Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT

Professional

Both

$1,644.00

Service Code	HCPCS 28295
Min. Negotiated Rate	$388.73
Max. Negotiated Rate	$1,564.75
Rate for Payer: Aetna Commercial	$819.40
Rate for Payer: Aetna Medicare	$822.00
Rate for Payer: BCBS Complete	$408.17
Rate for Payer: BCBS Trust/PPO	$982.11
Rate for Payer: BCN Commercial	$1,564.75
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Cash Price	$1,315.20
Rate for Payer: Meridian Medicaid	$408.17
Rate for Payer: Priority Health Choice Medicaid	$388.73
Rate for Payer: Priority Health Cigna Priority Health	$1,068.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$927.65
Rate for Payer: Priority Health Narrow Network	$927.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$674.69
Rate for Payer: UHC Exchange	$674.69
Rate for Payer: UHCCP Medicaid	$388.73

PR CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT

Professional

Both

$1,911.00

Service Code	HCPCS 28298
Min. Negotiated Rate	$329.09
Max. Negotiated Rate	$1,491.48
Rate for Payer: Aetna Commercial	$662.21
Rate for Payer: Aetna Medicare	$955.50
Rate for Payer: BCBS Complete	$345.54
Rate for Payer: BCBS Trust/PPO	$1,491.48
Rate for Payer: BCN Commercial	$1,212.90
Rate for Payer: Cash Price	$1,528.80
Rate for Payer: Cash Price	$1,528.80
Rate for Payer: Meridian Medicaid	$345.54
Rate for Payer: Priority Health Choice Medicaid	$329.09
Rate for Payer: Priority Health Cigna Priority Health	$1,242.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$782.63
Rate for Payer: Priority Health Narrow Network	$782.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$597.28
Rate for Payer: UHC Exchange	$597.28
Rate for Payer: UHCCP Medicaid	$329.09

PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE

Professional

Both

$1,780.00

Service Code	HCPCS 28292
Min. Negotiated Rate	$316.52
Max. Negotiated Rate	$1,544.75
Rate for Payer: Aetna Commercial	$635.54
Rate for Payer: Aetna Medicare	$890.00
Rate for Payer: BCBS Complete	$332.35
Rate for Payer: BCBS Trust/PPO	$1,544.75
Rate for Payer: BCN Commercial	$1,011.07
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Cash Price	$1,424.00
Rate for Payer: Meridian Medicaid	$332.35
Rate for Payer: Priority Health Choice Medicaid	$316.52
Rate for Payer: Priority Health Cigna Priority Health	$1,157.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$749.04
Rate for Payer: Priority Health Narrow Network	$749.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$695.87
Rate for Payer: UHC Exchange	$695.87
Rate for Payer: UHCCP Medicaid	$316.52

PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY

Professional

Both

$2,406.00

Service Code	HCPCS 28299
Min. Negotiated Rate	$387.02
Max. Negotiated Rate	$1,563.90
Rate for Payer: Aetna Commercial	$775.94
Rate for Payer: Aetna Medicare	$1,203.00
Rate for Payer: BCBS Complete	$406.37
Rate for Payer: BCBS Trust/PPO	$1,113.66
Rate for Payer: BCN Commercial	$1,468.47
Rate for Payer: Cash Price	$1,924.80
Rate for Payer: Cash Price	$1,924.80
Rate for Payer: Meridian Medicaid	$406.37
Rate for Payer: Priority Health Choice Medicaid	$387.02
Rate for Payer: Priority Health Cigna Priority Health	$1,563.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$916.46
Rate for Payer: Priority Health Narrow Network	$916.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$808.02
Rate for Payer: UHC Exchange	$808.02
Rate for Payer: UHCCP Medicaid	$387.02

PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD

Professional

Both

$2,997.00

Service Code	HCPCS 67912
Min. Negotiated Rate	$307.79
Max. Negotiated Rate	$1,948.05
Rate for Payer: Aetna Commercial	$631.22
Rate for Payer: Aetna Medicare	$1,498.50
Rate for Payer: BCBS Complete	$323.18
Rate for Payer: BCN Commercial	$1,323.34
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Cash Price	$2,397.60
Rate for Payer: Meridian Medicaid	$323.18
Rate for Payer: Priority Health Choice Medicaid	$307.79
Rate for Payer: Priority Health Cigna Priority Health	$1,948.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$845.78
Rate for Payer: Priority Health Narrow Network	$845.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$522.82
Rate for Payer: UHC Exchange	$522.82
Rate for Payer: UHCCP Medicaid	$307.79

PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS

Professional

Both

$3,172.00

Service Code	HCPCS 44055
Min. Negotiated Rate	$957.44
Max. Negotiated Rate	$2,659.62
Rate for Payer: Aetna Commercial	$2,013.07
Rate for Payer: Aetna Medicare	$1,586.00
Rate for Payer: BCBS Complete	$1,005.31
Rate for Payer: BCBS Trust/PPO	$1,321.81
Rate for Payer: BCN Commercial	$2,163.86
Rate for Payer: Cash Price	$2,537.60
Rate for Payer: Cash Price	$2,537.60
Rate for Payer: Meridian Medicaid	$1,005.31
Rate for Payer: Priority Health Choice Medicaid	$957.44
Rate for Payer: Priority Health Cigna Priority Health	$2,061.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,659.62
Rate for Payer: Priority Health Narrow Network	$2,659.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,811.41
Rate for Payer: UHC Exchange	$1,811.41
Rate for Payer: UHCCP Medicaid	$957.44

PR COSMETIC CORRECTION OF INVERTED NIPPLES

Professional

Both

$1,530.00

Service Code	HCPCS 00557
Hospital Revenue Code	990
Min. Negotiated Rate	$612.00
Max. Negotiated Rate	$994.50
Rate for Payer: Aetna Medicare	$765.00
Rate for Payer: BCBS Complete	$612.00
Rate for Payer: Cash Price	$1,224.00
Rate for Payer: Priority Health Cigna Priority Health	$994.50

PR COSMETIC SCLEROTHERAPY

Professional

Both

$306.00

Service Code	HCPCS 00181
Hospital Revenue Code	960
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: Cash Price	$244.80
Rate for Payer: Priority Health Cigna Priority Health	$198.90

PR COSMETIC SCLEROTHERAPY/LASER

Professional

Both

$255.00

Service Code	HCPCS 00122
Hospital Revenue Code	960
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT

Professional

Both

$77.00

Service Code	HCPCS 00123
Hospital Revenue Code	960
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$50.05
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$50.05

PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG

Professional

Both

$6,256.00

Service Code	HCPCS 63064
Min. Negotiated Rate	$631.85
Max. Negotiated Rate	$4,066.40
Rate for Payer: Aetna Commercial	$2,309.28
Rate for Payer: Aetna Medicare	$3,128.00
Rate for Payer: BCBS Complete	$1,201.89
Rate for Payer: BCBS Trust/PPO	$631.85
Rate for Payer: BCN Commercial	$2,887.83
Rate for Payer: Cash Price	$5,004.80
Rate for Payer: Cash Price	$5,004.80
Rate for Payer: Meridian Medicaid	$1,201.89
Rate for Payer: Priority Health Choice Medicaid	$1,144.66
Rate for Payer: Priority Health Cigna Priority Health	$4,066.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,065.95
Rate for Payer: Priority Health Narrow Network	$3,065.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,057.65
Rate for Payer: UHC Exchange	$2,057.65
Rate for Payer: UHCCP Medicaid	$1,144.66

PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG

Professional

Both

$2,145.00

Service Code	HCPCS 63066
Min. Negotiated Rate	$132.06
Max. Negotiated Rate	$1,394.25
Rate for Payer: Aetna Commercial	$266.49
Rate for Payer: Aetna Medicare	$1,072.50
Rate for Payer: BCBS Complete	$138.66
Rate for Payer: BCBS Trust/PPO	$766.04
Rate for Payer: BCN Commercial	$330.92
Rate for Payer: Cash Price	$1,716.00
Rate for Payer: Cash Price	$1,716.00
Rate for Payer: Meridian Medicaid	$138.66
Rate for Payer: Priority Health Choice Medicaid	$132.06
Rate for Payer: Priority Health Cigna Priority Health	$1,394.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$350.89
Rate for Payer: Priority Health Narrow Network	$350.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$247.18
Rate for Payer: UHC Exchange	$247.18
Rate for Payer: UHCCP Medicaid	$132.06

