Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$967.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$73.96
Max. Negotiated Rate	$793.28
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: BCBS Complete	$386.80
Rate for Payer: BCBS Trust/PPO	$73.96
Rate for Payer: BCN Commercial	$684.64
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.28
Rate for Payer: Priority Health Narrow Network	$793.28

PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

Professional

Both

$1,883.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$111.83
Max. Negotiated Rate	$4,073.19
Rate for Payer: Aetna Commercial	$235.80
Rate for Payer: Aetna Medicare	$175.97
Rate for Payer: BCBS Complete	$117.42
Rate for Payer: BCBS MAPPO	$175.97
Rate for Payer: BCBS Trust/PPO	$4,073.19
Rate for Payer: BCN Commercial	$1,238.31
Rate for Payer: BCN Medicare Advantage	$175.97
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cofinity Commercial	$253.40
Rate for Payer: Cofinity Commercial	$235.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$175.97
Rate for Payer: Healthscope Commercial	$211.16
Rate for Payer: Healthscope Whirlpool	$211.16
Rate for Payer: Meridian Medicaid	$117.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$184.77
Rate for Payer: PACE SWMI	$175.97
Rate for Payer: PHP Medicare Advantage	$175.97
Rate for Payer: Priority Health Choice Medicaid	$111.83
Rate for Payer: Priority Health Cigna Priority Health	$1,318.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.23
Rate for Payer: Priority Health Medicare	$175.97
Rate for Payer: Priority Health Narrow Network	$284.23
Rate for Payer: UHC Medicare Advantage	$181.25

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$176.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$123.20
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20

PR BCN APNEALINK PLUS

Professional

Both

$738.65

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$295.46
Max. Negotiated Rate	$517.06
Rate for Payer: BCBS Complete	$295.46
Rate for Payer: Cash Price	$590.92
Rate for Payer: Priority Health Cigna Priority Health	$517.06

PR BCN WATCHPAT

Professional

Both

$547.64

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$219.06
Max. Negotiated Rate	$383.35
Rate for Payer: BCBS Complete	$219.06
Rate for Payer: Cash Price	$438.11
Rate for Payer: Priority Health Cigna Priority Health	$383.35

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCN Commercial	$10.69
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$986.86
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare	$4.38
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS MAPPO	$4.38
Rate for Payer: BCBS Trust/PPO	$986.86
Rate for Payer: BCN Commercial	$6.85
Rate for Payer: BCN Medicare Advantage	$4.38
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cofinity Commercial	$6.31
Rate for Payer: Cofinity Commercial	$5.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.38
Rate for Payer: Healthscope Commercial	$5.26
Rate for Payer: Healthscope Whirlpool	$5.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.60
Rate for Payer: PACE SWMI	$4.38
Rate for Payer: PHP Medicare Advantage	$4.38
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.89
Rate for Payer: Priority Health Medicare	$4.38
Rate for Payer: Priority Health Narrow Network	$8.89
Rate for Payer: UHC Medicare Advantage	$4.51

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$539.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$377.30
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Priority Health Cigna Priority Health	$377.30

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$176.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$1,450.71
Rate for Payer: Aetna Commercial	$143.55
Rate for Payer: Aetna Medicare	$107.13
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS MAPPO	$107.13
Rate for Payer: BCBS Trust/PPO	$1,450.71
Rate for Payer: BCN Commercial	$159.79
Rate for Payer: BCN Medicare Advantage	$107.13
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cofinity Commercial	$154.27
Rate for Payer: Cofinity Commercial	$143.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$107.13
Rate for Payer: Healthscope Commercial	$128.56
Rate for Payer: Healthscope Whirlpool	$128.56
Rate for Payer: Meridian Wellcare - Medicare Advantage	$112.49
Rate for Payer: PACE SWMI	$107.13
Rate for Payer: PHP Medicare Advantage	$107.13
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.87
Rate for Payer: Priority Health Medicare	$107.13
Rate for Payer: Priority Health Narrow Network	$146.87
Rate for Payer: UHC Medicare Advantage	$110.34

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$44.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$1,436.98
Rate for Payer: Aetna Commercial	$30.24
Rate for Payer: Aetna Medicare	$22.57
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS MAPPO	$22.57
Rate for Payer: BCBS Trust/PPO	$1,436.98
Rate for Payer: BCN Commercial	$37.14
Rate for Payer: BCN Medicare Advantage	$22.57
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$32.50
Rate for Payer: Cofinity Commercial	$30.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.57
Rate for Payer: Healthscope Commercial	$27.08
Rate for Payer: Healthscope Whirlpool	$27.08
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23.70
Rate for Payer: PACE SWMI	$22.57
Rate for Payer: PHP Medicare Advantage	$22.57
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.23
Rate for Payer: Priority Health Medicare	$22.57
Rate for Payer: Priority Health Narrow Network	$27.23
Rate for Payer: UHC Medicare Advantage	$23.25

