Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR HAIR REDUC UDR ARMS OR BUTTOCKS

Professional

Both

$50.00

Service Code	HCPCS 00064
Hospital Revenue Code	990
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00

PR HAIR REDUC UP/LOW LEGS

Professional

Both

$200.00

Service Code	HCPCS 00065
Hospital Revenue Code	990
Min. Negotiated Rate	$80.00
Max. Negotiated Rate	$140.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Priority Health Cigna Priority Health	$140.00

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

Professional

Both

$1,441.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$309.28
Max. Negotiated Rate	$1,803.62
Rate for Payer: Aetna Commercial	$635.33
Rate for Payer: Aetna Medicare	$474.13
Rate for Payer: BCBS Complete	$324.74
Rate for Payer: BCBS MAPPO	$474.13
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: BCN Commercial	$1,013.03
Rate for Payer: BCN Medicare Advantage	$474.13
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cofinity Commercial	$682.75
Rate for Payer: Cofinity Commercial	$635.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$474.13
Rate for Payer: Healthscope Commercial	$568.96
Rate for Payer: Healthscope Whirlpool	$568.96
Rate for Payer: Meridian Medicaid	$324.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$497.84
Rate for Payer: PACE SWMI	$474.13
Rate for Payer: PHP Medicare Advantage	$474.13
Rate for Payer: Priority Health Choice Medicaid	$309.28
Rate for Payer: Priority Health Cigna Priority Health	$1,008.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$737.38
Rate for Payer: Priority Health Medicare	$474.13
Rate for Payer: Priority Health Narrow Network	$737.38
Rate for Payer: UHC Medicare Advantage	$488.35

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

Professional

Both

$1,212.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$297.77
Max. Negotiated Rate	$2,027.62
Rate for Payer: Aetna Commercial	$602.61
Rate for Payer: Aetna Medicare	$449.71
Rate for Payer: BCBS Complete	$312.66
Rate for Payer: BCBS MAPPO	$449.71
Rate for Payer: BCBS Trust/PPO	$2,027.62
Rate for Payer: BCN Commercial	$1,002.27
Rate for Payer: BCN Medicare Advantage	$449.71
Rate for Payer: Cash Price	$969.60
Rate for Payer: Cash Price	$969.60
Rate for Payer: Cofinity Commercial	$602.61
Rate for Payer: Cofinity Commercial	$647.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$449.71
Rate for Payer: Healthscope Commercial	$539.65
Rate for Payer: Healthscope Whirlpool	$539.65
Rate for Payer: Meridian Medicaid	$312.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$472.20
Rate for Payer: PACE SWMI	$449.71
Rate for Payer: PHP Medicare Advantage	$449.71
Rate for Payer: Priority Health Choice Medicaid	$297.77
Rate for Payer: Priority Health Cigna Priority Health	$848.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$702.15
Rate for Payer: Priority Health Medicare	$449.71
Rate for Payer: Priority Health Narrow Network	$702.15
Rate for Payer: UHC Medicare Advantage	$463.20

PR HAMMER TOE CREST FELT - LARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00044
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - LARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00045
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - MEDIUM LT

Professional

Both

$7.00

Service Code	HCPCS 00042
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - MEDIUM RT

Professional

Both

$7.00

Service Code	HCPCS 00043
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - SMALL LT

Professional

Both

$7.00

Service Code	HCPCS 00040
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - SMALL RT

Professional

Both

$7.00

Service Code	HCPCS 00041
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - XLARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00046
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAMMER TOE CREST FELT - XLARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00047
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.90
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.90

PR HAND-HELD PEFR METER

Professional

Both

$50.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$35.00
Rate for Payer: Aetna Commercial	$22.15
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCN Commercial	$26.19
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$35.00

PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

Professional

Both

$16.00

Service Code	HCPCS 99000
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$595.92
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Complete	$15.66
Rate for Payer: BCBS Trust/PPO	$595.92
Rate for Payer: BCN Commercial	$10.15
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Meridian Medicaid	$15.66
Rate for Payer: Priority Health Choice Medicaid	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$11.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.18
Rate for Payer: Priority Health Narrow Network	$7.18

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$84.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$58.80
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Priority Health Cigna Priority Health	$58.80

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,120.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$213.21
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$452.84
Rate for Payer: Aetna Medicare	$337.94
Rate for Payer: BCBS Complete	$223.87
Rate for Payer: BCBS MAPPO	$337.94
Rate for Payer: BCBS Trust/PPO	$987.92
Rate for Payer: BCN Commercial	$488.19
Rate for Payer: BCN Medicare Advantage	$337.94
Rate for Payer: Cash Price	$896.00
Rate for Payer: Cash Price	$896.00
Rate for Payer: Cofinity Commercial	$486.63
Rate for Payer: Cofinity Commercial	$452.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$337.94
Rate for Payer: Healthscope Commercial	$405.53
Rate for Payer: Healthscope Whirlpool	$405.53
Rate for Payer: Meridian Medicaid	$223.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$354.84
Rate for Payer: PACE SWMI	$337.94
Rate for Payer: PHP Medicare Advantage	$337.94
Rate for Payer: Priority Health Choice Medicaid	$213.21
Rate for Payer: Priority Health Cigna Priority Health	$784.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$531.42
Rate for Payer: Priority Health Medicare	$337.94
Rate for Payer: Priority Health Narrow Network	$531.42
Rate for Payer: UHC Medicare Advantage	$348.08

