$968.00

Service Code	HCPCS 00615
Hospital Revenue Code	270
Min. Negotiated Rate	$387.20
Max. Negotiated Rate	$629.20
Rate for Payer: Aetna Medicare	$484.00
Rate for Payer: BCBS Complete	$387.20
Rate for Payer: Cash Price	$774.40
Rate for Payer: Priority Health Cigna Priority Health	$629.20

HC DEVICE NOT RETURNED ACTIWATCH

Professional

Both

$968.00

Service Code	HCPCS 00615
Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$387.20
Max. Negotiated Rate	$629.20
Rate for Payer: Aetna Medicare	$484.00
Rate for Payer: BCBS Complete	$387.20
Rate for Payer: Cash Price	$774.40
Rate for Payer: Priority Health Cigna Priority Health	$629.20

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$616.85
Max. Negotiated Rate	$949.00
Rate for Payer: Aetna Commercial	$854.10
Rate for Payer: ASR ASR	$920.53
Rate for Payer: ASR Commercial	$920.53
Rate for Payer: BCBS Trust/PPO	$773.34
Rate for Payer: BCN Commercial	$735.76
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$892.06
Rate for Payer: Encore Health Key Benefits Commercial	$759.20
Rate for Payer: Healthscope Commercial	$949.00
Rate for Payer: Healthscope Whirlpool	$920.53
Rate for Payer: Mclaren Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$806.65
Rate for Payer: Nomi Health Commercial	$778.18
Rate for Payer: Priority Health Cigna Priority Health	$616.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$835.12

HC DEVICE NOT RETURNED ACTIWATCH

Facility

$949.00

Hospital Charge Code	27000615
Hospital Revenue Code	270
Min. Negotiated Rate	$379.60
Max. Negotiated Rate	$949.00
Rate for Payer: Aetna Commercial	$854.10
Rate for Payer: Aetna Medicare	$474.50
Rate for Payer: ASR ASR	$920.53
Rate for Payer: ASR Commercial	$920.53
Rate for Payer: BCBS Complete	$379.60
Rate for Payer: BCBS Trust/PPO	$777.14
Rate for Payer: BCN Commercial	$735.76
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cofinity Commercial	$892.06
Rate for Payer: Encore Health Key Benefits Commercial	$759.20
Rate for Payer: Healthscope Commercial	$949.00
Rate for Payer: Healthscope Whirlpool	$920.53
Rate for Payer: Mclaren Commercial	$854.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$806.65
Rate for Payer: Nomi Health Commercial	$778.18
Rate for Payer: Priority Health Cigna Priority Health	$616.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$831.51
Rate for Payer: Priority Health Narrow Network	$665.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$835.12

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Facility

$310.00

Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$201.50
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$279.00
Rate for Payer: ASR ASR	$300.70
Rate for Payer: ASR Commercial	$300.70
Rate for Payer: BCBS Trust/PPO	$252.62
Rate for Payer: BCN Commercial	$240.34
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cofinity Commercial	$291.40
Rate for Payer: Encore Health Key Benefits Commercial	$248.00
Rate for Payer: Healthscope Commercial	$310.00
Rate for Payer: Healthscope Whirlpool	$300.70
Rate for Payer: Mclaren Commercial	$279.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.50
Rate for Payer: Nomi Health Commercial	$254.20
Rate for Payer: Priority Health Cigna Priority Health	$201.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$272.80

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$316.00

Service Code	HCPCS 00616
Hospital Revenue Code	270
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$205.40
Rate for Payer: Aetna Medicare	$158.00
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: Cash Price	$252.80
Rate for Payer: Priority Health Cigna Priority Health	$205.40

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Facility

$310.00

Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$124.00
Max. Negotiated Rate	$310.00
Rate for Payer: Aetna Commercial	$279.00
Rate for Payer: Aetna Medicare	$155.00
Rate for Payer: ASR ASR	$300.70
Rate for Payer: ASR Commercial	$300.70
Rate for Payer: BCBS Complete	$124.00
Rate for Payer: BCBS Trust/PPO	$253.86
Rate for Payer: BCN Commercial	$240.34
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cofinity Commercial	$291.40
Rate for Payer: Encore Health Key Benefits Commercial	$248.00
Rate for Payer: Healthscope Commercial	$310.00
Rate for Payer: Healthscope Whirlpool	$300.70
Rate for Payer: Mclaren Commercial	$279.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.50
Rate for Payer: Nomi Health Commercial	$254.20
Rate for Payer: Priority Health Cigna Priority Health	$201.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$271.62
Rate for Payer: Priority Health Narrow Network	$217.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$272.80