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$61.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$1,118.41
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$1,118.41
Rate for Payer: BCN Commercial	$42.82
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.41
Rate for Payer: Priority Health Narrow Network	$37.41

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$10.02
Rate for Payer: Aetna Commercial	$9.32
Rate for Payer: Aetna Medicare	$6.96
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS MAPPO	$6.96
Rate for Payer: BCBS Trust/PPO	$3.84
Rate for Payer: BCN Commercial	$4.80
Rate for Payer: BCN Medicare Advantage	$6.96
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$9.32
Rate for Payer: Cofinity Commercial	$10.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.96
Rate for Payer: Healthscope Commercial	$8.35
Rate for Payer: Healthscope Whirlpool	$8.35
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7.30
Rate for Payer: PACE SWMI	$6.96
Rate for Payer: PHP Medicare Advantage	$6.96
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: UHC Medicare Advantage	$7.16

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$165.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$41.84
Max. Negotiated Rate	$184.91
Rate for Payer: Aetna Commercial	$56.07
Rate for Payer: Aetna Medicare	$41.84
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS MAPPO	$41.84
Rate for Payer: BCBS Trust/PPO	$184.91
Rate for Payer: BCN Commercial	$117.28
Rate for Payer: BCN Medicare Advantage	$41.84
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cofinity Commercial	$56.07
Rate for Payer: Cofinity Commercial	$60.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$41.84
Rate for Payer: Healthscope Commercial	$50.21
Rate for Payer: Healthscope Whirlpool	$50.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$43.93
Rate for Payer: PACE SWMI	$41.84
Rate for Payer: PHP Medicare Advantage	$41.84
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.04
Rate for Payer: Priority Health Medicare	$41.84
Rate for Payer: Priority Health Narrow Network	$65.04
Rate for Payer: UHC Medicare Advantage	$43.10

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$31.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$23.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,200.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,280.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: BCBS Complete	$1,280.00
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Priority Health Cigna Priority Health	$2,240.00

PR BILATERAL MASTOPEXY

Professional

Both

$3,800.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00

PR BILATERAL OTOPLASTY

Professional

Both

$3,100.00

Service Code	HCPCS 00533
Hospital Revenue Code	990
Min. Negotiated Rate	$1,240.00
Max. Negotiated Rate	$2,170.00
Rate for Payer: BCBS Complete	$1,240.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,800.00

Service Code	HCPCS 00526
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00

PR BILATERAL THORACIC ROLL EXCISION

Professional

Both

$2,700.00

Service Code	HCPCS 00543
Hospital Revenue Code	990
Min. Negotiated Rate	$1,080.00
Max. Negotiated Rate	$1,890.00
Rate for Payer: BCBS Complete	$1,080.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Priority Health Cigna Priority Health	$1,890.00

PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$898.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$279.88
Max. Negotiated Rate	$7,499.75
Rate for Payer: Aetna Commercial	$589.55
Rate for Payer: Aetna Medicare	$439.96
Rate for Payer: BCBS Complete	$293.87
Rate for Payer: BCBS MAPPO	$439.96
Rate for Payer: BCBS Trust/PPO	$7,499.75
Rate for Payer: BCN Commercial	$642.61
Rate for Payer: BCN Medicare Advantage	$439.96
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cofinity Commercial	$589.55
Rate for Payer: Cofinity Commercial	$633.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$439.96
Rate for Payer: Healthscope Commercial	$527.95
Rate for Payer: Healthscope Whirlpool	$527.95
Rate for Payer: Meridian Medicaid	$293.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$461.96
Rate for Payer: PACE SWMI	$439.96
Rate for Payer: PHP Medicare Advantage	$439.96
Rate for Payer: Priority Health Choice Medicaid	$279.88
Rate for Payer: Priority Health Cigna Priority Health	$628.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$773.19
Rate for Payer: Priority Health Medicare	$439.96
Rate for Payer: Priority Health Narrow Network	$773.19
Rate for Payer: UHC Medicare Advantage	$453.16

