Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANASTOMOSIS FACIAL HYPOGLOSSAL

Professional

Both

$1,914.00

Service Code	HCPCS 64868
Min. Negotiated Rate	$553.59
Max. Negotiated Rate	$1,736.94
Rate for Payer: Aetna Commercial	$1,139.11
Rate for Payer: Aetna Medicare	$850.08
Rate for Payer: BCBS Complete	$581.27
Rate for Payer: BCBS MAPPO	$850.08
Rate for Payer: BCN Commercial	$1,484.98
Rate for Payer: BCN Medicare Advantage	$850.08
Rate for Payer: Cash Price	$1,531.20
Rate for Payer: Cash Price	$1,531.20
Rate for Payer: Cofinity Commercial	$1,224.12
Rate for Payer: Cofinity Commercial	$1,139.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$850.08
Rate for Payer: Healthscope Commercial	$1,020.10
Rate for Payer: Healthscope Whirlpool	$1,020.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$892.58
Rate for Payer: Meridian Medicaid	$581.27
Rate for Payer: Molina Medicare/Medicaid	$935.09
Rate for Payer: Nomi Health Commercial	$1,020.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,435.50
Rate for Payer: PACE SWMI	$850.08
Rate for Payer: PHP Medicare Advantage	$850.08
Rate for Payer: Priority Health Choice Medicaid	$553.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,724.77
Rate for Payer: Priority Health Medicare	$850.08
Rate for Payer: Priority Health Narrow Network	$1,724.77
Rate for Payer: Railroad Medicare Medicare	$850.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,736.94
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$850.08
Rate for Payer: UHC Exchange	$1,736.94
Rate for Payer: UHC Medicaid	$553.59
Rate for Payer: UHCCP DNSP	$850.08
Rate for Payer: UHCCP Medicaid	$553.59

PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI

Professional

Both

$4,851.00

Service Code	HCPCS 47780
Min. Negotiated Rate	$1,456.28
Max. Negotiated Rate	$4,508.20
Rate for Payer: Aetna Commercial	$3,056.49
Rate for Payer: Aetna Medicare	$2,280.96
Rate for Payer: BCBS Complete	$1,529.09
Rate for Payer: BCBS MAPPO	$2,280.96
Rate for Payer: BCN Commercial	$3,700.00
Rate for Payer: BCN Medicare Advantage	$2,280.96
Rate for Payer: Cash Price	$3,880.80
Rate for Payer: Cash Price	$3,880.80
Rate for Payer: Cofinity Commercial	$3,284.58
Rate for Payer: Cofinity Commercial	$3,056.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,280.96
Rate for Payer: Healthscope Commercial	$2,737.15
Rate for Payer: Healthscope Whirlpool	$2,737.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,395.01
Rate for Payer: Meridian Medicaid	$1,529.09
Rate for Payer: Molina Medicare/Medicaid	$2,509.06
Rate for Payer: Nomi Health Commercial	$2,737.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,638.25
Rate for Payer: PACE SWMI	$2,280.96
Rate for Payer: PHP Medicare Advantage	$2,280.96
Rate for Payer: Priority Health Choice Medicaid	$1,456.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$4,508.20
Rate for Payer: Priority Health Medicare	$2,280.96
Rate for Payer: Priority Health Narrow Network	$4,508.20
Rate for Payer: Railroad Medicare Medicare	$2,280.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,424.14
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,280.96
Rate for Payer: UHC Exchange	$4,424.14
Rate for Payer: UHC Medicaid	$1,456.28
Rate for Payer: UHCCP DNSP	$2,280.96
Rate for Payer: UHCCP Medicaid	$1,456.28

PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT

Professional

Both

$4,396.00

Service Code	HCPCS 47760
Min. Negotiated Rate	$1,325.07
Max. Negotiated Rate	$4,099.25
Rate for Payer: Aetna Commercial	$2,778.65
Rate for Payer: Aetna Medicare	$2,073.62
Rate for Payer: BCBS Complete	$1,391.32
Rate for Payer: BCBS MAPPO	$2,073.62
Rate for Payer: BCN Commercial	$3,364.36
Rate for Payer: BCN Medicare Advantage	$2,073.62
Rate for Payer: Cash Price	$3,516.80
Rate for Payer: Cash Price	$3,516.80
Rate for Payer: Cofinity Commercial	$2,986.01
Rate for Payer: Cofinity Commercial	$2,778.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,073.62
Rate for Payer: Healthscope Commercial	$2,488.34
Rate for Payer: Healthscope Whirlpool	$2,488.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,177.30
Rate for Payer: Meridian Medicaid	$1,391.32
Rate for Payer: Molina Medicare/Medicaid	$2,280.98
Rate for Payer: Nomi Health Commercial	$2,488.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,297.00
Rate for Payer: PACE SWMI	$2,073.62
Rate for Payer: PHP Medicare Advantage	$2,073.62
Rate for Payer: Priority Health Choice Medicaid	$1,325.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$4,099.25
Rate for Payer: Priority Health Medicare	$2,073.62
Rate for Payer: Priority Health Narrow Network	$4,099.25
Rate for Payer: Railroad Medicare Medicare	$2,073.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,026.60
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,073.62
Rate for Payer: UHC Exchange	$4,026.60
Rate for Payer: UHC Medicaid	$1,325.07
Rate for Payer: UHCCP DNSP	$2,073.62
Rate for Payer: UHCCP Medicaid	$1,325.07

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA

Professional

Both

$5.00

Service Code	HCPCS 01952
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA

Professional

Both

$3.00

Service Code	HCPCS 01951
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA

Professional

Both

$1.00

Service Code	HCPCS 01953
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$44.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$44.50
Rate for Payer: Priority Health Narrow Network	$44.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.00
Rate for Payer: UHC Exchange	$40.00

PR ANES ALL CAST APPLICATION RMVL/REPAIR KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL CLOSED PX UPR END TIBIA FIBULA&/PATELLA

Professional

Both

$3.00

Service Code	HCPCS 01390
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL CLSD PX RADIUS ULNA WRIST/HAND BONES

Professional

Both

$3.00

Service Code	HCPCS 01820
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL OPEN PX UPR ENDS TIBIA FIBULA&/PATELLA

Professional

Both

$4.00

Service Code	HCPCS 01392
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX INTEG MUSC&NRV HEAD NCK&PST TRNK NOS

Professional

Both

$5.00

Service Code	HCPCS 00300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES ALL PX NRV MUSC TDN FASCIA&BURSAE KNEE&/POP

Professional

Both

$4.00

Service Code	HCPCS 01320
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX NRV MUSC TDN FASCIA&BURSAE UPPER LEG

Professional

Both

$4.00

Service Code	HCPCS 01250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX NRV MUSC TDN FSCA&BRS F/ARM WRST&HND

Professional

Both

$3.00

Service Code	HCPCS 01810
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL PX NRV MUSC TND FSCA&BRS SHOULDER&AX

Professional

Both

$5.00

Service Code	HCPCS 01610
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES ALL PX VEINS UPR LEG INCLUDING EXPLORATION

Professional

Both

$3.00

Service Code	HCPCS 01260
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ARTHRS/NDSC DSTL RADIUS ULNA/WRIST/HAND NOS

Professional

Both

$3.00

Service Code	HCPCS 01830
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY

Professional

Both

$7.00

Service Code	HCPCS 01920
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES C DLVR FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$2.00

Service Code	HCPCS 01968
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.50
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.50

PR ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$5.00

Service Code	HCPCS 01969
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES CLOSED PX SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES CLSD CH PX MEDIASTSC&THRSC W/1 LUNG VNTJ

Professional

Both

$11.00

Service Code	HCPCS 00529
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$8.25
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25

PR ANES CLSD CH PX MEDIASTSC&THRSC W/O 1 LUNG VNTJ

Professional

Both

$8.00

Service Code	HCPCS 00528
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES CLSD PX HUMRL H&N STRNCLAV ACROMCLAV&SHO JT

Professional

Both

$4.00

Service Code	HCPCS 01620
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

Know your out-of-pocket cost for care.

All Charges