PR COUDE TIP URINARY CATHETER

Professional

Both

$8.00

Service Code	HCPCS A4352
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.01
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCN Commercial	$6.01
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.44
Rate for Payer: UHC Exchange	$3.44

PR COUNSEL IMMUNE <21 16-30 M

Professional

Both

$46.00

Service Code	HCPCS G0314
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$29.90
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$29.90

PR COUNSEL IMMUNE <21 5-15 M

Professional

Both

$31.00

Service Code	HCPCS G0315
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

PR CPAP VENTILATION CPAP INITIATION&MGMT

Professional

Both

$233.00

Service Code	HCPCS 94660
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$313.28
Rate for Payer: Aetna Commercial	$41.58
Rate for Payer: Aetna Medicare	$116.50
Rate for Payer: BCBS Complete	$24.38
Rate for Payer: BCBS Trust/PPO	$313.28
Rate for Payer: BCN Commercial	$91.87
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cash Price	$186.40
Rate for Payer: Meridian Medicaid	$24.38
Rate for Payer: Priority Health Choice Medicaid	$23.22
Rate for Payer: Priority Health Cigna Priority Health	$151.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.76
Rate for Payer: Priority Health Narrow Network	$49.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$38.92
Rate for Payer: UHC Exchange	$38.92
Rate for Payer: UHCCP Medicaid	$23.22

PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO

Professional

Both

$57.00

Service Code	HCPCS 99489
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$1,256.83
Rate for Payer: Aetna Commercial	$25.42
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$32.66
Rate for Payer: BCBS Trust/PPO	$1,256.83
Rate for Payer: BCN Commercial	$74.52
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Meridian Medicaid	$32.66
Rate for Payer: Priority Health Choice Medicaid	$31.10
Rate for Payer: Priority Health Cigna Priority Health	$37.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$66.86
Rate for Payer: Priority Health Narrow Network	$66.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$48.14
Rate for Payer: UHC Exchange	$48.14
Rate for Payer: UHCCP Medicaid	$31.10

PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$10,302.00

Service Code	HCPCS 61698
Min. Negotiated Rate	$905.51
Max. Negotiated Rate	$9,419.88
Rate for Payer: Aetna Commercial	$5,979.62
Rate for Payer: Aetna Medicare	$5,151.00
Rate for Payer: BCBS Complete	$3,140.72
Rate for Payer: BCBS Trust/PPO	$905.51
Rate for Payer: BCN Commercial	$9,419.88
Rate for Payer: Cash Price	$8,241.60
Rate for Payer: Cash Price	$8,241.60
Rate for Payer: Meridian Medicaid	$3,140.72
Rate for Payer: Priority Health Choice Medicaid	$2,991.16
Rate for Payer: Priority Health Cigna Priority Health	$6,696.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,956.89
Rate for Payer: Priority Health Narrow Network	$7,956.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,377.37
Rate for Payer: UHC Exchange	$5,377.37
Rate for Payer: UHCCP Medicaid	$2,991.16

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI

Professional

Both

$510.00

Service Code	HCPCS 0055T
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$514.32
Rate for Payer: Aetna Commercial	$210.14
Rate for Payer: Aetna Medicare	$255.00
Rate for Payer: BCBS Complete	$154.02
Rate for Payer: BCBS Trust/PPO	$448.43
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Meridian Medicaid	$154.02
Rate for Payer: Priority Health Choice Medicaid	$146.69
Rate for Payer: Priority Health Cigna Priority Health	$331.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$514.32
Rate for Payer: UHC Exchange	$514.32
Rate for Payer: UHCCP Medicaid	$146.69

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES

Professional

Both

$267.00

Service Code	HCPCS 0054T
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$384.66
Rate for Payer: Aetna Commercial	$179.20
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCBS Complete	$96.34
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Meridian Medicaid	$96.34
Rate for Payer: Priority Health Choice Medicaid	$91.75
Rate for Payer: Priority Health Cigna Priority Health	$173.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$384.66
Rate for Payer: UHC Exchange	$384.66
Rate for Payer: UHCCP Medicaid	$91.75

