Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR DELAY FLAP/SECTIONING FLAP TRUNK

Professional

Both

$529.00

Service Code	HCPCS 15600
Min. Negotiated Rate	$198.78
Max. Negotiated Rate	$343.85
Rate for Payer: Aetna Commercial	$266.37
Rate for Payer: Aetna Medicare	$198.78
Rate for Payer: BCBS Complete	$211.60
Rate for Payer: BCBS MAPPO	$198.78
Rate for Payer: BCN Medicare Advantage	$198.78
Rate for Payer: Cash Price	$423.20
Rate for Payer: Cash Price	$423.20
Rate for Payer: Cofinity Commercial	$286.24
Rate for Payer: Cofinity Commercial	$266.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$198.78
Rate for Payer: Healthscope Commercial	$238.54
Rate for Payer: Healthscope Whirlpool	$238.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$208.72
Rate for Payer: Nomi Health Commercial	$238.54
Rate for Payer: PACE SWMI	$198.78
Rate for Payer: PHP Medicare Advantage	$198.78
Rate for Payer: Priority Health Cigna Priority Health	$343.85
Rate for Payer: Priority Health Medicare	$198.78
Rate for Payer: UHC Dual Complete DSNP	$198.78
Rate for Payer: UHC Medicare Advantage	$198.78
Rate for Payer: UHCCP DNSP	$198.78

PR DELIVERY/BIRTHING ROOM RESUSCITATION

Professional

Both

$465.00

Service Code	HCPCS 99465
Min. Negotiated Rate	$133.60
Max. Negotiated Rate	$302.25
Rate for Payer: Aetna Commercial	$179.02
Rate for Payer: Aetna Medicare	$133.60
Rate for Payer: BCBS Complete	$186.00
Rate for Payer: BCBS MAPPO	$133.60
Rate for Payer: BCN Medicare Advantage	$133.60
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cofinity Commercial	$192.38
Rate for Payer: Cofinity Commercial	$179.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$133.60
Rate for Payer: Healthscope Commercial	$146.96
Rate for Payer: Healthscope Whirlpool	$146.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.28
Rate for Payer: Nomi Health Commercial	$160.32
Rate for Payer: PACE SWMI	$133.60
Rate for Payer: PHP Medicare Advantage	$133.60
Rate for Payer: Priority Health Cigna Priority Health	$302.25
Rate for Payer: Priority Health Medicare	$133.60
Rate for Payer: UHC Dual Complete DSNP	$133.60
Rate for Payer: UHC Medicare Advantage	$133.60
Rate for Payer: UHCCP DNSP	$133.60

PR DELIVERY PLACENTA SEPARATE PROCEDURE

Professional

Both

$259.00

Service Code	HCPCS 59414
Min. Negotiated Rate	$89.32
Max. Negotiated Rate	$168.35
Rate for Payer: Aetna Commercial	$119.69
Rate for Payer: Aetna Medicare	$89.32
Rate for Payer: BCBS Complete	$103.60
Rate for Payer: BCBS MAPPO	$89.32
Rate for Payer: BCN Medicare Advantage	$89.32
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cofinity Commercial	$128.62
Rate for Payer: Cofinity Commercial	$119.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$89.32
Rate for Payer: Healthscope Commercial	$107.18
Rate for Payer: Healthscope Whirlpool	$107.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$93.79
Rate for Payer: Nomi Health Commercial	$107.18
Rate for Payer: PACE SWMI	$89.32
Rate for Payer: PHP Medicare Advantage	$89.32
Rate for Payer: Priority Health Cigna Priority Health	$168.35
Rate for Payer: Priority Health Medicare	$89.32
Rate for Payer: UHC Dual Complete DSNP	$89.32
Rate for Payer: UHC Medicare Advantage	$89.32
Rate for Payer: UHCCP DNSP	$89.32