HC DEVICE NOT RETURNED AIR 10 OXIMETRY

Professional

Both

$316.00

Service Code	HCPCS 00616
Hospital Charge Code	27000616
Hospital Revenue Code	270
Min. Negotiated Rate	$126.40
Max. Negotiated Rate	$205.40
Rate for Payer: Aetna Medicare	$158.00
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: Cash Price	$252.80
Rate for Payer: Priority Health Cigna Priority Health	$205.40

HC DEVICE NOT RETURNED APNEALINK

Professional

Both

$845.00

Service Code	HCPCS 00602
Hospital Revenue Code	270
Min. Negotiated Rate	$338.00
Max. Negotiated Rate	$549.25
Rate for Payer: Aetna Medicare	$422.50
Rate for Payer: BCBS Complete	$338.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Priority Health Cigna Priority Health	$549.25

HC DEVICE NOT RETURNED APNEALINK PLUS

Facility

$1,548.00

Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$1,006.20
Max. Negotiated Rate	$1,548.00
Rate for Payer: Aetna Commercial	$1,393.20
Rate for Payer: ASR ASR	$1,501.56
Rate for Payer: ASR Commercial	$1,501.56
Rate for Payer: BCBS Trust/PPO	$1,261.47
Rate for Payer: BCN Commercial	$1,200.16
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.40
Rate for Payer: Healthscope Commercial	$1,548.00
Rate for Payer: Healthscope Whirlpool	$1,501.56
Rate for Payer: Mclaren Commercial	$1,393.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,315.80
Rate for Payer: Nomi Health Commercial	$1,269.36
Rate for Payer: Priority Health Cigna Priority Health	$1,006.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,362.24

HC DEVICE NOT RETURNED APNEALINK PLUS

Professional

Both

$1,579.00

Service Code	HCPCS 00603
Hospital Revenue Code	270
Min. Negotiated Rate	$631.60
Max. Negotiated Rate	$1,026.35
Rate for Payer: Aetna Medicare	$789.50
Rate for Payer: BCBS Complete	$631.60
Rate for Payer: Cash Price	$1,263.20
Rate for Payer: Priority Health Cigna Priority Health	$1,026.35

HC DEVICE NOT RETURNED APNEALINK PLUS

Professional

Both

$1,579.00

Service Code	HCPCS 00603
Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$631.60
Max. Negotiated Rate	$1,026.35
Rate for Payer: Aetna Medicare	$789.50
Rate for Payer: BCBS Complete	$631.60
Rate for Payer: Cash Price	$1,263.20
Rate for Payer: Priority Health Cigna Priority Health	$1,026.35

HC DEVICE NOT RETURNED APNEALINK PLUS

Facility

$1,548.00

Hospital Charge Code	27000603
Hospital Revenue Code	270
Min. Negotiated Rate	$619.20
Max. Negotiated Rate	$1,548.00
Rate for Payer: Aetna Commercial	$1,393.20
Rate for Payer: Aetna Medicare	$774.00
Rate for Payer: ASR ASR	$1,501.56
Rate for Payer: ASR Commercial	$1,501.56
Rate for Payer: BCBS Complete	$619.20
Rate for Payer: BCBS Trust/PPO	$1,267.66
Rate for Payer: BCN Commercial	$1,200.16
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cofinity Commercial	$1,455.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,238.40
Rate for Payer: Healthscope Commercial	$1,548.00
Rate for Payer: Healthscope Whirlpool	$1,501.56
Rate for Payer: Mclaren Commercial	$1,393.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,315.80
Rate for Payer: Nomi Health Commercial	$1,269.36
Rate for Payer: Priority Health Cigna Priority Health	$1,006.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,356.36
Rate for Payer: Priority Health Narrow Network	$1,085.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,362.24

