Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR PHTFAC FL LEGS

Professional

Both

$357.00

Service Code	HCPCS 00080
Hospital Revenue Code	990
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Priority Health Cigna Priority Health	$232.05

PR PHTFAC HANDS

Professional

Both

$51.00

Service Code	HCPCS 00078
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 PHTFAC HEMANGIOMAS/WARTS

Professional

Both

$36.00

Service Code	HCPCS 00083
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 PHTFAC NASAL VEIN

Professional

Both

$46.00

Service Code	HCPCS 00082
Hospital Revenue Code	990
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$29.90
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$29.90

PR PHTFAC SNGL PIGMENT

Professional

Both

$36.00

Service Code	HCPCS 00081
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 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN

Professional

Both

$54.00

Service Code	HCPCS 97750
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$45.69
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare	$31.73
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS MAPPO	$31.73
Rate for Payer: BCN Medicare Advantage	$31.73
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cofinity Commercial	$45.69
Rate for Payer: Cofinity Commercial	$42.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.73
Rate for Payer: Healthscope Commercial	$38.08
Rate for Payer: Healthscope Whirlpool	$38.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$33.32
Rate for Payer: Nomi Health Commercial	$38.08
Rate for Payer: PACE SWMI	$31.73
Rate for Payer: PHP Medicare Advantage	$31.73
Rate for Payer: Priority Health Cigna Priority Health	$35.10
Rate for Payer: Priority Health Medicare	$31.73
Rate for Payer: UHC Dual Complete DSNP	$31.73
Rate for Payer: UHC Medicare Advantage	$31.73
Rate for Payer: UHCCP DNSP	$31.73

PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

Professional

Both

$183.00

Service Code	HCPCS 93464
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$282.14
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna Medicare	$195.93
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: BCBS MAPPO	$195.93
Rate for Payer: BCN Medicare Advantage	$195.93
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cofinity Commercial	$282.14
Rate for Payer: Cofinity Commercial	$262.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$195.93
Rate for Payer: Healthscope Commercial	$235.12
Rate for Payer: Healthscope Whirlpool	$235.12
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$205.73
Rate for Payer: Nomi Health Commercial	$235.12
Rate for Payer: PACE SWMI	$195.93
Rate for Payer: PHP Medicare Advantage	$195.93
Rate for Payer: Priority Health Cigna Priority Health	$118.95
Rate for Payer: Priority Health Medicare	$195.93
Rate for Payer: UHC Dual Complete DSNP	$195.93
Rate for Payer: UHC Medicare Advantage	$195.93
Rate for Payer: UHCCP DNSP	$195.93

PR PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT

Professional

Both

$7.00

Service Code	HCPCS 01990
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 PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION

Professional

Both

$373.00

Service Code	HCPCS 99183
Min. Negotiated Rate	$101.48
Max. Negotiated Rate	$242.45
Rate for Payer: Aetna Commercial	$135.98
Rate for Payer: Aetna Medicare	$101.48
Rate for Payer: BCBS Complete	$149.20
Rate for Payer: BCBS MAPPO	$101.48
Rate for Payer: BCN Medicare Advantage	$101.48
Rate for Payer: Cash Price	$298.40
Rate for Payer: Cash Price	$298.40
Rate for Payer: Cofinity Commercial	$146.13
Rate for Payer: Cofinity Commercial	$135.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$101.48
Rate for Payer: Healthscope Commercial	$121.78
Rate for Payer: Healthscope Whirlpool	$121.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$106.55
Rate for Payer: Nomi Health Commercial	$121.78
Rate for Payer: PACE SWMI	$101.48
Rate for Payer: PHP Medicare Advantage	$101.48
Rate for Payer: Priority Health Cigna Priority Health	$242.45
Rate for Payer: Priority Health Medicare	$101.48
Rate for Payer: UHC Dual Complete DSNP	$101.48
Rate for Payer: UHC Medicare Advantage	$101.48
Rate for Payer: UHCCP DNSP	$101.48

PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS

Professional

Both

$250.00

Service Code	HCPCS 99288
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Medicare	$125.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$162.50

PR PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING

Professional

Both

$45.00

Service Code	HCPCS 99078
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$29.25

PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE

Professional

Both

$50.00

Service Code	HCPCS 99444
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$32.50

