Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR ANES URGENT HYSTERECTOMY FOLLOWING DELIVERY

Professional

Both

$8.00

Service Code	HCPCS 01962
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES VASECTOMY UNI/BI INCL OPEN URETHRAL PX

Professional

Both

$3.00

Service Code	HCPCS 00921
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR ANES VEINS FOREARM WRIST & HAND PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01852
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH

Professional

Both

$5.00

Service Code	HCPCS 01522
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR ANES VEINS OF UPPER LEG INCLUDING EXPLORATION

Professional

Both

$3.00

Service Code	HCPCS 01260
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR ANES VENOUS/LYMPHATIC NOS THER IVNTL RAD NOS

Professional

Both

$5.00

Service Code	HCPCS 01930
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR ANES XTRNL MID & INNER EAR W/BX TYMPANOTOMY

Professional

Both

$4.00

Service Code	HCPCS 00126
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES XTRPRTL LOWER ABD UR TRACT RENAL DON NFRCT

Professional

Both

$7.00

Service Code	HCPCS 00862
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR ANES XTRPRTL LOWER ABD W/URIN TRACT ADRENLECTOMY

Professional

Both

$10.00

Service Code	HCPCS 00866
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR ANES XTRPRTL LWER ABD W/URINARY TRACT TOT CYSTEC

Professional

Both

$8.00

Service Code	HCPCS 00864
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES XTRPRTL LWR ABD W/URINARY TRACT RAD PRSTECT

Professional

Both

$7.00

Service Code	HCPCS 00865
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR ANES XTRPRTL LWR ABD W/URIN TRACT CSTOLITHOTOMY

Professional

Both

$5.00

Service Code	HCPCS 00870
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR ANES XTRPRTL LWR ABD W/URIN TRACT RENAL TRANSPL

Professional

Both

$10.00

Service Code	HCPCS 00868
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR ANKLE CONTROL ORTHO PRE OTS

Professional

Both

$95.00

Service Code	HCPCS L4350
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$91.87
Rate for Payer: Aetna Commercial	$58.28
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: BCN Commercial	$91.87
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Priority Health Cigna Priority Health	$61.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.57
Rate for Payer: UHC Exchange	$52.57

PR ANKLE DISARTICULATION

Professional

Both

$1,336.00

Service Code	HCPCS 27889
Min. Negotiated Rate	$410.24
Max. Negotiated Rate	$1,940.55
Rate for Payer: Aetna Commercial	$853.82
Rate for Payer: Aetna Medicare	$668.00
Rate for Payer: BCBS Complete	$430.75
Rate for Payer: BCBS Trust/PPO	$1,940.55
Rate for Payer: BCN Commercial	$924.57
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Meridian Medicaid	$430.75
Rate for Payer: Priority Health Choice Medicaid	$410.24
Rate for Payer: Priority Health Cigna Priority Health	$868.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$975.99
Rate for Payer: Priority Health Narrow Network	$975.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$815.21
Rate for Payer: UHC Exchange	$815.21
Rate for Payer: UHCCP Medicaid	$410.24

PR ANN BREAST EXAM

Professional

Both

$20.00

Service Code	HCPCS S0613
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$79.25
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$79.25
Rate for Payer: BCN Commercial	$18.94
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00

PR ANNUAL GYNECOLOGICAL EXAMINA

Professional

Both

$81.00

Service Code	HCPCS S0612
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$176.98
Rate for Payer: Aetna Commercial	$55.00
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCBS Trust/PPO	$176.98
Rate for Payer: BCN Commercial	$65.39
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Priority Health Cigna Priority Health	$52.65

PR ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG

Professional

Both

$268.00

Service Code	HCPCS 99170
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$820.45
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare	$134.00
Rate for Payer: BCBS Complete	$56.13
Rate for Payer: BCBS Trust/PPO	$820.45
Rate for Payer: BCN Commercial	$236.52
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Meridian Medicaid	$56.13
Rate for Payer: Priority Health Choice Medicaid	$53.46
Rate for Payer: Priority Health Cigna Priority Health	$174.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.53
Rate for Payer: Priority Health Narrow Network	$113.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.20
Rate for Payer: UHC Exchange	$100.20
Rate for Payer: UHCCP Medicaid	$53.46

PR ANOPLASTY PLASTIC OPERATION STRICTURE ADULT

Professional

Both

$1,349.00

Service Code	HCPCS 46700
Min. Negotiated Rate	$272.07
Max. Negotiated Rate	$1,172.90
Rate for Payer: Aetna Commercial	$877.26
Rate for Payer: Aetna Medicare	$674.50
Rate for Payer: BCBS Complete	$444.39
Rate for Payer: BCBS Trust/PPO	$272.07
Rate for Payer: BCN Commercial	$958.78
Rate for Payer: Cash Price	$1,079.20
Rate for Payer: Cash Price	$1,079.20
Rate for Payer: Meridian Medicaid	$444.39
Rate for Payer: Priority Health Choice Medicaid	$423.23
Rate for Payer: Priority Health Cigna Priority Health	$876.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,172.90
Rate for Payer: Priority Health Narrow Network	$1,172.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$756.81
Rate for Payer: UHC Exchange	$756.81
Rate for Payer: UHCCP Medicaid	$423.23

