Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,142.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$213.64
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$465.42
Rate for Payer: Aetna Medicare	$571.00
Rate for Payer: BCBS Complete	$224.32
Rate for Payer: BCBS Trust/PPO	$987.92
Rate for Payer: BCN Commercial	$488.19
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cash Price	$913.60
Rate for Payer: Meridian Medicaid	$224.32
Rate for Payer: Priority Health Choice Medicaid	$213.64
Rate for Payer: Priority Health Cigna Priority Health	$742.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$532.36
Rate for Payer: Priority Health Narrow Network	$532.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$468.50
Rate for Payer: UHC Exchange	$468.50
Rate for Payer: UHCCP Medicaid	$213.64

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$555.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$80.94
Max. Negotiated Rate	$386.55
Rate for Payer: Aetna Commercial	$135.10
Rate for Payer: Aetna Medicare	$277.50
Rate for Payer: BCBS Complete	$84.99
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: BCN Commercial	$386.55
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Meridian Medicaid	$84.99
Rate for Payer: Priority Health Choice Medicaid	$80.94
Rate for Payer: Priority Health Cigna Priority Health	$360.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$168.87
Rate for Payer: Priority Health Narrow Network	$168.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$137.07
Rate for Payer: UHC Exchange	$137.07
Rate for Payer: UHCCP Medicaid	$80.94

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,127.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$197.88
Max. Negotiated Rate	$777.66
Rate for Payer: Aetna Commercial	$429.28
Rate for Payer: Aetna Medicare	$563.50
Rate for Payer: BCBS Complete	$207.77
Rate for Payer: BCBS Trust/PPO	$777.66
Rate for Payer: BCN Commercial	$451.54
Rate for Payer: Cash Price	$901.60
Rate for Payer: Cash Price	$901.60
Rate for Payer: Meridian Medicaid	$207.77
Rate for Payer: Priority Health Choice Medicaid	$197.88
Rate for Payer: Priority Health Cigna Priority Health	$732.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$493.54
Rate for Payer: Priority Health Narrow Network	$493.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$435.54
Rate for Payer: UHC Exchange	$435.54
Rate for Payer: UHCCP Medicaid	$197.88

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$161.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$49.26
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$153.19
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCBS Complete	$64.40
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: BCN Commercial	$248.25
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$247.41
Rate for Payer: Priority Health Narrow Network	$247.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$49.26
Rate for Payer: UHC Exchange	$49.26

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$42.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$27.30

PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS

Professional

Both

$41.00

Service Code	HCPCS 96151
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$26.65
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$26.65

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT

Professional

Both

$39.00

Service Code	HCPCS 96155
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT

Professional

Both

$38.00

Service Code	HCPCS 96154
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$24.70

PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

Professional

Both

$39.00

Service Code	HCPCS 96152
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$198.00

Service Code	HCPCS 96156
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$137.32
Rate for Payer: Aetna Commercial	$95.48
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS Complete	$59.93
Rate for Payer: BCBS Trust/PPO	$135.77
Rate for Payer: BCN Commercial	$137.32
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Meridian Medicaid	$59.93
Rate for Payer: Priority Health Choice Medicaid	$57.08
Rate for Payer: Priority Health Cigna Priority Health	$128.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$118.96
Rate for Payer: Priority Health Narrow Network	$118.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$97.00
Rate for Payer: UHC Exchange	$97.00
Rate for Payer: UHCCP Medicaid	$57.08

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN

Professional

Both

$128.00

Service Code	HCPCS 96170
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$113.38
Rate for Payer: Aetna Commercial	$84.24
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: BCBS Trust/PPO	$66.04
Rate for Payer: BCN Commercial	$113.38
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	$98.15
Rate for Payer: Priority Health Narrow Network	$98.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$84.29
Rate for Payer: UHC Exchange	$84.29

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15

Professional

Both

$57.00

Service Code	HCPCS 96171
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$102.49
Rate for Payer: Aetna Commercial	$30.11
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: BCBS Trust/PPO	$102.49
Rate for Payer: BCN Commercial	$41.05
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$37.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.27
Rate for Payer: Priority Health Narrow Network	$35.27
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$30.83
Rate for Payer: UHC Exchange	$30.83

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN

Professional

Both

$145.00

Service Code	HCPCS 96167
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$115.70
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna Medicare	$72.50
Rate for Payer: BCBS Complete	$43.62
Rate for Payer: BCBS Trust/PPO	$115.70
Rate for Payer: BCN Commercial	$99.69
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Meridian Medicaid	$43.62
Rate for Payer: Priority Health Choice Medicaid	$41.54
Rate for Payer: Priority Health Cigna Priority Health	$94.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.12
Rate for Payer: Priority Health Narrow Network	$84.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$70.72
Rate for Payer: UHC Exchange	$70.72
Rate for Payer: UHCCP Medicaid	$41.54

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN

Professional

Both

$51.00

Service Code	HCPCS 96168
Min. Negotiated Rate	$14.91
Max. Negotiated Rate	$168.53
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$15.66
Rate for Payer: BCBS Trust/PPO	$168.53
Rate for Payer: BCN Commercial	$35.19
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Meridian Medicaid	$15.66
Rate for Payer: Priority Health Choice Medicaid	$14.91
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.85
Rate for Payer: Priority Health Narrow Network	$29.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.12
Rate for Payer: UHC Exchange	$25.12
Rate for Payer: UHCCP Medicaid	$14.91

PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

Professional

Both

$136.00

Service Code	HCPCS 96158
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$831.54
Rate for Payer: Aetna Commercial	$65.34
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCBS Trust/PPO	$831.54
Rate for Payer: BCN Commercial	$93.82
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health	$88.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$79.61
Rate for Payer: Priority Health Narrow Network	$79.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$66.06
Rate for Payer: UHC Exchange	$66.06
Rate for Payer: UHCCP Medicaid	$39.19

PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

Professional

Both

$47.00

Service Code	HCPCS 96159
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$208.15
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: BCBS Complete	$14.09
Rate for Payer: BCBS Trust/PPO	$208.15
Rate for Payer: BCN Commercial	$32.25
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Meridian Medicaid	$14.09
Rate for Payer: Priority Health Choice Medicaid	$13.42
Rate for Payer: Priority Health Cigna Priority Health	$30.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26.69
Rate for Payer: Priority Health Narrow Network	$26.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$22.81
Rate for Payer: UHC Exchange	$22.81
Rate for Payer: UHCCP Medicaid	$13.42

PR HEALTH RISK ASSESSMENT TEST

Professional

Both

$51.00

Service Code	HCPCS 99420
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 HEARING AID CHECK BINAURAL

Professional

Both

$61.00

Service Code	HCPCS 92593
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$392.83
Rate for Payer: Aetna Commercial	$39.35
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$392.83
Rate for Payer: BCN Commercial	$47.99
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$39.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50.21
Rate for Payer: Priority Health Narrow Network	$50.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$33.37
Rate for Payer: UHC Exchange	$33.37

PR HEARING AID CHECK MONAURAL

Professional

Both

$54.00

Service Code	HCPCS 92592
Min. Negotiated Rate	$20.49
Max. Negotiated Rate	$2,403.24
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS Trust/PPO	$2,403.24
Rate for Payer: BCN Commercial	$47.99
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$35.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30.30
Rate for Payer: Priority Health Narrow Network	$30.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.49
Rate for Payer: UHC Exchange	$20.49

PR HEARING AID EXAMINATION & SELECTION BINAURAL

Professional

Both

$143.00

Service Code	HCPCS 92591
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$864.19
Rate for Payer: Aetna Commercial	$76.88
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$57.20
Rate for Payer: BCBS Trust/PPO	$864.19
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Priority Health Cigna Priority Health	$92.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.70
Rate for Payer: Priority Health Narrow Network	$97.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$65.19
Rate for Payer: UHC Exchange	$65.19

PR HEARING AID EXAMINATION & SELECTION MONAURAL

Professional

Both

$143.00

Service Code	HCPCS 92590
Min. Negotiated Rate	$51.18
Max. Negotiated Rate	$1,399.47
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$57.20
Rate for Payer: BCBS Trust/PPO	$1,399.47
Rate for Payer: BCN Commercial	$98.85
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Priority Health Cigna Priority Health	$92.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$76.89
Rate for Payer: Priority Health Narrow Network	$76.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$51.18
Rate for Payer: UHC Exchange	$51.18

PR HEARING AID, PROG, BIN, BTE

Professional

Both

$5,516.00

Service Code	HCPCS V5253
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$5,000.00
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare	$2,758.00
Rate for Payer: BCBS Complete	$2,206.40
Rate for Payer: Cash Price	$4,412.80
Rate for Payer: Cash Price	$4,412.80
Rate for Payer: Priority Health Cigna Priority Health	$3,585.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,000.00
Rate for Payer: UHC Exchange	$5,000.00

PR HEARING AID REPAIR/MODIFYING

Professional

Both

$102.00

Service Code	HCPCS V5014
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$94.61
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: Aetna Medicare	$217.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCBS Complete	$173.60
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$347.20
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$347.20
Rate for Payer: Priority Health Cigna Priority Health	$282.10
Rate for Payer: Priority Health Cigna Priority Health	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$94.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$94.61
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$94.61
Rate for Payer: UHC Exchange	$94.61
Rate for Payer: UHC Exchange	$94.61
Rate for Payer: UHC Exchange	$94.61

PR HEMIARTHROPLASTY HIP PARTIAL

Professional

Both

$2,333.00

Service Code	HCPCS 27125
Min. Negotiated Rate	$732.93
Max. Negotiated Rate	$1,736.74
Rate for Payer: Aetna Commercial	$1,512.35
Rate for Payer: Aetna Medicare	$1,166.50
Rate for Payer: BCBS Complete	$769.58
Rate for Payer: BCBS Trust/PPO	$984.22
Rate for Payer: BCN Commercial	$1,655.64
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Cash Price	$1,866.40
Rate for Payer: Meridian Medicaid	$769.58
Rate for Payer: Priority Health Choice Medicaid	$732.93
Rate for Payer: Priority Health Cigna Priority Health	$1,516.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,736.74
Rate for Payer: Priority Health Narrow Network	$1,736.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,307.65
Rate for Payer: UHC Exchange	$1,307.65
Rate for Payer: UHCCP Medicaid	$732.93

PR HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE

Professional

Both

$697.00

Service Code	HCPCS 28160
Min. Negotiated Rate	$174.23
Max. Negotiated Rate	$888.60
Rate for Payer: Aetna Commercial	$351.28
Rate for Payer: Aetna Medicare	$348.50
Rate for Payer: BCBS Complete	$182.94
Rate for Payer: BCBS Trust/PPO	$888.60
Rate for Payer: BCN Commercial	$592.77
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cash Price	$557.60
Rate for Payer: Meridian Medicaid	$182.94
Rate for Payer: Priority Health Choice Medicaid	$174.23
Rate for Payer: Priority Health Cigna Priority Health	$453.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$412.18
Rate for Payer: Priority Health Narrow Network	$412.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$317.05
Rate for Payer: UHC Exchange	$317.05
Rate for Payer: UHCCP Medicaid	$174.23

Know your out-of-pocket cost for care.

All Charges