PR PHYS/QHP O/P CARDIAC RHAB W/O CONT ECG MONITOR

Professional

Both

$33.00

Service Code	HCPCS 93797
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$21.45
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: Aetna Medicare	$7.97
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS MAPPO	$7.97
Rate for Payer: BCN Medicare Advantage	$7.97
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cofinity Commercial	$10.68
Rate for Payer: Cofinity Commercial	$11.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$7.97
Rate for Payer: Healthscope Commercial	$9.56
Rate for Payer: Healthscope Whirlpool	$9.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.37
Rate for Payer: Nomi Health Commercial	$9.56
Rate for Payer: PACE SWMI	$7.97
Rate for Payer: PHP Medicare Advantage	$7.97
Rate for Payer: Priority Health Cigna Priority Health	$21.45
Rate for Payer: Priority Health Medicare	$7.97
Rate for Payer: UHC Dual Complete DSNP	$7.97
Rate for Payer: UHC Medicare Advantage	$7.97
Rate for Payer: UHCCP DNSP	$7.97

PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Professional

Both

$149.00

Service Code	HCPCS 99442
Min. Negotiated Rate	$59.60
Max. Negotiated Rate	$96.85
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$59.60
Rate for Payer: Cash Price	$119.20
Rate for Payer: Priority Health Cigna Priority Health	$96.85

PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Professional

Both

$216.00

Service Code	HCPCS 99443
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS Complete	$86.40
Rate for Payer: Cash Price	$172.80
Rate for Payer: Priority Health Cigna Priority Health	$140.40

PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN

Professional

Both

$90.00

Service Code	HCPCS 99441
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$58.50

PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES

Professional

Both

$261.00

Service Code	HCPCS 99360
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$169.65
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS Complete	$104.40
Rate for Payer: Cash Price	$208.80
Rate for Payer: Priority Health Cigna Priority Health	$169.65

PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM

Professional

Both

$917.00

Service Code	HCPCS 15050
Min. Negotiated Rate	$366.80
Max. Negotiated Rate	$626.99
Rate for Payer: Aetna Commercial	$583.45
Rate for Payer: Aetna Medicare	$435.41
Rate for Payer: BCBS Complete	$366.80
Rate for Payer: BCBS MAPPO	$435.41
Rate for Payer: BCN Medicare Advantage	$435.41
Rate for Payer: Cash Price	$733.60
Rate for Payer: Cash Price	$733.60
Rate for Payer: Cofinity Commercial	$583.45
Rate for Payer: Cofinity Commercial	$626.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$435.41
Rate for Payer: Healthscope Commercial	$522.49
Rate for Payer: Healthscope Whirlpool	$522.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$457.18
Rate for Payer: Nomi Health Commercial	$522.49
Rate for Payer: PACE SWMI	$435.41
Rate for Payer: PHP Medicare Advantage	$435.41
Rate for Payer: Priority Health Cigna Priority Health	$596.05
Rate for Payer: Priority Health Medicare	$435.41
Rate for Payer: UHC Dual Complete DSNP	$435.41
Rate for Payer: UHC Medicare Advantage	$435.41
Rate for Payer: UHCCP DNSP	$435.41

PR PLACE CATH BRACHIAL ART

Professional

Both

$761.00

Service Code	HCPCS 36120
Min. Negotiated Rate	$304.40
Max. Negotiated Rate	$494.65
Rate for Payer: Aetna Medicare	$380.50
Rate for Payer: BCBS Complete	$304.40
Rate for Payer: Cash Price	$608.80
Rate for Payer: Priority Health Cigna Priority Health	$494.65

PR PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS

Professional

Both

$3,283.00

Service Code	HCPCS 48000
Min. Negotiated Rate	$1,313.20
Max. Negotiated Rate	$2,634.36
Rate for Payer: Aetna Commercial	$2,451.42
Rate for Payer: Aetna Medicare	$1,829.42
Rate for Payer: BCBS Complete	$1,313.20
Rate for Payer: BCBS MAPPO	$1,829.42
Rate for Payer: BCN Medicare Advantage	$1,829.42
Rate for Payer: Cash Price	$2,626.40
Rate for Payer: Cash Price	$2,626.40
Rate for Payer: Cofinity Commercial	$2,634.36
Rate for Payer: Cofinity Commercial	$2,451.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,829.42
Rate for Payer: Healthscope Commercial	$2,195.30
Rate for Payer: Healthscope Whirlpool	$2,195.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,920.89
Rate for Payer: Nomi Health Commercial	$2,195.30
Rate for Payer: PACE SWMI	$1,829.42
Rate for Payer: PHP Medicare Advantage	$1,829.42
Rate for Payer: Priority Health Cigna Priority Health	$2,133.95
Rate for Payer: Priority Health Medicare	$1,829.42
Rate for Payer: UHC Dual Complete DSNP	$1,829.42
Rate for Payer: UHC Medicare Advantage	$1,829.42
Rate for Payer: UHCCP DNSP	$1,829.42

