Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR LASER ENUCLEATION PROSTATE W/MORCELLATION

Professional

Both

$1,709.00

Service Code	HCPCS 52649
Min. Negotiated Rate	$528.03
Max. Negotiated Rate	$1,312.32
Rate for Payer: Aetna Commercial	$1,059.01
Rate for Payer: Aetna Medicare	$854.50
Rate for Payer: BCBS Complete	$554.43
Rate for Payer: BCBS Trust/PPO	$1,289.05
Rate for Payer: BCN Commercial	$1,189.93
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Meridian Medicaid	$554.43
Rate for Payer: Priority Health Choice Medicaid	$528.03
Rate for Payer: Priority Health Cigna Priority Health	$1,110.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,312.32
Rate for Payer: Priority Health Narrow Network	$1,312.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,174.32
Rate for Payer: UHC Exchange	$1,174.32
Rate for Payer: UHCCP Medicaid	$528.03

PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW

Professional

Both

$3,308.00

Service Code	HCPCS 52648
Min. Negotiated Rate	$444.32
Max. Negotiated Rate	$2,363.74
Rate for Payer: Aetna Commercial	$886.93
Rate for Payer: Aetna Medicare	$1,654.00
Rate for Payer: BCBS Complete	$466.54
Rate for Payer: BCBS Trust/PPO	$1,272.67
Rate for Payer: BCN Commercial	$2,363.74
Rate for Payer: Cash Price	$2,646.40
Rate for Payer: Cash Price	$2,646.40
Rate for Payer: Meridian Medicaid	$466.54
Rate for Payer: Priority Health Choice Medicaid	$444.32
Rate for Payer: Priority Health Cigna Priority Health	$2,150.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,103.55
Rate for Payer: Priority Health Narrow Network	$1,103.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$830.15
Rate for Payer: UHC Exchange	$830.15
Rate for Payer: UHCCP Medicaid	$444.32

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,697.00

Service Code	HCPCS 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$1,208.75
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: Aetna Medicare	$848.50
Rate for Payer: BCBS Complete	$315.13
Rate for Payer: BCBS Trust/PPO	$1,208.75
Rate for Payer: BCN Commercial	$741.46
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Meridian Medicaid	$315.13
Rate for Payer: Priority Health Choice Medicaid	$300.12
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$710.36
Rate for Payer: Priority Health Narrow Network	$710.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$497.64
Rate for Payer: UHC Exchange	$497.64
Rate for Payer: UHCCP Medicaid	$300.12

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,697.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$1,103.05
Max. Negotiated Rate	$1,697.00
Rate for Payer: Aetna Commercial	$1,527.30
Rate for Payer: ASR ASR	$1,646.09
Rate for Payer: ASR Commercial	$1,646.09
Rate for Payer: BCBS Trust/PPO	$1,382.89
Rate for Payer: BCN Commercial	$1,315.68
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$1,595.18
Rate for Payer: Encore Health Key Benefits Commercial	$1,357.60
Rate for Payer: Healthscope Commercial	$1,697.00
Rate for Payer: Healthscope Whirlpool	$1,646.09
Rate for Payer: Mclaren Commercial	$1,527.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,442.45
Rate for Payer: Nomi Health Commercial	$1,391.54
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,493.36

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,697.00

Service Code	HCPCS 27425
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$1,208.75
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: Aetna Medicare	$848.50
Rate for Payer: BCBS Complete	$315.13
Rate for Payer: BCBS Trust/PPO	$1,208.75
Rate for Payer: BCN Commercial	$741.46
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Meridian Medicaid	$315.13
Rate for Payer: Priority Health Choice Medicaid	$300.12
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$710.36
Rate for Payer: Priority Health Narrow Network	$710.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$497.64
Rate for Payer: UHC Exchange	$497.64
Rate for Payer: UHCCP Medicaid	$300.12

