Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR MD CERTIFICATION HHA PATIENT

Professional

Both

$104.00

Service Code	HCPCS G0180
Min. Negotiated Rate	$41.60
Max. Negotiated Rate	$76.60
Rate for Payer: Aetna Commercial	$51.34
Rate for Payer: Aetna Medicare	$52.00
Rate for Payer: BCBS Complete	$41.60
Rate for Payer: BCBS Trust/PPO	$76.60
Rate for Payer: BCN Commercial	$75.75
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Priority Health Cigna Priority Health	$67.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.82
Rate for Payer: Priority Health Narrow Network	$72.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.01
Rate for Payer: UHC Exchange	$54.01

PR MD INR TEST REVIE INTER MGMT

Professional

Both

$31.00

Service Code	HCPCS G0250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$459.09
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$459.09
Rate for Payer: BCN Commercial	$12.71
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.66
Rate for Payer: Priority Health Narrow Network	$11.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.36
Rate for Payer: UHC Exchange	$10.36

PR MD RECERTIFICATION HHA PT

Professional

Both

$79.00

Service Code	HCPCS G0179
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$83.63
Rate for Payer: Aetna Commercial	$39.71
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: BCBS Trust/PPO	$83.63
Rate for Payer: BCN Commercial	$60.11
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Priority Health Cigna Priority Health	$51.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$56.99
Rate for Payer: Priority Health Narrow Network	$56.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$40.98
Rate for Payer: UHC Exchange	$40.98

PR MD SERVICE REQUIRED FOR PMD

Professional

Both

$29.00

Service Code	HCPCS G0372
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$1,453.88
Rate for Payer: Aetna Commercial	$8.90
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCBS Trust/PPO	$1,453.88
Rate for Payer: BCN Commercial	$12.71
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$18.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.75
Rate for Payer: Priority Health Narrow Network	$11.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.86
Rate for Payer: UHC Exchange	$8.86

PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$306.00

Service Code	HCPCS 90710
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$333.79
Rate for Payer: Aetna Commercial	$275.04
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: BCBS Trust/PPO	$260.00
Rate for Payer: BCN Commercial	$258.46
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$333.79
Rate for Payer: UHC Exchange	$333.79

PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$107.00

Service Code	HCPCS 90707
Min. Negotiated Rate	$42.80
Max. Negotiated Rate	$112.62
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare	$53.50
Rate for Payer: BCBS Complete	$42.80
Rate for Payer: BCBS Trust/PPO	$88.32
Rate for Payer: BCN Commercial	$88.32
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Priority Health Cigna Priority Health	$69.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$112.62
Rate for Payer: UHC Exchange	$112.62

PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP

Professional

Both

$34.00

Service Code	HCPCS 51798
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$3,662.70
Rate for Payer: Aetna Commercial	$12.43
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: BCBS Trust/PPO	$3,662.70
Rate for Payer: BCN Commercial	$15.64
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Priority Health Cigna Priority Health	$22.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.11
Rate for Payer: Priority Health Narrow Network	$18.11
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.26
Rate for Payer: UHC Exchange	$21.26

PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT

Professional

Both

$342.00

Service Code	HCPCS 53020
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$359.24
Rate for Payer: Aetna Commercial	$123.91
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS Complete	$64.64
Rate for Payer: BCBS Trust/PPO	$359.24
Rate for Payer: BCN Commercial	$138.79
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Meridian Medicaid	$64.64
Rate for Payer: Priority Health Choice Medicaid	$61.56
Rate for Payer: Priority Health Cigna Priority Health	$222.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$152.86
Rate for Payer: Priority Health Narrow Network	$152.86
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$117.74
Rate for Payer: UHC Exchange	$117.74
Rate for Payer: UHCCP Medicaid	$61.56