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$544.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$79.66
Max. Negotiated Rate	$386.55
Rate for Payer: Aetna Commercial	$163.09
Rate for Payer: Aetna Medicare	$121.71
Rate for Payer: BCBS Complete	$83.64
Rate for Payer: BCBS MAPPO	$121.71
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: BCN Commercial	$386.55
Rate for Payer: BCN Medicare Advantage	$121.71
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cash Price	$435.20
Rate for Payer: Cofinity Commercial	$175.26
Rate for Payer: Cofinity Commercial	$163.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$121.71
Rate for Payer: Healthscope Commercial	$146.05
Rate for Payer: Healthscope Whirlpool	$146.05
Rate for Payer: Meridian Medicaid	$83.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$127.80
Rate for Payer: PACE SWMI	$121.71
Rate for Payer: PHP Medicare Advantage	$121.71
Rate for Payer: Priority Health Choice Medicaid	$79.66
Rate for Payer: Priority Health Cigna Priority Health	$380.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$151.26
Rate for Payer: Priority Health Medicare	$121.71
Rate for Payer: Priority Health Narrow Network	$151.26
Rate for Payer: UHC Medicare Advantage	$125.36

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,105.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$197.66
Max. Negotiated Rate	$777.66
Rate for Payer: Aetna Commercial	$419.88
Rate for Payer: Aetna Medicare	$313.34
Rate for Payer: BCBS Complete	$207.54
Rate for Payer: BCBS MAPPO	$313.34
Rate for Payer: BCBS Trust/PPO	$777.66
Rate for Payer: BCN Commercial	$451.54
Rate for Payer: BCN Medicare Advantage	$313.34
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cofinity Commercial	$451.21
Rate for Payer: Cofinity Commercial	$419.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$313.34
Rate for Payer: Healthscope Commercial	$376.01
Rate for Payer: Healthscope Whirlpool	$376.01
Rate for Payer: Meridian Medicaid	$207.54
Rate for Payer: Meridian Wellcare - Medicare Advantage	$329.01
Rate for Payer: PACE SWMI	$313.34
Rate for Payer: PHP Medicare Advantage	$313.34
Rate for Payer: Priority Health Choice Medicaid	$197.66
Rate for Payer: Priority Health Cigna Priority Health	$773.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$491.53
Rate for Payer: Priority Health Medicare	$313.34
Rate for Payer: Priority Health Narrow Network	$491.53
Rate for Payer: UHC Medicare Advantage	$322.74

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$158.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$210.30
Rate for Payer: Aetna Medicare	$156.94
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: BCBS MAPPO	$156.94
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: BCN Commercial	$248.25
Rate for Payer: BCN Medicare Advantage	$156.94
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cofinity Commercial	$210.30
Rate for Payer: Cofinity Commercial	$225.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$156.94
Rate for Payer: Healthscope Commercial	$188.33
Rate for Payer: Healthscope Whirlpool	$188.33
Rate for Payer: Meridian Wellcare - Medicare Advantage	$164.79
Rate for Payer: PACE SWMI	$156.94
Rate for Payer: PHP Medicare Advantage	$156.94
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$228.17
Rate for Payer: Priority Health Medicare	$156.94
Rate for Payer: Priority Health Narrow Network	$228.17
Rate for Payer: UHC Medicare Advantage	$161.65

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$41.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$28.70
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$28.70

PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS

Professional

Both

$40.00

Service Code	HCPCS 96151
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$28.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT

Professional

Both

$38.00

Service Code	HCPCS 96155
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT

Professional

Both

$37.00

Service Code	HCPCS 96154
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$25.90
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$25.90

PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

Professional

Both

$38.00

Service Code	HCPCS 96152
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$26.60
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60

PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$194.00

Service Code	HCPCS 96156
Min. Negotiated Rate	$56.02
Max. Negotiated Rate	$137.32
Rate for Payer: Aetna Commercial	$111.94
Rate for Payer: Aetna Medicare	$83.54
Rate for Payer: BCBS Complete	$58.82
Rate for Payer: BCBS MAPPO	$83.54
Rate for Payer: BCBS Trust/PPO	$135.77
Rate for Payer: BCN Commercial	$137.32
Rate for Payer: BCN Medicare Advantage	$83.54
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cofinity Commercial	$120.30
Rate for Payer: Cofinity Commercial	$111.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$83.54
Rate for Payer: Healthscope Commercial	$100.25
Rate for Payer: Healthscope Whirlpool	$100.25
Rate for Payer: Meridian Medicaid	$58.82
Rate for Payer: Meridian Wellcare - Medicare Advantage	$87.72
Rate for Payer: PACE SWMI	$83.54
Rate for Payer: PHP Medicare Advantage	$83.54
Rate for Payer: Priority Health Choice Medicaid	$56.02
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$111.84
Rate for Payer: Priority Health Medicare	$83.54
Rate for Payer: Priority Health Narrow Network	$111.84
Rate for Payer: UHC Medicare Advantage	$86.05

Know your out-of-pocket cost for care.

All Charges