Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR HAIR REDUC BACK

Professional

Both

$306.00

Service Code	HCPCS 00054
Hospital Revenue Code	990
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 HAIR REDUC BIKINI LN

Professional

Both

$51.00

Service Code	HCPCS 00055
Hospital Revenue Code	990
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 HAIR REDUC BRAZ

Professional

Both

$128.00

Service Code	HCPCS 00056
Hospital Revenue Code	990
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20

PR HAIR REDUC BROW/NOSE/EARS/TOE/HND

Professional

Both

$36.00

Service Code	HCPCS 00061
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR HAIR REDUC CHIN/NECK

Professional

Both

$51.00

Service Code	HCPCS 00057
Hospital Revenue Code	990
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 HAIR REDUC FL FACE/SCALP/FL ABD

Professional

Both

$92.00

Service Code	HCPCS 00058
Hospital Revenue Code	990
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$59.80
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Priority Health Cigna Priority Health	$59.80

PR HAIR REDUC FL LEGS

Professional

Both

$408.00

Service Code	HCPCS 00059
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 HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR

Professional

Both

$102.00

Service Code	HCPCS 00053
Hospital Revenue Code	990
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$66.30

PR HAIR REDUC LIP

Professional

Both

$36.00

Service Code	HCPCS 00062
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR HAIR REDUC LIP & CHIN

Professional

Both

$82.00

Service Code	HCPCS 00063
Hospital Revenue Code	990
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$53.30
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCBS Complete	$32.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Priority Health Cigna Priority Health	$53.30

PR HAIR REDUC UDR ARMS OR BUTTOCKS

Professional

Both

$51.00

Service Code	HCPCS 00064
Hospital Revenue Code	990
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 HAIR REDUC UP/LOW LEGS

Professional

Both

$204.00

Service Code	HCPCS 00065
Hospital Revenue Code	990
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$132.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$132.60

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

Professional

Both

$1,470.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$309.06
Max. Negotiated Rate	$1,803.62
Rate for Payer: Aetna Commercial	$653.60
Rate for Payer: Aetna Medicare	$735.00
Rate for Payer: BCBS Complete	$324.51
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: BCN Commercial	$1,013.03
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Meridian Medicaid	$324.51
Rate for Payer: Priority Health Choice Medicaid	$309.06
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$738.86
Rate for Payer: Priority Health Narrow Network	$738.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$606.71
Rate for Payer: UHC Exchange	$606.71
Rate for Payer: UHCCP Medicaid	$309.06

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

Professional

Both

$1,236.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$2,027.62
Rate for Payer: Aetna Commercial	$605.08
Rate for Payer: Aetna Medicare	$618.00
Rate for Payer: BCBS Complete	$315.80
Rate for Payer: BCBS Trust/PPO	$2,027.62
Rate for Payer: BCN Commercial	$1,002.27
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Meridian Medicaid	$315.80
Rate for Payer: Priority Health Choice Medicaid	$300.76
Rate for Payer: Priority Health Cigna Priority Health	$803.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$711.39
Rate for Payer: Priority Health Narrow Network	$711.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$641.95
Rate for Payer: UHC Exchange	$641.95
Rate for Payer: UHCCP Medicaid	$300.76

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	$4.55
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 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	$4.55
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 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	$4.55
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 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	$4.55
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 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	$4.55
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 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	$4.55
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 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	$4.55
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 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	$4.55
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 HAND-HELD PEFR METER

Professional

Both

$51.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Commercial	$22.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCN Commercial	$26.19
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.98
Rate for Payer: UHC Exchange	$14.98

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

Professional

Both

$16.00

Service Code	HCPCS 99000
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$595.92
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCBS Complete	$6.40
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: Priority Health Cigna Priority Health	$10.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.24
Rate for Payer: Priority Health Narrow Network	$7.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.46
Rate for Payer: UHC Exchange	$3.46

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$86.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$55.90
Rate for Payer: Aetna Medicare	$43.00
Rate for Payer: BCBS Complete	$34.40
Rate for Payer: Cash Price	$68.80
Rate for Payer: Priority Health Cigna Priority Health	$55.90

Know your out-of-pocket cost for care.

All Charges