PR MEATOTOMY CUTTING MEATUS SPX INFANT

Professional

Both

$357.00

Service Code	HCPCS 53025
Min. Negotiated Rate	$44.30
Max. Negotiated Rate	$718.49
Rate for Payer: Aetna Commercial	$86.37
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$46.52
Rate for Payer: BCBS Trust/PPO	$718.49
Rate for Payer: BCN Commercial	$98.72
Rate for Payer: Cash Price	$285.60
Rate for Payer: Cash Price	$285.60
Rate for Payer: Meridian Medicaid	$46.52
Rate for Payer: Priority Health Choice Medicaid	$44.30
Rate for Payer: Priority Health Cigna Priority Health	$232.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$109.18
Rate for Payer: Priority Health Narrow Network	$109.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$77.54
Rate for Payer: UHC Exchange	$77.54
Rate for Payer: UHCCP Medicaid	$44.30

PR MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED

Professional

Both

$2,243.00

Service Code	HCPCS 39400
Min. Negotiated Rate	$897.20
Max. Negotiated Rate	$1,457.95
Rate for Payer: Aetna Medicare	$1,121.50
Rate for Payer: BCBS Complete	$897.20
Rate for Payer: Cash Price	$1,794.40
Rate for Payer: Priority Health Cigna Priority Health	$1,457.95

PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY

Professional

Both

$970.00

Service Code	HCPCS 39401
Min. Negotiated Rate	$195.53
Max. Negotiated Rate	$630.50
Rate for Payer: Aetna Commercial	$314.80
Rate for Payer: Aetna Medicare	$485.00
Rate for Payer: BCBS Complete	$205.31
Rate for Payer: BCBS Trust/PPO	$207.62
Rate for Payer: BCN Commercial	$442.74
Rate for Payer: Cash Price	$776.00
Rate for Payer: Cash Price	$776.00
Rate for Payer: Meridian Medicaid	$205.31
Rate for Payer: Priority Health Choice Medicaid	$195.53
Rate for Payer: Priority Health Cigna Priority Health	$630.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$484.49
Rate for Payer: Priority Health Narrow Network	$484.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$384.56
Rate for Payer: UHC Exchange	$384.56
Rate for Payer: UHCCP Medicaid	$195.53

PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES

Professional

Both

$845.00

Service Code	HCPCS 39402
Min. Negotiated Rate	$254.96
Max. Negotiated Rate	$632.34
Rate for Payer: Aetna Commercial	$412.59
Rate for Payer: Aetna Medicare	$422.50
Rate for Payer: BCBS Complete	$267.71
Rate for Payer: BCBS Trust/PPO	$487.62
Rate for Payer: BCN Commercial	$578.11
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Meridian Medicaid	$267.71
Rate for Payer: Priority Health Choice Medicaid	$254.96
Rate for Payer: Priority Health Cigna Priority Health	$549.25
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$632.34
Rate for Payer: Priority Health Narrow Network	$632.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$502.68
Rate for Payer: UHC Exchange	$502.68
Rate for Payer: UHCCP Medicaid	$254.96

PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR

Professional

Both

$2,549.00

Service Code	HCPCS 39000
Min. Negotiated Rate	$323.97
Max. Negotiated Rate	$1,656.85
Rate for Payer: Aetna Commercial	$505.24
Rate for Payer: Aetna Medicare	$1,274.50
Rate for Payer: BCBS Complete	$340.17
Rate for Payer: BCBS Trust/PPO	$418.94
Rate for Payer: BCN Commercial	$700.27
Rate for Payer: Cash Price	$2,039.20
Rate for Payer: Cash Price	$2,039.20
Rate for Payer: Meridian Medicaid	$340.17
Rate for Payer: Priority Health Choice Medicaid	$323.97
Rate for Payer: Priority Health Cigna Priority Health	$1,656.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$805.72
Rate for Payer: Priority Health Narrow Network	$805.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$569.62
Rate for Payer: UHC Exchange	$569.62
Rate for Payer: UHCCP Medicaid	$323.97

PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR

Professional

Both

$5,247.00

Service Code	HCPCS 39010
Min. Negotiated Rate	$502.68
Max. Negotiated Rate	$3,410.55
Rate for Payer: Aetna Commercial	$804.81
Rate for Payer: Aetna Medicare	$2,623.50
Rate for Payer: BCBS Complete	$527.81
Rate for Payer: BCBS Trust/PPO	$1,750.26
Rate for Payer: BCN Commercial	$1,138.13
Rate for Payer: Cash Price	$4,197.60
Rate for Payer: Cash Price	$4,197.60
Rate for Payer: Meridian Medicaid	$527.81
Rate for Payer: Priority Health Choice Medicaid	$502.68
Rate for Payer: Priority Health Cigna Priority Health	$3,410.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,248.20
Rate for Payer: Priority Health Narrow Network	$1,248.20
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$940.27
Rate for Payer: UHC Exchange	$940.27
Rate for Payer: UHCCP Medicaid	$502.68

PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI

Professional

Both

$61.00

Service Code	HCPCS 97802
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$1,112.07
Rate for Payer: Aetna Commercial	$47.63
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$1,112.07
Rate for Payer: BCN Commercial	$53.26
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	$33.34
Rate for Payer: Priority Health Narrow Network	$33.34
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$29.56
Rate for Payer: UHC Exchange	$29.56

PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M

Professional

Both

$50.00

Service Code	HCPCS 97803
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$561.58
Rate for Payer: Aetna Commercial	$40.61
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCBS Trust/PPO	$561.58
Rate for Payer: BCN Commercial	$46.43
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$32.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29.82
Rate for Payer: Priority Health Narrow Network	$29.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$25.34
Rate for Payer: UHC Exchange	$25.34

PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Professional

Both

$28.00

Service Code	HCPCS 97804
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$641.36
Rate for Payer: Aetna Commercial	$22.56
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCBS Trust/PPO	$641.36
Rate for Payer: BCN Commercial	$24.44
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$18.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15.57
Rate for Payer: Priority Health Narrow Network	$15.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.82
Rate for Payer: UHC Exchange	$13.82

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$328.00

Service Code	HCPCS 93463
Min. Negotiated Rate	$61.13
Max. Negotiated Rate	$735.92
Rate for Payer: Aetna Commercial	$131.17
Rate for Payer: Aetna Medicare	$164.00
Rate for Payer: BCBS Complete	$64.19
Rate for Payer: BCBS Trust/PPO	$735.92
Rate for Payer: BCN Commercial	$140.25
Rate for Payer: Cash Price	$262.40
Rate for Payer: Cash Price	$262.40
Rate for Payer: Meridian Medicaid	$64.19
Rate for Payer: Priority Health Choice Medicaid	$61.13
Rate for Payer: Priority Health Cigna Priority Health	$213.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.66
Rate for Payer: Priority Health Narrow Network	$134.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$146.68
Rate for Payer: UHC Exchange	$146.68
Rate for Payer: UHCCP Medicaid	$61.13

PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN

Professional

Both

$13.00

Service Code	HCPCS 99607
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$370.34
Rate for Payer: Aetna Commercial	$45.29
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: BCBS Trust/PPO	$370.34
Rate for Payer: Cash Price	$10.40
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45

PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT

Professional

Both

$32.00

Service Code	HCPCS 99606
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$62.87
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCBS Trust/PPO	$62.87
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$20.80

PR MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT

Professional

Both

$64.00

Service Code	HCPCS 99605
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$79.81
Rate for Payer: Aetna Commercial	$67.55
Rate for Payer: Aetna Medicare	$32.00
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: BCBS Trust/PPO	$79.81
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Priority Health Cigna Priority Health	$41.60

PR MEDROXYPROGESTERONE ACETATE

Professional

Both

$1.00

Service Code	HCPCS J1050
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna Commercial	$0.52
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.14
Rate for Payer: BCN Commercial	$0.14
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$0.53
Rate for Payer: UHC Exchange	$0.53

PR MEDROXYPROGESTERONE INJ

Professional

Both

$31.00

Service Code	HCPCS J1051
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

PR MEDRXYPROGESTER ACETATE INJ

Professional

Both

$82.00

Service Code	HCPCS J1055
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 MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE

Professional

Both

$143.00

Service Code	HCPCS 90734
Min. Negotiated Rate	$57.20
Max. Negotiated Rate	$188.82
Rate for Payer: Aetna Commercial	$151.33
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$57.20
Rate for Payer: BCBS Trust/PPO	$150.00
Rate for Payer: BCN Commercial	$147.22
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: UHC All Payor (Choice/PPO) + Core	$188.82
Rate for Payer: UHC Exchange	$188.82

Know your out-of-pocket cost for care.

All Charges