HC DEVICE NOT RETURNED CADD PUMP

Facility

$3,723.00

Hospital Charge Code	27000642
Hospital Revenue Code	270
Min. Negotiated Rate	$1,489.20
Max. Negotiated Rate	$3,723.00
Rate for Payer: Aetna Commercial	$3,350.70
Rate for Payer: Aetna Medicare	$1,861.50
Rate for Payer: ASR ASR	$3,611.31
Rate for Payer: ASR Commercial	$3,611.31
Rate for Payer: BCBS Complete	$1,489.20
Rate for Payer: BCBS Trust/PPO	$3,048.76
Rate for Payer: BCN Commercial	$2,886.44
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Cofinity Commercial	$3,499.62
Rate for Payer: Encore Health Key Benefits Commercial	$2,978.40
Rate for Payer: Healthscope Commercial	$3,723.00
Rate for Payer: Healthscope Whirlpool	$3,611.31
Rate for Payer: Mclaren Commercial	$3,350.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,164.55
Rate for Payer: Nomi Health Commercial	$3,052.86
Rate for Payer: Priority Health Cigna Priority Health	$2,419.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,262.09
Rate for Payer: Priority Health Narrow Network	$2,609.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,276.24

HC DEVICE NOT RETURNED CADD PUMP

Facility

$3,723.00

Hospital Charge Code	27000642
Hospital Revenue Code	270
Min. Negotiated Rate	$2,419.95
Max. Negotiated Rate	$3,723.00
Rate for Payer: Aetna Commercial	$3,350.70
Rate for Payer: ASR ASR	$3,611.31
Rate for Payer: ASR Commercial	$3,611.31
Rate for Payer: BCBS Trust/PPO	$3,033.87
Rate for Payer: BCN Commercial	$2,886.44
Rate for Payer: Cash Price	$2,978.40
Rate for Payer: Cofinity Commercial	$3,499.62
Rate for Payer: Encore Health Key Benefits Commercial	$2,978.40
Rate for Payer: Healthscope Commercial	$3,723.00
Rate for Payer: Healthscope Whirlpool	$3,611.31
Rate for Payer: Mclaren Commercial	$3,350.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,164.55
Rate for Payer: Nomi Health Commercial	$3,052.86
Rate for Payer: Priority Health Cigna Priority Health	$2,419.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,276.24

HC DEVICE NOT RETURNED HOLTER MONITOR

Facility

$652.00

Hospital Charge Code	27000705
Hospital Revenue Code	270
Min. Negotiated Rate	$260.80
Max. Negotiated Rate	$652.00
Rate for Payer: Aetna Commercial	$586.80
Rate for Payer: Aetna Medicare	$326.00
Rate for Payer: ASR ASR	$632.44
Rate for Payer: ASR Commercial	$632.44
Rate for Payer: BCBS Complete	$260.80
Rate for Payer: BCBS Trust/PPO	$533.92
Rate for Payer: BCN Commercial	$505.50
Rate for Payer: Cash Price	$521.60
Rate for Payer: Cofinity Commercial	$612.88
Rate for Payer: Encore Health Key Benefits Commercial	$521.60
Rate for Payer: Healthscope Commercial	$652.00
Rate for Payer: Healthscope Whirlpool	$632.44
Rate for Payer: Mclaren Commercial	$586.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$554.20
Rate for Payer: Nomi Health Commercial	$534.64
Rate for Payer: Priority Health Cigna Priority Health	$423.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$571.28
Rate for Payer: Priority Health Narrow Network	$457.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$573.76

HC DEVICE NOT RETURNED HOLTER MONITOR

Facility

$652.00

Hospital Charge Code	27000705
Hospital Revenue Code	270
Min. Negotiated Rate	$423.80
Max. Negotiated Rate	$652.00
Rate for Payer: Aetna Commercial	$586.80
Rate for Payer: ASR ASR	$632.44
Rate for Payer: ASR Commercial	$632.44
Rate for Payer: BCBS Trust/PPO	$531.31
Rate for Payer: BCN Commercial	$505.50
Rate for Payer: Cash Price	$521.60
Rate for Payer: Cofinity Commercial	$612.88
Rate for Payer: Encore Health Key Benefits Commercial	$521.60
Rate for Payer: Healthscope Commercial	$652.00
Rate for Payer: Healthscope Whirlpool	$632.44
Rate for Payer: Mclaren Commercial	$586.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$554.20
Rate for Payer: Nomi Health Commercial	$534.64
Rate for Payer: Priority Health Cigna Priority Health	$423.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$573.76