PR DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP

Professional

Both

$56.00

Service Code	HCPCS 94664
Min. Negotiated Rate	$16.08
Max. Negotiated Rate	$36.40
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: Aetna Medicare	$16.08
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCBS MAPPO	$16.08
Rate for Payer: BCN Medicare Advantage	$16.08
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cofinity Commercial	$23.16
Rate for Payer: Cofinity Commercial	$21.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.08
Rate for Payer: Healthscope Commercial	$19.30
Rate for Payer: Healthscope Whirlpool	$19.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.88
Rate for Payer: Nomi Health Commercial	$19.30
Rate for Payer: PACE SWMI	$16.08
Rate for Payer: PHP Medicare Advantage	$16.08
Rate for Payer: Priority Health Cigna Priority Health	$36.40
Rate for Payer: Priority Health Medicare	$16.08
Rate for Payer: UHC Dual Complete DSNP	$16.08
Rate for Payer: UHC Medicare Advantage	$16.08
Rate for Payer: UHCCP DNSP	$16.08

PR DENOSUMAB INJECTION

Professional

Both

$26.00

Service Code	HCPCS J0897
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$42.31
Rate for Payer: Aetna Commercial	$39.37
Rate for Payer: Aetna Medicare	$29.38
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCBS MAPPO	$29.38
Rate for Payer: BCN Medicare Advantage	$29.38
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cofinity Commercial	$42.31
Rate for Payer: Cofinity Commercial	$39.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$29.38
Rate for Payer: Healthscope Commercial	$35.26
Rate for Payer: Healthscope Whirlpool	$35.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.85
Rate for Payer: Nomi Health Commercial	$35.26
Rate for Payer: PACE SWMI	$29.38
Rate for Payer: PHP Medicare Advantage	$29.38
Rate for Payer: Priority Health Cigna Priority Health	$16.90
Rate for Payer: Priority Health Medicare	$29.38
Rate for Payer: UHC Dual Complete DSNP	$29.38
Rate for Payer: UHC Medicare Advantage	$29.38
Rate for Payer: UHCCP DNSP	$29.38

PR DEPO-ESTRADIOL CYPIONATE INJ

Professional

Both

$17.00

Service Code	HCPCS J1000
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$70.96
Rate for Payer: Aetna Commercial	$66.04
Rate for Payer: Aetna Medicare	$49.28
Rate for Payer: BCBS Complete	$6.80
Rate for Payer: BCBS MAPPO	$49.28
Rate for Payer: BCN Medicare Advantage	$49.28
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cash Price	$13.60
Rate for Payer: Cofinity Commercial	$70.96
Rate for Payer: Cofinity Commercial	$66.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$49.28
Rate for Payer: Healthscope Commercial	$59.14
Rate for Payer: Healthscope Whirlpool	$59.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$51.74
Rate for Payer: Nomi Health Commercial	$59.14
Rate for Payer: PACE SWMI	$49.28
Rate for Payer: PHP Medicare Advantage	$49.28
Rate for Payer: Priority Health Cigna Priority Health	$11.05
Rate for Payer: Priority Health Medicare	$49.28
Rate for Payer: UHC Dual Complete DSNP	$49.28
Rate for Payer: UHC Medicare Advantage	$49.28
Rate for Payer: UHCCP DNSP	$49.28

PR DEPRESSION SCREEN ANNUAL

Professional

Both

$32.00

Service Code	HCPCS G0444
Min. Negotiated Rate	$8.56
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Commercial	$11.47
Rate for Payer: Aetna Medicare	$8.56
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS MAPPO	$8.56
Rate for Payer: BCN Medicare Advantage	$8.56
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cofinity Commercial	$12.33
Rate for Payer: Cofinity Commercial	$11.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$8.56
Rate for Payer: Healthscope Commercial	$10.27
Rate for Payer: Healthscope Whirlpool	$10.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.99
Rate for Payer: Nomi Health Commercial	$10.27
Rate for Payer: PACE SWMI	$8.56
Rate for Payer: PHP Medicare Advantage	$8.56
Rate for Payer: Priority Health Cigna Priority Health	$20.80
Rate for Payer: Priority Health Medicare	$8.56
Rate for Payer: UHC Dual Complete DSNP	$8.56
Rate for Payer: UHC Medicare Advantage	$8.56
Rate for Payer: UHCCP DNSP	$8.56