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,697.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$1,103.05
Max. Negotiated Rate	$4,927.45
Rate for Payer: Aetna Commercial	$1,527.30
Rate for Payer: Aetna Medicare	$3,179.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,973.75
Rate for Payer: Amish Plain Church Group Commercial	$3,973.75
Rate for Payer: ASR ASR	$1,646.09
Rate for Payer: ASR Commercial	$1,646.09
Rate for Payer: BCBS Complete	$1,789.14
Rate for Payer: BCBS MAPPO	$3,179.00
Rate for Payer: BCBS Trust/PPO	$1,389.67
Rate for Payer: BCN Commercial	$1,315.68
Rate for Payer: BCN Medicare Advantage	$3,179.00
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$1,595.18
Rate for Payer: Encore Health Key Benefits Commercial	$1,357.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,179.00
Rate for Payer: Healthscope Commercial	$1,697.00
Rate for Payer: Healthscope Whirlpool	$1,646.09
Rate for Payer: Humana Choice PPO Medicare	$3,179.00
Rate for Payer: Mclaren Commercial	$1,527.30
Rate for Payer: Mclaren Medicaid	$1,703.94
Rate for Payer: Mclaren Medicare	$3,179.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,337.95
Rate for Payer: Meridian Medicaid	$1,789.14
Rate for Payer: MI Amish Medical Board Commercial	$3,655.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,442.45
Rate for Payer: Nomi Health Commercial	$1,391.54
Rate for Payer: PACE Medicare	$3,020.05
Rate for Payer: PACE SWMI	$3,179.00
Rate for Payer: PHP Commercial	$3,496.90
Rate for Payer: PHP Medicaid	$1,703.94
Rate for Payer: PHP Medicare Advantage	$3,179.00
Rate for Payer: Priority Health Choice Medicaid	$1,703.94
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,486.91
Rate for Payer: Priority Health Medicare	$3,179.00
Rate for Payer: Priority Health Narrow Network	$1,189.60
Rate for Payer: Railroad Medicare Medicare	$3,179.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,493.36
Rate for Payer: UHC Dual Complete DSNP	$3,179.00
Rate for Payer: UHC Exchange	$4,927.45
Rate for Payer: UHC Medicare Advantage	$3,179.00
Rate for Payer: UHCCP DNSP	$3,179.00
Rate for Payer: UHCCP Medicaid	$1,703.94
Rate for Payer: VA VA	$3,179.00

PR LATISSE

Professional

Both

$183.00

Service Code	HCPCS 00267
Hospital Revenue Code	990
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$118.95
Rate for Payer: Aetna Medicare	$91.50
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: Cash Price	$146.40
Rate for Payer: Priority Health Cigna Priority Health	$118.95

PR LAVAGE CANNULATION MAXILLARY SINUS

Professional

Both

$292.00

Service Code	HCPCS 31000
Min. Negotiated Rate	$71.57
Max. Negotiated Rate	$694.71
Rate for Payer: Aetna Commercial	$134.27
Rate for Payer: Aetna Medicare	$146.00
Rate for Payer: BCBS Complete	$75.15
Rate for Payer: BCBS Trust/PPO	$694.71
Rate for Payer: BCN Commercial	$274.15
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cash Price	$233.60
Rate for Payer: Meridian Medicaid	$75.15
Rate for Payer: Priority Health Choice Medicaid	$71.57
Rate for Payer: Priority Health Cigna Priority Health	$189.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$155.26
Rate for Payer: Priority Health Narrow Network	$155.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$113.40
Rate for Payer: UHC Exchange	$113.40
Rate for Payer: UHCCP Medicaid	$71.57

