Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

Professional

Both

$1,175.00

Service Code	HCPCS 47542
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$763.75
Rate for Payer: Aetna Commercial	$180.97
Rate for Payer: Aetna Medicare	$587.50
Rate for Payer: BCBS Complete	$88.57
Rate for Payer: BCN Commercial	$736.44
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Meridian Medicaid	$88.57
Rate for Payer: Priority Health Choice Medicaid	$84.35
Rate for Payer: Priority Health Cigna Priority Health	$763.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$234.46
Rate for Payer: Priority Health Narrow Network	$234.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$179.71
Rate for Payer: UHC Exchange	$179.71
Rate for Payer: UHCCP Medicaid	$84.35

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$986.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$73.96
Max. Negotiated Rate	$796.77
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: Aetna Medicare	$493.00
Rate for Payer: BCBS Complete	$394.40
Rate for Payer: BCBS Trust/PPO	$73.96
Rate for Payer: BCN Commercial	$684.64
Rate for Payer: Cash Price	$788.80
Rate for Payer: Cash Price	$788.80
Rate for Payer: Priority Health Cigna Priority Health	$640.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$796.77
Rate for Payer: Priority Health Narrow Network	$796.77
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$758.41
Rate for Payer: UHC Exchange	$758.41

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

Professional

Both

$1,921.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$112.68
Max. Negotiated Rate	$4,073.19
Rate for Payer: Aetna Commercial	$233.34
Rate for Payer: Aetna Medicare	$960.50
Rate for Payer: BCBS Complete	$118.31
Rate for Payer: BCBS Trust/PPO	$4,073.19
Rate for Payer: BCN Commercial	$1,238.31
Rate for Payer: Cash Price	$1,536.80
Rate for Payer: Cash Price	$1,536.80
Rate for Payer: Meridian Medicaid	$118.31
Rate for Payer: Priority Health Choice Medicaid	$112.68
Rate for Payer: Priority Health Cigna Priority Health	$1,248.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$279.62
Rate for Payer: Priority Health Narrow Network	$279.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$229.47
Rate for Payer: UHC Exchange	$229.47
Rate for Payer: UHCCP Medicaid	$112.68

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$180.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00

PR BCN APNEALINK PLUS

Professional

Both

$753.00

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$301.20
Max. Negotiated Rate	$489.45
Rate for Payer: Aetna Medicare	$376.50
Rate for Payer: BCBS Complete	$301.20
Rate for Payer: Cash Price	$602.40
Rate for Payer: Priority Health Cigna Priority Health	$489.45

PR BCN WATCHPAT

Professional

Both

$559.00

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$223.60
Max. Negotiated Rate	$363.35
Rate for Payer: Aetna Medicare	$279.50
Rate for Payer: BCBS Complete	$223.60
Rate for Payer: Cash Price	$447.20
Rate for Payer: Priority Health Cigna Priority Health	$363.35

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: Aetna Medicare	$7.50
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	$9.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.11
Rate for Payer: UHC Exchange	$6.11

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$986.86
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS Trust/PPO	$986.86
Rate for Payer: BCN Commercial	$6.85
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.89
Rate for Payer: Priority Health Narrow Network	$8.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.64
Rate for Payer: UHC Exchange	$5.64

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$550.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$357.50
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: Aetna Medicare	$275.00
Rate for Payer: BCBS Complete	$220.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Priority Health Cigna Priority Health	$357.50

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$180.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$1,450.71
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCBS Trust/PPO	$1,450.71
Rate for Payer: BCN Commercial	$159.79
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$148.82
Rate for Payer: Priority Health Narrow Network	$148.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$103.14
Rate for Payer: UHC Exchange	$103.14

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$45.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$1,436.98
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS Trust/PPO	$1,436.98
Rate for Payer: BCN Commercial	$37.14
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.23
Rate for Payer: Priority Health Narrow Network	$27.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.13
Rate for Payer: UHC Exchange	$26.13

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$62.00

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: Aetna Medicare	$31.00
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCBS Trust/PPO	$1,118.41
Rate for Payer: BCN Commercial	$42.82
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Priority Health Cigna Priority Health	$40.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.59
Rate for Payer: Priority Health Narrow Network	$65.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.90
Rate for Payer: UHC Exchange	$54.90

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$7.28
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$3.84
Rate for Payer: BCN Commercial	$4.80
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$7.28
Rate for Payer: UHC Exchange	$7.28

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

Professional

Both

$168.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$184.91
Rate for Payer: Aetna Commercial	$48.12
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS Trust/PPO	$184.91
Rate for Payer: BCN Commercial	$117.28
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Priority Health Cigna Priority Health	$109.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.04
Rate for Payer: Priority Health Narrow Network	$65.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$48.49
Rate for Payer: UHC Exchange	$48.49

