Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Professional

Both

$190.00

Service Code	HCPCS 90619
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$177.11
Rate for Payer: Aetna Commercial	$159.10
Rate for Payer: BCBS Trust/PPO	$177.11
Rate for Payer: BCN Commercial	$169.10
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.54
Rate for Payer: UHC Exchange	$174.54

PR MENB-4C RECOMBNT PRTN & OUTER MEMB VESIC VACC IM

Professional

Both

$271.00

Service Code	HCPCS 90620
Min. Negotiated Rate	$203.25
Max. Negotiated Rate	$237.13
Rate for Payer: Aetna Commercial	$215.42
Rate for Payer: BCBS Trust/PPO	$237.13
Rate for Payer: BCN Commercial	$233.20
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$237.13
Rate for Payer: UHC Exchange	$237.13

PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM

Professional

Both

$190.00

Service Code	HCPCS 90621
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$225.91
Rate for Payer: Aetna Commercial	$183.17
Rate for Payer: BCBS Trust/PPO	$225.91
Rate for Payer: BCN Commercial	$203.87
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$225.16
Rate for Payer: UHC Exchange	$225.16

PR MEPERIDINE HYDROCHL /100 MG

Professional

Both

$10.00

Service Code	HCPCS J2175
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$12.70
Rate for Payer: Aetna Commercial	$11.82
Rate for Payer: Aetna Medicare	$8.82
Rate for Payer: BCBS MAPPO	$8.82
Rate for Payer: BCBS Trust/PPO	$2.20
Rate for Payer: BCN Commercial	$2.57
Rate for Payer: BCN Medicare Advantage	$8.82
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$12.70
Rate for Payer: Cofinity Commercial	$11.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$8.82
Rate for Payer: Healthscope Commercial	$10.58
Rate for Payer: Healthscope Whirlpool	$10.58
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9.26
Rate for Payer: Molina Medicare/Medicaid	$9.70
Rate for Payer: Nomi Health Commercial	$10.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: PACE SWMI	$8.82
Rate for Payer: PHP Medicare Advantage	$8.82
Rate for Payer: Priority Health Medicare	$8.82
Rate for Payer: Railroad Medicare Medicare	$8.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.15
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8.82
Rate for Payer: UHC Exchange	$8.15
Rate for Payer: UHCCP DNSP	$8.82

PR MEPERIDINE/PROMETHAZINE INJ

Professional

Both

$11.00

Service Code	HCPCS J2180
Min. Negotiated Rate	$3.79
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Commercial	$7.58
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.79
Rate for Payer: UHC Exchange	$3.79

PR METATARSECTOMY

Professional

Both

$1,103.00

Service Code	HCPCS 28140
Min. Negotiated Rate	$252.62
Max. Negotiated Rate	$827.25
Rate for Payer: Aetna Commercial	$520.35
Rate for Payer: Aetna Medicare	$388.32
Rate for Payer: BCBS Complete	$265.25
Rate for Payer: BCBS MAPPO	$388.32
Rate for Payer: BCN Commercial	$641.40
Rate for Payer: BCN Medicare Advantage	$388.32
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cofinity Commercial	$559.18
Rate for Payer: Cofinity Commercial	$520.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$388.32
Rate for Payer: Healthscope Commercial	$465.98
Rate for Payer: Healthscope Whirlpool	$465.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$407.74
Rate for Payer: Meridian Medicaid	$265.25
Rate for Payer: Molina Medicare/Medicaid	$427.15
Rate for Payer: Nomi Health Commercial	$465.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$827.25
Rate for Payer: PACE SWMI	$388.32
Rate for Payer: PHP Medicare Advantage	$388.32
Rate for Payer: Priority Health Choice Medicaid	$252.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$685.63
Rate for Payer: Priority Health Medicare	$388.32
Rate for Payer: Priority Health Narrow Network	$685.63
Rate for Payer: Railroad Medicare Medicare	$388.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$764.59
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$388.32
Rate for Payer: UHC Exchange	$764.59
Rate for Payer: UHC Medicaid	$252.62
Rate for Payer: UHCCP DNSP	$388.32
Rate for Payer: UHCCP Medicaid	$252.62

PR METHYLPREDNISOLONE 20 MG INJ

Professional

Both

$10.00

Service Code	HCPCS J1020
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$7.25
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCN Commercial	$1.79
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR METHYLPREDNISOLONE 40 MG INJ

Professional

Both

$15.00

Service Code	HCPCS J1030
Min. Negotiated Rate	$3.27
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$6.61
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCN Commercial	$3.27
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25