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Facility

$283.00

Service Code	CPT 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$113.20
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$254.70
Rate for Payer: Aetna Medicare	$141.50
Rate for Payer: ASR ASR	$274.51
Rate for Payer: ASR Commercial	$274.51
Rate for Payer: BCBS Complete	$113.20
Rate for Payer: BCBS Trust/PPO	$231.75
Rate for Payer: BCN Commercial	$219.41
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cofinity Commercial	$266.02
Rate for Payer: Encore Health Key Benefits Commercial	$226.40
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: Healthscope Whirlpool	$274.51
Rate for Payer: Mclaren Commercial	$254.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$240.55
Rate for Payer: Nomi Health Commercial	$232.06
Rate for Payer: Priority Health Cigna Priority Health	$183.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$247.96
Rate for Payer: Priority Health Narrow Network	$198.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$249.04

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Professional

Both

$283.00

Service Code	HCPCS 20985
Min. Negotiated Rate	$92.23
Max. Negotiated Rate	$218.82
Rate for Payer: Aetna Commercial	$194.83
Rate for Payer: Aetna Medicare	$141.50
Rate for Payer: BCBS Complete	$96.84
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: BCN Commercial	$210.13
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$226.40
Rate for Payer: Meridian Medicaid	$96.84
Rate for Payer: Priority Health Choice Medicaid	$92.23
Rate for Payer: Priority Health Cigna Priority Health	$183.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$218.82
Rate for Payer: Priority Health Narrow Network	$218.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$175.55
Rate for Payer: UHC Exchange	$175.55
Rate for Payer: UHCCP Medicaid	$92.23

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Professional

Both

$283.00

Service Code	HCPCS 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$92.23
Max. Negotiated Rate	$218.82
Rate for Payer: Aetna Commercial	$194.83
Rate for Payer: Aetna Medicare	$141.50
Rate for Payer: BCBS Complete	$96.84
Rate for Payer: BCBS Trust/PPO	$99.81
Rate for Payer: BCN Commercial	$210.13
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cash Price	$226.40
Rate for Payer: Meridian Medicaid	$96.84
Rate for Payer: Priority Health Choice Medicaid	$92.23
Rate for Payer: Priority Health Cigna Priority Health	$183.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$218.82
Rate for Payer: Priority Health Narrow Network	$218.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$175.55
Rate for Payer: UHC Exchange	$175.55
Rate for Payer: UHCCP Medicaid	$92.23

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Facility

$283.00

Service Code	CPT 20985
Hospital Charge Code	20985
Min. Negotiated Rate	$183.95
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$254.70
Rate for Payer: ASR ASR	$274.51
Rate for Payer: ASR Commercial	$274.51
Rate for Payer: BCBS Trust/PPO	$230.62
Rate for Payer: BCN Commercial	$219.41
Rate for Payer: Cash Price	$226.40
Rate for Payer: Cofinity Commercial	$266.02
Rate for Payer: Encore Health Key Benefits Commercial	$226.40
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: Healthscope Whirlpool	$274.51
Rate for Payer: Mclaren Commercial	$254.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$240.55
Rate for Payer: Nomi Health Commercial	$232.06
Rate for Payer: Priority Health Cigna Priority Health	$183.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$249.04

PR CRANFCL ANT CRANIAL FOSSA UNI/BI CRANIOT/OSTEOT

Professional

Both

$7,294.00

Service Code	HCPCS 61582
Min. Negotiated Rate	$893.36
Max. Negotiated Rate	$6,455.95
Rate for Payer: Aetna Commercial	$3,893.94
Rate for Payer: Aetna Medicare	$3,647.00
Rate for Payer: BCBS Complete	$2,059.60
Rate for Payer: BCBS Trust/PPO	$893.36
Rate for Payer: BCN Commercial	$6,455.95
Rate for Payer: Cash Price	$5,835.20
Rate for Payer: Cash Price	$5,835.20
Rate for Payer: Meridian Medicaid	$2,059.60
Rate for Payer: Priority Health Choice Medicaid	$1,961.52
Rate for Payer: Priority Health Cigna Priority Health	$4,741.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,171.32
Rate for Payer: Priority Health Narrow Network	$5,171.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,356.93
Rate for Payer: UHC Exchange	$3,356.93
Rate for Payer: UHCCP Medicaid	$1,961.52

Know your out-of-pocket cost for care.

All Charges