PR LAVAGE CANNULATION SPHENOID SINUS

Professional

Both

$337.00

Service Code	HCPCS 31002
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$689.96
Rate for Payer: Aetna Commercial	$246.23
Rate for Payer: Aetna Medicare	$168.50
Rate for Payer: BCBS Complete	$125.46
Rate for Payer: BCBS Trust/PPO	$689.96
Rate for Payer: BCN Commercial	$282.46
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Meridian Medicaid	$125.46
Rate for Payer: Priority Health Choice Medicaid	$119.49
Rate for Payer: Priority Health Cigna Priority Health	$219.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$264.64
Rate for Payer: Priority Health Narrow Network	$264.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$215.03
Rate for Payer: UHC Exchange	$215.03
Rate for Payer: UHCCP Medicaid	$119.49

PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

Professional

Both

$442.00

Service Code	HCPCS 93462
Min. Negotiated Rate	$129.08
Max. Negotiated Rate	$548.90
Rate for Payer: Aetna Commercial	$282.18
Rate for Payer: Aetna Medicare	$221.00
Rate for Payer: BCBS Complete	$135.53
Rate for Payer: BCBS Trust/PPO	$548.90
Rate for Payer: BCN Commercial	$298.58
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Meridian Medicaid	$135.53
Rate for Payer: Priority Health Choice Medicaid	$129.08
Rate for Payer: Priority Health Cigna Priority Health	$287.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$285.32
Rate for Payer: Priority Health Narrow Network	$285.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$277.04
Rate for Payer: UHC Exchange	$277.04
Rate for Payer: UHCCP Medicaid	$129.08

PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$1,348.00

Service Code	HCPCS 26476
Min. Negotiated Rate	$415.14
Max. Negotiated Rate	$1,727.54
Rate for Payer: Aetna Commercial	$846.36
Rate for Payer: Aetna Medicare	$674.00
Rate for Payer: BCBS Complete	$435.90
Rate for Payer: BCBS Trust/PPO	$1,727.54
Rate for Payer: BCN Commercial	$959.76
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Meridian Medicaid	$435.90
Rate for Payer: Priority Health Choice Medicaid	$415.14
Rate for Payer: Priority Health Cigna Priority Health	$876.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$998.89
Rate for Payer: Priority Health Narrow Network	$998.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$636.34
Rate for Payer: UHC Exchange	$636.34
Rate for Payer: UHCCP Medicaid	$415.14

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,040.00

Service Code	HCPCS 26478
Min. Negotiated Rate	$425.79
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Commercial	$874.34
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$447.08
Rate for Payer: BCBS Trust/PPO	$878.03
Rate for Payer: BCN Commercial	$989.08
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Meridian Medicaid	$447.08
Rate for Payer: Priority Health Choice Medicaid	$425.79
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,019.25
Rate for Payer: Priority Health Narrow Network	$1,019.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$688.14
Rate for Payer: UHC Exchange	$688.14
Rate for Payer: UHCCP Medicaid	$425.79

PR LESION <15

Professional

Both

$128.00

Service Code	HCPCS 00074
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 LESION FL FACE/NECK

Professional

Both

$255.00

Service Code	HCPCS 00075
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR LESION REMOVAL COLONOSCOPY

Professional

Both

$1,584.00

Service Code	HCPCS G6024
Min. Negotiated Rate	$633.60
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna Medicare	$792.00
Rate for Payer: BCBS Complete	$633.60
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Priority Health Cigna Priority Health	$1,029.60

PR LESION SINGLE

Professional

Both

$36.00

Service Code	HCPCS 00073
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 LEUPROLIDE ACETATE /3.75 MG

Professional

Both

$1,103.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$1,863.44
Rate for Payer: Aetna Commercial	$1,611.54
Rate for Payer: Aetna Medicare	$551.50
Rate for Payer: BCBS Complete	$441.20
Rate for Payer: BCBS Trust/PPO	$1,111.82
Rate for Payer: BCN Commercial	$1,126.47
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Priority Health Cigna Priority Health	$716.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,863.44
Rate for Payer: UHC Exchange	$1,863.44

PR LEUPROLIDE ACETATE INJECITON

Professional

Both

$38.00

Service Code	HCPCS J9218
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$13.04
Rate for Payer: BCN Commercial	$7.60
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$24.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.18
Rate for Payer: UHC Exchange	$5.18