PR DERMAGRAFT

Professional

Both

$51.00

Service Code	HCPCS Q4106
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM

Professional

Both

$1,586.00

Service Code	HCPCS 15135
Min. Negotiated Rate	$634.40
Max. Negotiated Rate	$1,035.94
Rate for Payer: Aetna Commercial	$964.00
Rate for Payer: Aetna Medicare	$719.40
Rate for Payer: BCBS Complete	$634.40
Rate for Payer: BCBS MAPPO	$719.40
Rate for Payer: BCN Medicare Advantage	$719.40
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cofinity Commercial	$964.00
Rate for Payer: Cofinity Commercial	$1,035.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$719.40
Rate for Payer: Healthscope Commercial	$863.28
Rate for Payer: Healthscope Whirlpool	$863.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$755.37
Rate for Payer: Nomi Health Commercial	$863.28
Rate for Payer: PACE SWMI	$719.40
Rate for Payer: PHP Medicare Advantage	$719.40
Rate for Payer: Priority Health Cigna Priority Health	$1,030.90
Rate for Payer: Priority Health Medicare	$719.40
Rate for Payer: UHC Dual Complete DSNP	$719.40
Rate for Payer: UHC Medicare Advantage	$719.40
Rate for Payer: UHCCP DNSP	$719.40

PR DERMAL FILLER JUVEDERM ULTRA

Professional

Both

$689.00

Service Code	HCPCS 00087
Hospital Revenue Code	990
Min. Negotiated Rate	$275.60
Max. Negotiated Rate	$447.85
Rate for Payer: Aetna Medicare	$344.50
Rate for Payer: BCBS Complete	$275.60
Rate for Payer: Cash Price	$551.20
Rate for Payer: Priority Health Cigna Priority Health	$447.85

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS

Professional

Both

$408.00

Service Code	HCPCS 00089
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS >1

Professional

Both

$689.00

Service Code	HCPCS 00090
Hospital Revenue Code	990
Min. Negotiated Rate	$275.60
Max. Negotiated Rate	$447.85
Rate for Payer: Aetna Medicare	$344.50
Rate for Payer: BCBS Complete	$275.60
Rate for Payer: Cash Price	$551.20
Rate for Payer: Priority Health Cigna Priority Health	$447.85

PR DERMAL FILLER JUVEDERM VOLLURE

Professional

Both

$714.00

Service Code	HCPCS 00118
Hospital Revenue Code	990
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$464.10
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$285.60
Rate for Payer: Cash Price	$571.20
Rate for Payer: Priority Health Cigna Priority Health	$464.10

PR DERMAL FILLER JUVEDERM VOLUMA

Professional

Both

$816.00

Service Code	HCPCS 00091
Hospital Revenue Code	990
Min. Negotiated Rate	$326.40
Max. Negotiated Rate	$530.40
Rate for Payer: Aetna Medicare	$408.00
Rate for Payer: BCBS Complete	$326.40
Rate for Payer: Cash Price	$652.80
Rate for Payer: Priority Health Cigna Priority Health	$530.40

PR DERMAL FILLER RESTYLANE 1/2 UNIT

Professional

Both

$408.00

Service Code	HCPCS 00252
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20

PR DERMAL FILLER RESTYLANE 1 UNIT

Professional

Both

$663.00

Service Code	HCPCS 00253
Hospital Revenue Code	990
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$430.95
Rate for Payer: Aetna Medicare	$331.50
Rate for Payer: BCBS Complete	$265.20
Rate for Payer: Cash Price	$530.40
Rate for Payer: Priority Health Cigna Priority Health	$430.95

PR DERMAL FILLER RESTYLANE DEFYNE

Professional

Both

$714.00

Service Code	HCPCS 00360
Hospital Revenue Code	990
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$464.10
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$285.60
Rate for Payer: Cash Price	$571.20
Rate for Payer: Priority Health Cigna Priority Health	$464.10

PR DERMAL FILLER RESTYLANE LYFT

Professional

Both

$663.00

Service Code	HCPCS 00359
Hospital Revenue Code	990
Min. Negotiated Rate	$265.20
Max. Negotiated Rate	$430.95
Rate for Payer: Aetna Medicare	$331.50
Rate for Payer: BCBS Complete	$265.20
Rate for Payer: Cash Price	$530.40
Rate for Payer: Priority Health Cigna Priority Health	$430.95

PR DERMAL FILLER RESTYLANE REFYNE

Professional

Both

$714.00

Service Code	HCPCS 00361
Hospital Revenue Code	990
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$464.10
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$285.60
Rate for Payer: Cash Price	$571.20
Rate for Payer: Priority Health Cigna Priority Health	$464.10