PR BILIARY NDSC INTRAOPERATIVE

Professional

Both

$520.00

Service Code	HCPCS 47550
Min. Negotiated Rate	$103.31
Max. Negotiated Rate	$5,071.68
Rate for Payer: Aetna Commercial	$218.65
Rate for Payer: Aetna Medicare	$163.17
Rate for Payer: BCBS Complete	$108.48
Rate for Payer: BCBS MAPPO	$163.17
Rate for Payer: BCBS Trust/PPO	$5,071.68
Rate for Payer: BCN Commercial	$237.49
Rate for Payer: BCN Medicare Advantage	$163.17
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Cofinity Commercial	$218.65
Rate for Payer: Cofinity Commercial	$234.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$163.17
Rate for Payer: Healthscope Commercial	$195.80
Rate for Payer: Healthscope Whirlpool	$195.80
Rate for Payer: Meridian Medicaid	$108.48
Rate for Payer: Meridian Wellcare - Medicare Advantage	$171.33
Rate for Payer: PACE SWMI	$163.17
Rate for Payer: PHP Medicare Advantage	$163.17
Rate for Payer: Priority Health Choice Medicaid	$103.31
Rate for Payer: Priority Health Cigna Priority Health	$364.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$285.75
Rate for Payer: Priority Health Medicare	$163.17
Rate for Payer: Priority Health Narrow Network	$285.75
Rate for Payer: UHC Medicare Advantage	$168.07

PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE

Professional

Both

$100.00

Service Code	HCPCS 92504
Min. Negotiated Rate	$9.24
Max. Negotiated Rate	$2,190.33
Rate for Payer: Aetna Commercial	$12.38
Rate for Payer: Aetna Medicare	$9.24
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCBS MAPPO	$9.24
Rate for Payer: BCBS Trust/PPO	$2,190.33
Rate for Payer: BCN Commercial	$34.16
Rate for Payer: BCN Medicare Advantage	$9.24
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cofinity Commercial	$13.31
Rate for Payer: Cofinity Commercial	$12.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.24
Rate for Payer: Healthscope Commercial	$11.09
Rate for Payer: Healthscope Whirlpool	$11.09
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9.70
Rate for Payer: PACE SWMI	$9.24
Rate for Payer: PHP Medicare Advantage	$9.24
Rate for Payer: Priority Health Cigna Priority Health	$70.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.58
Rate for Payer: Priority Health Medicare	$9.24
Rate for Payer: Priority Health Narrow Network	$12.58
Rate for Payer: UHC Medicare Advantage	$9.52

PR BIOFEEDBACK PERI/URO/RECTAL

Professional

Both

$184.00

Service Code	HCPCS 90911
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$128.80
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Priority Health Cigna Priority Health	$128.80

PR BIOFEEDBACK TRAINING ANY MODALITY

Professional

Both

$125.00

Service Code	HCPCS 90901
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$724.83
Rate for Payer: Aetna Commercial	$24.90
Rate for Payer: Aetna Medicare	$18.58
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCBS MAPPO	$18.58
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: BCN Commercial	$59.62
Rate for Payer: BCN Medicare Advantage	$18.58
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cofinity Commercial	$24.90
Rate for Payer: Cofinity Commercial	$26.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.58
Rate for Payer: Healthscope Commercial	$22.30
Rate for Payer: Healthscope Whirlpool	$22.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$19.51
Rate for Payer: PACE SWMI	$18.58
Rate for Payer: PHP Medicare Advantage	$18.58
Rate for Payer: Priority Health Cigna Priority Health	$87.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.18
Rate for Payer: Priority Health Medicare	$18.58
Rate for Payer: Priority Health Narrow Network	$61.18
Rate for Payer: UHC Medicare Advantage	$19.14

PR BIOPSY BONE OPEN DEEP

Professional

Both

$1,239.00

Service Code	HCPCS 20245
Min. Negotiated Rate	$106.88
Max. Negotiated Rate	$867.30
Rate for Payer: Aetna Commercial	$455.16
Rate for Payer: Aetna Medicare	$339.67
Rate for Payer: BCBS Complete	$229.25
Rate for Payer: BCBS MAPPO	$339.67
Rate for Payer: BCBS Trust/PPO	$106.88
Rate for Payer: BCN Commercial	$499.92
Rate for Payer: BCN Medicare Advantage	$339.67
Rate for Payer: Cash Price	$991.20
Rate for Payer: Cash Price	$991.20
Rate for Payer: Cofinity Commercial	$489.12
Rate for Payer: Cofinity Commercial	$455.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$339.67
Rate for Payer: Healthscope Commercial	$407.60
Rate for Payer: Healthscope Whirlpool	$407.60
Rate for Payer: Meridian Medicaid	$229.25
Rate for Payer: Meridian Wellcare - Medicare Advantage	$356.65
Rate for Payer: PACE SWMI	$339.67
Rate for Payer: PHP Medicare Advantage	$339.67
Rate for Payer: Priority Health Choice Medicaid	$218.33
Rate for Payer: Priority Health Cigna Priority Health	$867.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$522.40
Rate for Payer: Priority Health Medicare	$339.67
Rate for Payer: Priority Health Narrow Network	$522.40
Rate for Payer: UHC Medicare Advantage	$349.86

Know your out-of-pocket cost for care.

All Charges