PR LEUPROLIDE ACETATE SUSPNSION

Professional

Both

$461.00

Service Code	HCPCS J9217
Min. Negotiated Rate	$182.32
Max. Negotiated Rate	$299.65
Rate for Payer: Aetna Commercial	$186.74
Rate for Payer: Aetna Medicare	$230.50
Rate for Payer: BCBS Complete	$184.40
Rate for Payer: BCBS Trust/PPO	$191.56
Rate for Payer: BCN Commercial	$182.32
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Priority Health Cigna Priority Health	$299.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$200.98
Rate for Payer: UHC Exchange	$200.98

PR LEVALBUTEROL NON-COMP UNIT

Professional

Both

$5.00

Service Code	HCPCS J7614
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$0.05
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCN Commercial	$0.02
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.05
Rate for Payer: UHC Exchange	$0.05

PR LEVONORGESTREL IMPLANT SYS

Professional

Both

$561.00

Service Code	HCPCS J7306
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$2,147.54
Rate for Payer: Aetna Commercial	$406.00
Rate for Payer: Aetna Medicare	$280.50
Rate for Payer: BCBS Complete	$224.40
Rate for Payer: BCBS Trust/PPO	$2,147.54
Rate for Payer: Cash Price	$448.80
Rate for Payer: Cash Price	$448.80
Rate for Payer: Priority Health Cigna Priority Health	$364.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$507.50
Rate for Payer: UHC Exchange	$507.50

PR LEVONORGESTREL IU CONTRACEPT

Professional

Both

$839.00

Service Code	HCPCS J7302
Min. Negotiated Rate	$335.60
Max. Negotiated Rate	$545.35
Rate for Payer: Aetna Medicare	$419.50
Rate for Payer: BCBS Complete	$335.60
Rate for Payer: Cash Price	$671.20
Rate for Payer: Priority Health Cigna Priority Health	$545.35

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$495.00

Service Code	HCPCS 93452
Min. Negotiated Rate	$146.76
Max. Negotiated Rate	$1,383.09
Rate for Payer: Aetna Commercial	$1,229.14
Rate for Payer: Aetna Medicare	$247.50
Rate for Payer: BCBS Complete	$154.10
Rate for Payer: BCBS Trust/PPO	$1,383.09
Rate for Payer: BCN Commercial	$1,319.43
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Meridian Medicaid	$154.10
Rate for Payer: Priority Health Choice Medicaid	$146.76
Rate for Payer: Priority Health Cigna Priority Health	$321.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$324.40
Rate for Payer: Priority Health Narrow Network	$324.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,120.68
Rate for Payer: UHC Exchange	$1,120.68
Rate for Payer: UHCCP Medicaid	$146.76

PR LIDOCAINE INJECTION

Professional

Both

$3.00

Service Code	HCPCS J2001
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.02
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.03
Rate for Payer: UHC Exchange	$0.03

PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

Professional

Both

$2,489.00

Service Code	HCPCS 27427
Min. Negotiated Rate	$462.42
Max. Negotiated Rate	$1,617.85
Rate for Payer: Aetna Commercial	$951.25
Rate for Payer: Aetna Medicare	$1,244.50
Rate for Payer: BCBS Complete	$485.54
Rate for Payer: BCBS Trust/PPO	$1,194.49
Rate for Payer: BCN Commercial	$1,046.26
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Meridian Medicaid	$485.54
Rate for Payer: Priority Health Choice Medicaid	$462.42
Rate for Payer: Priority Health Cigna Priority Health	$1,617.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,096.60
Rate for Payer: Priority Health Narrow Network	$1,096.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$819.56
Rate for Payer: UHC Exchange	$819.56
Rate for Payer: UHCCP Medicaid	$462.42

Know your out-of-pocket cost for care.

All Charges