HC DEVICE NOT RETURNED RU SLEEPING

Facility

$495.00

Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$445.50
Rate for Payer: Aetna Medicare	$247.50
Rate for Payer: ASR ASR	$480.15
Rate for Payer: ASR Commercial	$480.15
Rate for Payer: BCBS Complete	$198.00
Rate for Payer: BCBS Trust/PPO	$405.36
Rate for Payer: BCN Commercial	$383.77
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cofinity Commercial	$465.30
Rate for Payer: Encore Health Key Benefits Commercial	$396.00
Rate for Payer: Healthscope Commercial	$495.00
Rate for Payer: Healthscope Whirlpool	$480.15
Rate for Payer: Mclaren Commercial	$445.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.75
Rate for Payer: Nomi Health Commercial	$405.90
Rate for Payer: Priority Health Cigna Priority Health	$321.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$433.72
Rate for Payer: Priority Health Narrow Network	$347.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$435.60

HC DEVICE NOT RETURNED RU SLEEPING

Professional

Both

$505.00

Service Code	HCPCS 00614
Hospital Revenue Code	270
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$328.25
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$202.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Priority Health Cigna Priority Health	$328.25

HC DEVICE NOT RETURNED RU SLEEPING

Professional

Both

$505.00

Service Code	HCPCS 00614
Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$328.25
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$202.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Priority Health Cigna Priority Health	$328.25

HC DEVICE NOT RETURNED RU SLEEPING

Facility

$495.00

Hospital Charge Code	27000614
Hospital Revenue Code	270
Min. Negotiated Rate	$321.75
Max. Negotiated Rate	$495.00
Rate for Payer: Aetna Commercial	$445.50
Rate for Payer: ASR ASR	$480.15
Rate for Payer: ASR Commercial	$480.15
Rate for Payer: BCBS Trust/PPO	$403.38
Rate for Payer: BCN Commercial	$383.77
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cofinity Commercial	$465.30
Rate for Payer: Encore Health Key Benefits Commercial	$396.00
Rate for Payer: Healthscope Commercial	$495.00
Rate for Payer: Healthscope Whirlpool	$480.15
Rate for Payer: Mclaren Commercial	$445.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.75
Rate for Payer: Nomi Health Commercial	$405.90
Rate for Payer: Priority Health Cigna Priority Health	$321.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$435.60

HC DEVICE NOT RETURNED WATCHPAT

Professional

Both

$5,049.00

Service Code	HCPCS 00604
Hospital Charge Code	27000604
Hospital Revenue Code	270
Min. Negotiated Rate	$2,019.60
Max. Negotiated Rate	$3,281.85
Rate for Payer: Aetna Medicare	$2,524.50
Rate for Payer: BCBS Complete	$2,019.60
Rate for Payer: Cash Price	$4,039.20
Rate for Payer: Priority Health Cigna Priority Health	$3,281.85

HC DEVICE NOT RETURNED WATCHPAT

Facility

$4,950.00

Hospital Charge Code	27000604
Hospital Revenue Code	270
Min. Negotiated Rate	$1,980.00
Max. Negotiated Rate	$4,950.00
Rate for Payer: Aetna Commercial	$4,455.00
Rate for Payer: Aetna Medicare	$2,475.00
Rate for Payer: ASR ASR	$4,801.50
Rate for Payer: ASR Commercial	$4,801.50
Rate for Payer: BCBS Complete	$1,980.00
Rate for Payer: BCBS Trust/PPO	$4,053.56
Rate for Payer: BCN Commercial	$3,837.74
Rate for Payer: Cash Price	$3,960.00
Rate for Payer: Cofinity Commercial	$4,653.00
Rate for Payer: Encore Health Key Benefits Commercial	$3,960.00
Rate for Payer: Healthscope Commercial	$4,950.00
Rate for Payer: Healthscope Whirlpool	$4,801.50
Rate for Payer: Mclaren Commercial	$4,455.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,207.50
Rate for Payer: Nomi Health Commercial	$4,059.00
Rate for Payer: Priority Health Cigna Priority Health	$3,217.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,337.19
Rate for Payer: Priority Health Narrow Network	$3,469.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,356.00

Know your out-of-pocket cost for care.

All Charges