Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR GROUP BEHAVE COUNS 2-10

Professional

Both

$31.00

Service Code	HCPCS G0473
Min. Negotiated Rate	$10.77
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Commercial	$14.43
Rate for Payer: Aetna Medicare	$10.77
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS MAPPO	$10.77
Rate for Payer: BCN Medicare Advantage	$10.77
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cofinity Commercial	$15.51
Rate for Payer: Cofinity Commercial	$14.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$10.77
Rate for Payer: Healthscope Commercial	$12.92
Rate for Payer: Healthscope Whirlpool	$12.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11.31
Rate for Payer: Nomi Health Commercial	$12.92
Rate for Payer: PACE SWMI	$10.77
Rate for Payer: PHP Medicare Advantage	$10.77
Rate for Payer: Priority Health Cigna Priority Health	$20.15
Rate for Payer: Priority Health Medicare	$10.77
Rate for Payer: UHC Dual Complete DSNP	$10.77
Rate for Payer: UHC Medicare Advantage	$10.77
Rate for Payer: UHCCP DNSP	$10.77

PR GROUP PSYCHOTHERAPY

Professional

Both

$55.00

Service Code	HCPCS 90853
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$35.75
Rate for Payer: Aetna Commercial	$32.35
Rate for Payer: Aetna Medicare	$24.14
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS MAPPO	$24.14
Rate for Payer: BCN Medicare Advantage	$24.14
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cofinity Commercial	$34.76
Rate for Payer: Cofinity Commercial	$32.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.14
Rate for Payer: Healthscope Commercial	$28.97
Rate for Payer: Healthscope Whirlpool	$28.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25.35
Rate for Payer: Nomi Health Commercial	$28.97
Rate for Payer: PACE SWMI	$24.14
Rate for Payer: PHP Medicare Advantage	$24.14
Rate for Payer: Priority Health Cigna Priority Health	$35.75
Rate for Payer: Priority Health Medicare	$24.14
Rate for Payer: UHC Dual Complete DSNP	$24.14
Rate for Payer: UHC Medicare Advantage	$24.14
Rate for Payer: UHCCP DNSP	$24.14

PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY

Professional

Both

$2,608.00

Service Code	HCPCS 43631
Min. Negotiated Rate	$1,043.20
Max. Negotiated Rate	$2,032.63
Rate for Payer: Aetna Commercial	$1,891.48
Rate for Payer: Aetna Medicare	$1,411.55
Rate for Payer: BCBS Complete	$1,043.20
Rate for Payer: BCBS MAPPO	$1,411.55
Rate for Payer: BCN Medicare Advantage	$1,411.55
Rate for Payer: Cash Price	$2,086.40
Rate for Payer: Cash Price	$2,086.40
Rate for Payer: Cofinity Commercial	$2,032.63
Rate for Payer: Cofinity Commercial	$1,891.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,411.55
Rate for Payer: Healthscope Commercial	$1,693.86
Rate for Payer: Healthscope Whirlpool	$1,693.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,482.13
Rate for Payer: Nomi Health Commercial	$1,693.86
Rate for Payer: PACE SWMI	$1,411.55
Rate for Payer: PHP Medicare Advantage	$1,411.55
Rate for Payer: Priority Health Cigna Priority Health	$1,695.20
Rate for Payer: Priority Health Medicare	$1,411.55
Rate for Payer: UHC Dual Complete DSNP	$1,411.55
Rate for Payer: UHC Medicare Advantage	$1,411.55
Rate for Payer: UHCCP DNSP	$1,411.55

PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY

Professional

Both

$3,761.00

Service Code	HCPCS 43632
Min. Negotiated Rate	$1,504.40
Max. Negotiated Rate	$2,850.71
Rate for Payer: Aetna Commercial	$2,652.74
Rate for Payer: Aetna Medicare	$1,979.66
Rate for Payer: BCBS Complete	$1,504.40
Rate for Payer: BCBS MAPPO	$1,979.66
Rate for Payer: BCN Medicare Advantage	$1,979.66
Rate for Payer: Cash Price	$3,008.80
Rate for Payer: Cash Price	$3,008.80
Rate for Payer: Cofinity Commercial	$2,850.71
Rate for Payer: Cofinity Commercial	$2,652.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,979.66
Rate for Payer: Healthscope Commercial	$2,375.59
Rate for Payer: Healthscope Whirlpool	$2,375.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,078.64
Rate for Payer: Nomi Health Commercial	$2,375.59
Rate for Payer: PACE SWMI	$1,979.66
Rate for Payer: PHP Medicare Advantage	$1,979.66
Rate for Payer: Priority Health Cigna Priority Health	$2,444.65
Rate for Payer: Priority Health Medicare	$1,979.66
Rate for Payer: UHC Dual Complete DSNP	$1,979.66
Rate for Payer: UHC Medicare Advantage	$1,979.66
Rate for Payer: UHCCP DNSP	$1,979.66

PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

Professional

Both

$3,446.00

Service Code	HCPCS 43633
Min. Negotiated Rate	$1,378.40
Max. Negotiated Rate	$2,694.83
Rate for Payer: Aetna Commercial	$2,507.69
Rate for Payer: Aetna Medicare	$1,871.41
Rate for Payer: BCBS Complete	$1,378.40
Rate for Payer: BCBS MAPPO	$1,871.41
Rate for Payer: BCN Medicare Advantage	$1,871.41
Rate for Payer: Cash Price	$2,756.80
Rate for Payer: Cash Price	$2,756.80
Rate for Payer: Cofinity Commercial	$2,694.83
Rate for Payer: Cofinity Commercial	$2,507.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,871.41
Rate for Payer: Healthscope Commercial	$2,245.69
Rate for Payer: Healthscope Whirlpool	$2,245.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,964.98
Rate for Payer: Nomi Health Commercial	$2,245.69
Rate for Payer: PACE SWMI	$1,871.41
Rate for Payer: PHP Medicare Advantage	$1,871.41
Rate for Payer: Priority Health Cigna Priority Health	$2,239.90
Rate for Payer: Priority Health Medicare	$1,871.41
Rate for Payer: UHC Dual Complete DSNP	$1,871.41
Rate for Payer: UHC Medicare Advantage	$1,871.41
Rate for Payer: UHCCP DNSP	$1,871.41

PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY

Professional

Both

$6,616.00

Service Code	HCPCS 43620
Min. Negotiated Rate	$1,928.33
Max. Negotiated Rate	$4,300.40
Rate for Payer: Aetna Commercial	$2,583.96
Rate for Payer: Aetna Medicare	$1,928.33
Rate for Payer: BCBS Complete	$2,646.40
Rate for Payer: BCBS MAPPO	$1,928.33
Rate for Payer: BCN Medicare Advantage	$1,928.33
Rate for Payer: Cash Price	$5,292.80
Rate for Payer: Cash Price	$5,292.80
Rate for Payer: Cofinity Commercial	$2,776.80
Rate for Payer: Cofinity Commercial	$2,583.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,928.33
Rate for Payer: Healthscope Commercial	$2,314.00
Rate for Payer: Healthscope Whirlpool	$2,314.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,024.75
Rate for Payer: Nomi Health Commercial	$2,314.00
Rate for Payer: PACE SWMI	$1,928.33
Rate for Payer: PHP Medicare Advantage	$1,928.33
Rate for Payer: Priority Health Cigna Priority Health	$4,300.40
Rate for Payer: Priority Health Medicare	$1,928.33
Rate for Payer: UHC Dual Complete DSNP	$1,928.33
Rate for Payer: UHC Medicare Advantage	$1,928.33
Rate for Payer: UHCCP DNSP	$1,928.33

PR HAIR REDUC 1/2 LEGS

Professional

Both

$204.00

Service Code	HCPCS 00060
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 HAIR REDUC ABD TRAIL

Professional

Both

$51.00

Service Code	HCPCS 00052
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 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	$456.65
Max. Negotiated Rate	$955.50
Rate for Payer: Aetna Commercial	$611.91
Rate for Payer: Aetna Medicare	$456.65
Rate for Payer: BCBS Complete	$588.00
Rate for Payer: BCBS MAPPO	$456.65
Rate for Payer: BCN Medicare Advantage	$456.65
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cofinity Commercial	$611.91
Rate for Payer: Cofinity Commercial	$657.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$456.65
Rate for Payer: Healthscope Commercial	$547.98
Rate for Payer: Healthscope Whirlpool	$547.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$479.48
Rate for Payer: Nomi Health Commercial	$547.98
Rate for Payer: PACE SWMI	$456.65
Rate for Payer: PHP Medicare Advantage	$456.65
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health Medicare	$456.65
Rate for Payer: UHC Dual Complete DSNP	$456.65
Rate for Payer: UHC Medicare Advantage	$456.65
Rate for Payer: UHCCP DNSP	$456.65

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

Professional

Both

$1,236.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$442.81
Max. Negotiated Rate	$803.40
Rate for Payer: Aetna Commercial	$593.37
Rate for Payer: Aetna Medicare	$442.81
Rate for Payer: BCBS Complete	$494.40
Rate for Payer: BCBS MAPPO	$442.81
Rate for Payer: BCN Medicare Advantage	$442.81
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cofinity Commercial	$637.65
Rate for Payer: Cofinity Commercial	$593.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$442.81
Rate for Payer: Healthscope Commercial	$531.37
Rate for Payer: Healthscope Whirlpool	$531.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$464.95
Rate for Payer: Nomi Health Commercial	$531.37
Rate for Payer: PACE SWMI	$442.81
Rate for Payer: PHP Medicare Advantage	$442.81
Rate for Payer: Priority Health Cigna Priority Health	$803.40
Rate for Payer: Priority Health Medicare	$442.81
Rate for Payer: UHC Dual Complete DSNP	$442.81
Rate for Payer: UHC Medicare Advantage	$442.81
Rate for Payer: UHCCP DNSP	$442.81

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

Know your out-of-pocket cost for care.

All Charges