PR METHYLPREDNISOLONE 80 MG INJ

Professional

Both

$27.00

Service Code	HCPCS J1040
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$10.10
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCN Commercial	$5.37
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$27.00

Service Code	HCPCS J2930
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$6.06
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCN Commercial	$3.00
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$10.00

Service Code	HCPCS J2920
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.31
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCN Commercial	$3.17
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR MGMT LVR HEMRRG CPLX SUTR WND/INJ

Professional

Both

$3,558.00

Service Code	HCPCS 47360
Min. Negotiated Rate	$1,112.71
Max. Negotiated Rate	$3,419.09
Rate for Payer: Aetna Commercial	$2,332.47
Rate for Payer: Aetna Medicare	$1,740.65
Rate for Payer: BCBS Complete	$1,168.35
Rate for Payer: BCBS MAPPO	$1,740.65
Rate for Payer: BCN Commercial	$2,806.12
Rate for Payer: BCN Medicare Advantage	$1,740.65
Rate for Payer: Cash Price	$2,846.40
Rate for Payer: Cash Price	$2,846.40
Rate for Payer: Cofinity Commercial	$2,506.54
Rate for Payer: Cofinity Commercial	$2,332.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,740.65
Rate for Payer: Healthscope Commercial	$2,088.78
Rate for Payer: Healthscope Whirlpool	$2,088.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,827.68
Rate for Payer: Meridian Medicaid	$1,168.35
Rate for Payer: Molina Medicare/Medicaid	$1,914.71
Rate for Payer: Nomi Health Commercial	$2,088.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,668.50
Rate for Payer: PACE SWMI	$1,740.65
Rate for Payer: PHP Medicare Advantage	$1,740.65
Rate for Payer: Priority Health Choice Medicaid	$1,112.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3,419.09
Rate for Payer: Priority Health Medicare	$1,740.65
Rate for Payer: Priority Health Narrow Network	$3,419.09
Rate for Payer: Railroad Medicare Medicare	$1,740.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,355.97
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,740.65
Rate for Payer: UHC Exchange	$3,355.97
Rate for Payer: UHC Medicaid	$1,112.71
Rate for Payer: UHCCP DNSP	$1,740.65
Rate for Payer: UHCCP Medicaid	$1,112.71

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$6,566.00

Service Code	HCPCS 47361
Min. Negotiated Rate	$1,766.20
Max. Negotiated Rate	$5,474.76
Rate for Payer: Aetna Commercial	$3,713.88
Rate for Payer: Aetna Medicare	$2,771.55
Rate for Payer: BCBS Complete	$1,854.51
Rate for Payer: BCBS MAPPO	$2,771.55
Rate for Payer: BCN Commercial	$4,493.28
Rate for Payer: BCN Medicare Advantage	$2,771.55
Rate for Payer: Cash Price	$5,252.80
Rate for Payer: Cash Price	$5,252.80
Rate for Payer: Cofinity Commercial	$3,991.03
Rate for Payer: Cofinity Commercial	$3,713.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,771.55
Rate for Payer: Healthscope Commercial	$3,325.86
Rate for Payer: Healthscope Whirlpool	$3,325.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,910.13
Rate for Payer: Meridian Medicaid	$1,854.51
Rate for Payer: Molina Medicare/Medicaid	$3,048.70
Rate for Payer: Nomi Health Commercial	$3,325.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,924.50
Rate for Payer: PACE SWMI	$2,771.55
Rate for Payer: PHP Medicare Advantage	$2,771.55
Rate for Payer: Priority Health Choice Medicaid	$1,766.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5,474.76
Rate for Payer: Priority Health Medicare	$2,771.55
Rate for Payer: Priority Health Narrow Network	$5,474.76
Rate for Payer: Railroad Medicare Medicare	$2,771.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,419.93
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$2,771.55
Rate for Payer: UHC Exchange	$5,419.93
Rate for Payer: UHC Medicaid	$1,766.20
Rate for Payer: UHCCP DNSP	$2,771.55
Rate for Payer: UHCCP Medicaid	$1,766.20

PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING

Professional

Both

$3,089.00

Service Code	HCPCS 47362
Min. Negotiated Rate	$853.28
Max. Negotiated Rate	$2,593.28
Rate for Payer: Aetna Commercial	$1,780.20
Rate for Payer: Aetna Medicare	$1,328.51
Rate for Payer: BCBS Complete	$895.94
Rate for Payer: BCBS MAPPO	$1,328.51
Rate for Payer: BCN Commercial	$2,128.37
Rate for Payer: BCN Medicare Advantage	$1,328.51
Rate for Payer: Cash Price	$2,471.20
Rate for Payer: Cash Price	$2,471.20
Rate for Payer: Cofinity Commercial	$1,913.05
Rate for Payer: Cofinity Commercial	$1,780.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,328.51
Rate for Payer: Healthscope Commercial	$1,594.21
Rate for Payer: Healthscope Whirlpool	$1,594.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,394.94
Rate for Payer: Meridian Medicaid	$895.94
Rate for Payer: Molina Medicare/Medicaid	$1,461.36
Rate for Payer: Nomi Health Commercial	$1,594.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,316.75
Rate for Payer: PACE SWMI	$1,328.51
Rate for Payer: PHP Medicare Advantage	$1,328.51
Rate for Payer: Priority Health Choice Medicaid	$853.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,593.28
Rate for Payer: Priority Health Medicare	$1,328.51
Rate for Payer: Priority Health Narrow Network	$2,593.28
Rate for Payer: Railroad Medicare Medicare	$1,328.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,587.97
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,328.51
Rate for Payer: UHC Exchange	$2,587.97
Rate for Payer: UHC Medicaid	$853.28
Rate for Payer: UHCCP DNSP	$1,328.51
Rate for Payer: UHCCP Medicaid	$853.28

PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ

Professional

Both

$2,990.00

Service Code	HCPCS 47350
Min. Negotiated Rate	$819.84
Max. Negotiated Rate	$2,488.31
Rate for Payer: Aetna Commercial	$1,709.85
Rate for Payer: Aetna Medicare	$1,276.01
Rate for Payer: BCBS Complete	$860.83
Rate for Payer: BCBS MAPPO	$1,276.01
Rate for Payer: BCN Commercial	$2,042.22
Rate for Payer: BCN Medicare Advantage	$1,276.01
Rate for Payer: Cash Price	$2,392.00
Rate for Payer: Cash Price	$2,392.00
Rate for Payer: Cofinity Commercial	$1,709.85
Rate for Payer: Cofinity Commercial	$1,837.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,276.01
Rate for Payer: Healthscope Commercial	$1,531.21
Rate for Payer: Healthscope Whirlpool	$1,531.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,339.81
Rate for Payer: Meridian Medicaid	$860.83
Rate for Payer: Molina Medicare/Medicaid	$1,403.61
Rate for Payer: Nomi Health Commercial	$1,531.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,242.50
Rate for Payer: PACE SWMI	$1,276.01
Rate for Payer: PHP Medicare Advantage	$1,276.01
Rate for Payer: Priority Health Choice Medicaid	$819.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,488.31
Rate for Payer: Priority Health Medicare	$1,276.01
Rate for Payer: Priority Health Narrow Network	$2,488.31
Rate for Payer: Railroad Medicare Medicare	$1,276.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,438.80
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,276.01
Rate for Payer: UHC Exchange	$2,438.80
Rate for Payer: UHC Medicaid	$819.84
Rate for Payer: UHCCP DNSP	$1,276.01
Rate for Payer: UHCCP Medicaid	$819.84

PR MH PARTIAL HOSP TX UNDER 24H

Professional

Both

$267.00

Service Code	HCPCS H0035
Min. Negotiated Rate	$106.80
Max. Negotiated Rate	$268.86
Rate for Payer: Aetna Commercial	$268.86
Rate for Payer: BCBS Complete	$106.80
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25

PR MICRONEEDLING PIN ADB/THIGHS/BACK

Professional

Both

$473.00

Hospital Revenue Code	990
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$354.75
Rate for Payer: BCBS Complete	$189.20
Rate for Payer: Cash Price	$378.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.75

PR MICRONEEDLING PIN FULL FACE

Professional

Both

$420.00

Hospital Revenue Code	990
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$315.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.00

PR MICRONEEDLING PIN NECK

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR MICRONEEDLING PIN UPPER OR LOWER FACE

Professional

Both

$263.00

Hospital Revenue Code	990
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

PR MICRONEEDLING SCARS - UP TO 4 INCHES

Professional

Both

$53.00

Hospital Revenue Code	990
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR MICRONEEDLING TAT RMVL 4-6 SQ INCHES

Professional

Both

$473.00

Hospital Revenue Code	990
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$354.75
Rate for Payer: BCBS Complete	$189.20
Rate for Payer: Cash Price	$378.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.75

PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES

Professional

Both

$210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$157.50
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

Know your out-of-pocket cost for care.

All Charges