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$32.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$140.36
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$23.09
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$20.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$140.36
Rate for Payer: UHC Exchange	$140.36

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,264.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$2,121.60
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60

PR BILATERAL MASTOPEXY

Professional

Both

$3,876.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,550.40
Max. Negotiated Rate	$2,519.40
Rate for Payer: Aetna Medicare	$1,938.00
Rate for Payer: BCBS Complete	$1,550.40
Rate for Payer: Cash Price	$3,100.80
Rate for Payer: Priority Health Cigna Priority Health	$2,519.40

PR BILATERAL OTOPLASTY

Professional

Both

$3,162.00

Service Code	HCPCS 00533
Hospital Revenue Code	990
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$2,055.30
Rate for Payer: Aetna Medicare	$1,581.00
Rate for Payer: BCBS Complete	$1,264.80
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Priority Health Cigna Priority Health	$2,055.30

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,876.00

Service Code	HCPCS 00526
Hospital Revenue Code	990
Min. Negotiated Rate	$1,550.40
Max. Negotiated Rate	$2,519.40
Rate for Payer: Aetna Medicare	$1,938.00
Rate for Payer: BCBS Complete	$1,550.40
Rate for Payer: Cash Price	$3,100.80
Rate for Payer: Priority Health Cigna Priority Health	$2,519.40

PR BILATERAL THORACIC ROLL EXCISION

Professional

Both

$2,754.00

Service Code	HCPCS 00543
Hospital Revenue Code	990
Min. Negotiated Rate	$1,101.60
Max. Negotiated Rate	$1,790.10
Rate for Payer: Aetna Medicare	$1,377.00
Rate for Payer: BCBS Complete	$1,101.60
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Priority Health Cigna Priority Health	$1,790.10

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

Professional

Both

$916.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$282.23
Max. Negotiated Rate	$7,499.75
Rate for Payer: Aetna Commercial	$696.48
Rate for Payer: Aetna Medicare	$458.00
Rate for Payer: BCBS Complete	$296.34
Rate for Payer: BCBS Trust/PPO	$7,499.75
Rate for Payer: BCN Commercial	$642.61
Rate for Payer: Cash Price	$732.80
Rate for Payer: Cash Price	$732.80
Rate for Payer: Meridian Medicaid	$296.34
Rate for Payer: Priority Health Choice Medicaid	$282.23
Rate for Payer: Priority Health Cigna Priority Health	$595.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$783.93
Rate for Payer: Priority Health Narrow Network	$783.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$627.73
Rate for Payer: UHC Exchange	$627.73
Rate for Payer: UHCCP Medicaid	$282.23

PR BILIARY NDSC INTRAOPERATIVE

Professional

Both

$530.00

Service Code	HCPCS 47550
Min. Negotiated Rate	$103.31
Max. Negotiated Rate	$5,071.68
Rate for Payer: Aetna Commercial	$223.49
Rate for Payer: Aetna Medicare	$265.00
Rate for Payer: BCBS Complete	$108.48
Rate for Payer: BCBS Trust/PPO	$5,071.68
Rate for Payer: BCN Commercial	$237.49
Rate for Payer: Cash Price	$424.00
Rate for Payer: Cash Price	$424.00
Rate for Payer: Meridian Medicaid	$108.48
Rate for Payer: Priority Health Choice Medicaid	$103.31
Rate for Payer: Priority Health Cigna Priority Health	$344.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$289.34
Rate for Payer: Priority Health Narrow Network	$289.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$205.16
Rate for Payer: UHC Exchange	$205.16
Rate for Payer: UHCCP Medicaid	$103.31

PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE

Professional

Both

$102.00

Service Code	HCPCS 92504
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$2,190.33
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Trust/PPO	$2,190.33
Rate for Payer: BCN Commercial	$34.16
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12.22
Rate for Payer: Priority Health Narrow Network	$12.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.36
Rate for Payer: UHC Exchange	$10.36

PR BIOFEEDBACK PERI/URO/RECTAL

Professional

Both

$188.00

Service Code	HCPCS 90911
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$122.20
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Priority Health Cigna Priority Health	$122.20

PR BIOFEEDBACK TRAINING ANY MODALITY

Professional

Both

$128.00

Service Code	HCPCS 90901
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$724.83
Rate for Payer: Aetna Commercial	$87.36
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$724.83
Rate for Payer: BCN Commercial	$59.62
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$61.18
Rate for Payer: Priority Health Narrow Network	$61.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.76
Rate for Payer: UHC Exchange	$20.76

Know your out-of-pocket cost for care.

All Charges