PR ANOPLASTY PLASTIC OPERATION STRICTURE INFANT

Professional

Both

$1,425.00

Service Code	HCPCS 46705
Min. Negotiated Rate	$137.36
Max. Negotiated Rate	$1,031.51
Rate for Payer: Aetna Commercial	$764.79
Rate for Payer: Aetna Medicare	$712.50
Rate for Payer: BCBS Complete	$391.17
Rate for Payer: BCBS Trust/PPO	$137.36
Rate for Payer: BCN Commercial	$841.50
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Cash Price	$1,140.00
Rate for Payer: Meridian Medicaid	$391.17
Rate for Payer: Priority Health Choice Medicaid	$372.54
Rate for Payer: Priority Health Cigna Priority Health	$926.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,031.51
Rate for Payer: Priority Health Narrow Network	$1,031.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$579.58
Rate for Payer: UHC Exchange	$579.58
Rate for Payer: UHCCP Medicaid	$372.54

PR ANORECTAL MANOMETRY

Professional

Both

$393.00

Service Code	HCPCS 91122
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$1,146.94
Rate for Payer: Aetna Commercial	$290.91
Rate for Payer: Aetna Medicare	$196.50
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCBS Trust/PPO	$1,146.94
Rate for Payer: BCN Commercial	$401.69
Rate for Payer: Cash Price	$314.40
Rate for Payer: Cash Price	$314.40
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health	$255.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$116.69
Rate for Payer: Priority Health Narrow Network	$116.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$229.06
Rate for Payer: UHC Exchange	$229.06
Rate for Payer: UHCCP Medicaid	$54.95

PR ANORECTAL MYOMECTOMY

Professional

Both

$1,665.00

Service Code	HCPCS 45108
Min. Negotiated Rate	$243.89
Max. Negotiated Rate	$1,082.25
Rate for Payer: Aetna Commercial	$499.66
Rate for Payer: Aetna Medicare	$832.50
Rate for Payer: BCBS Complete	$256.08
Rate for Payer: BCBS Trust/PPO	$359.24
Rate for Payer: BCN Commercial	$549.27
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Cash Price	$1,332.00
Rate for Payer: Meridian Medicaid	$256.08
Rate for Payer: Priority Health Choice Medicaid	$243.89
Rate for Payer: Priority Health Cigna Priority Health	$1,082.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$677.74
Rate for Payer: Priority Health Narrow Network	$677.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$424.46
Rate for Payer: UHC Exchange	$424.46
Rate for Payer: UHCCP Medicaid	$243.89

PR ANOSCOPY ABLATION LESION

Professional

Both

$670.00

Service Code	HCPCS 46615
Min. Negotiated Rate	$57.94
Max. Negotiated Rate	$435.50
Rate for Payer: Aetna Commercial	$121.05
Rate for Payer: Aetna Medicare	$335.00
Rate for Payer: BCBS Complete	$60.84
Rate for Payer: BCBS Trust/PPO	$245.13
Rate for Payer: BCN Commercial	$261.44
Rate for Payer: Cash Price	$536.00
Rate for Payer: Cash Price	$536.00
Rate for Payer: Meridian Medicaid	$60.84
Rate for Payer: Priority Health Choice Medicaid	$57.94
Rate for Payer: Priority Health Cigna Priority Health	$435.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$161.68
Rate for Payer: Priority Health Narrow Network	$161.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$114.65
Rate for Payer: UHC Exchange	$114.65
Rate for Payer: UHCCP Medicaid	$57.94

PR ANOSCOPY CONTROL BLEEDING

Professional

Both

$639.00

Service Code	HCPCS 46614
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$415.35
Rate for Payer: Aetna Commercial	$84.49
Rate for Payer: Aetna Medicare	$319.50
Rate for Payer: BCBS Complete	$43.62
Rate for Payer: BCBS Trust/PPO	$241.96
Rate for Payer: BCN Commercial	$249.71
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Meridian Medicaid	$43.62
Rate for Payer: Priority Health Choice Medicaid	$41.54
Rate for Payer: Priority Health Cigna Priority Health	$415.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.13
Rate for Payer: Priority Health Narrow Network	$115.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$79.01
Rate for Payer: UHC Exchange	$79.01
Rate for Payer: UHCCP Medicaid	$41.54

PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Professional

Both

$245.00

Service Code	HCPCS 46600
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$2,291.24
Rate for Payer: Aetna Commercial	$53.23
Rate for Payer: Aetna Medicare	$122.50
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCBS Trust/PPO	$2,291.24
Rate for Payer: BCN Commercial	$141.36
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health	$159.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$73.98
Rate for Payer: Priority Health Narrow Network	$73.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.08
Rate for Payer: UHC Exchange	$46.08
Rate for Payer: UHCCP Medicaid	$26.63

Know your out-of-pocket cost for care.

All Charges