PR DERMAL FILLER VOLBELLA

Professional

Both

$408.00

Service Code	HCPCS 00092
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20

PR DERMAL FILLER VOLBELLA >1

Professional

Both

$714.00

Service Code	HCPCS 00120
Hospital Revenue Code	990
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$464.10
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$285.60
Rate for Payer: Cash Price	$571.20
Rate for Payer: Priority Health Cigna Priority Health	$464.10

PR DESTROY NERVE,CERV SPINAL MUSCLES

Professional

Both

$361.00

Service Code	HCPCS 64613
Min. Negotiated Rate	$144.40
Max. Negotiated Rate	$234.65
Rate for Payer: Aetna Medicare	$180.50
Rate for Payer: BCBS Complete	$144.40
Rate for Payer: Cash Price	$288.80
Rate for Payer: Priority Health Cigna Priority Health	$234.65

PR DESTRUCTION BENIGN LESIONS 15/>

Professional

Both

$217.00

Service Code	HCPCS 17111
Min. Negotiated Rate	$78.78
Max. Negotiated Rate	$141.05
Rate for Payer: Aetna Commercial	$105.57
Rate for Payer: Aetna Medicare	$78.78
Rate for Payer: BCBS Complete	$86.80
Rate for Payer: BCBS MAPPO	$78.78
Rate for Payer: BCN Medicare Advantage	$78.78
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cash Price	$173.60
Rate for Payer: Cofinity Commercial	$105.57
Rate for Payer: Cofinity Commercial	$113.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$78.78
Rate for Payer: Healthscope Commercial	$94.54
Rate for Payer: Healthscope Whirlpool	$94.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$82.72
Rate for Payer: Nomi Health Commercial	$94.54
Rate for Payer: PACE SWMI	$78.78
Rate for Payer: PHP Medicare Advantage	$78.78
Rate for Payer: Priority Health Cigna Priority Health	$141.05
Rate for Payer: Priority Health Medicare	$78.78
Rate for Payer: UHC Dual Complete DSNP	$78.78
Rate for Payer: UHC Medicare Advantage	$78.78
Rate for Payer: UHCCP DNSP	$78.78

PR DESTRUCTION BENIGN LESIONS UP TO 14

Facility

$183.00

Service Code	CPT 17110
Hospital Charge Code	17110
Hospital Revenue Code	521
Min. Negotiated Rate	$118.95
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$164.70
Rate for Payer: ASR ASR	$177.51
Rate for Payer: ASR Commercial	$177.51
Rate for Payer: BCBS Trust/PPO	$149.13
Rate for Payer: BCN Commercial	$141.88
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cofinity Commercial	$172.02
Rate for Payer: Encore Health Key Benefits Commercial	$146.40
Rate for Payer: Healthscope Commercial	$183.00
Rate for Payer: Healthscope Whirlpool	$177.51
Rate for Payer: Mclaren Commercial	$164.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.55
Rate for Payer: Nomi Health Commercial	$150.06
Rate for Payer: Priority Health Cigna Priority Health	$118.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$161.04

PR DESTRUCTION BENIGN LESIONS UP TO 14

Professional

Both

$183.00

Service Code	HCPCS 17110
Hospital Charge Code	17110
Min. Negotiated Rate	$64.11
Max. Negotiated Rate	$118.95
Rate for Payer: Aetna Commercial	$85.91
Rate for Payer: Aetna Medicare	$64.11
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: BCBS MAPPO	$64.11
Rate for Payer: BCN Medicare Advantage	$64.11
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cofinity Commercial	$92.32
Rate for Payer: Cofinity Commercial	$85.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$64.11
Rate for Payer: Healthscope Commercial	$76.93
Rate for Payer: Healthscope Whirlpool	$76.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$67.32
Rate for Payer: Nomi Health Commercial	$76.93
Rate for Payer: PACE SWMI	$64.11
Rate for Payer: PHP Medicare Advantage	$64.11
Rate for Payer: Priority Health Cigna Priority Health	$118.95
Rate for Payer: Priority Health Medicare	$64.11
Rate for Payer: UHC Dual Complete DSNP	$64.11
Rate for Payer: UHC Medicare Advantage	$64.11
Rate for Payer: UHCCP DNSP	$64.11

Know your out-of-pocket cost for care.

All Charges