PR PLACEMENT CHOLEDOCHAL STENT

Professional

Both

$2,547.00

Service Code	HCPCS 47801
Min. Negotiated Rate	$1,018.80
Max. Negotiated Rate	$1,655.55
Rate for Payer: Aetna Commercial	$1,436.37
Rate for Payer: Aetna Medicare	$1,071.92
Rate for Payer: BCBS Complete	$1,018.80
Rate for Payer: BCBS MAPPO	$1,071.92
Rate for Payer: BCN Medicare Advantage	$1,071.92
Rate for Payer: Cash Price	$2,037.60
Rate for Payer: Cash Price	$2,037.60
Rate for Payer: Cofinity Commercial	$1,543.56
Rate for Payer: Cofinity Commercial	$1,436.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,071.92
Rate for Payer: Healthscope Commercial	$1,286.30
Rate for Payer: Healthscope Whirlpool	$1,286.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,125.52
Rate for Payer: Nomi Health Commercial	$1,286.30
Rate for Payer: PACE SWMI	$1,071.92
Rate for Payer: PHP Medicare Advantage	$1,071.92
Rate for Payer: Priority Health Cigna Priority Health	$1,655.55
Rate for Payer: Priority Health Medicare	$1,071.92
Rate for Payer: UHC Dual Complete DSNP	$1,071.92
Rate for Payer: UHC Medicare Advantage	$1,071.92
Rate for Payer: UHCCP DNSP	$1,071.92

PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN

Professional

Both

$1,971.00

Service Code	HCPCS 44300
Min. Negotiated Rate	$788.40
Max. Negotiated Rate	$1,281.15
Rate for Payer: Aetna Commercial	$1,094.95
Rate for Payer: Aetna Medicare	$817.13
Rate for Payer: BCBS Complete	$788.40
Rate for Payer: BCBS MAPPO	$817.13
Rate for Payer: BCN Medicare Advantage	$817.13
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cash Price	$1,576.80
Rate for Payer: Cofinity Commercial	$1,176.67
Rate for Payer: Cofinity Commercial	$1,094.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$817.13
Rate for Payer: Healthscope Commercial	$980.56
Rate for Payer: Healthscope Whirlpool	$980.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$857.99
Rate for Payer: Nomi Health Commercial	$980.56
Rate for Payer: PACE SWMI	$817.13
Rate for Payer: PHP Medicare Advantage	$817.13
Rate for Payer: Priority Health Cigna Priority Health	$1,281.15
Rate for Payer: Priority Health Medicare	$817.13
Rate for Payer: UHC Dual Complete DSNP	$817.13
Rate for Payer: UHC Medicare Advantage	$817.13
Rate for Payer: UHCCP DNSP	$817.13

PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION

Professional

Both

$565.00

Service Code	HCPCS 36680
Min. Negotiated Rate	$57.69
Max. Negotiated Rate	$367.25
Rate for Payer: Aetna Commercial	$77.30
Rate for Payer: Aetna Medicare	$57.69
Rate for Payer: BCBS Complete	$226.00
Rate for Payer: BCBS MAPPO	$57.69
Rate for Payer: BCN Medicare Advantage	$57.69
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cofinity Commercial	$83.07
Rate for Payer: Cofinity Commercial	$77.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$57.69
Rate for Payer: Healthscope Commercial	$69.23
Rate for Payer: Healthscope Whirlpool	$69.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$60.57
Rate for Payer: Nomi Health Commercial	$69.23
Rate for Payer: PACE SWMI	$57.69
Rate for Payer: PHP Medicare Advantage	$57.69
Rate for Payer: Priority Health Cigna Priority Health	$367.25
Rate for Payer: Priority Health Medicare	$57.69
Rate for Payer: UHC Dual Complete DSNP	$57.69
Rate for Payer: UHC Medicare Advantage	$57.69
Rate for Payer: UHCCP DNSP	$57.69

PR PLACEMENT SETON

Professional

Both

$390.00

Service Code	HCPCS 46020
Min. Negotiated Rate	$112.34
Max. Negotiated Rate	$253.50
Rate for Payer: Aetna Commercial	$150.54
Rate for Payer: Aetna Medicare	$112.34
Rate for Payer: BCBS Complete	$156.00
Rate for Payer: BCBS MAPPO	$112.34
Rate for Payer: BCN Medicare Advantage	$112.34
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cofinity Commercial	$161.77
Rate for Payer: Cofinity Commercial	$150.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$112.34
Rate for Payer: Healthscope Commercial	$134.81
Rate for Payer: Healthscope Whirlpool	$134.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$117.96
Rate for Payer: Nomi Health Commercial	$134.81
Rate for Payer: PACE SWMI	$112.34
Rate for Payer: PHP Medicare Advantage	$112.34
Rate for Payer: Priority Health Cigna Priority Health	$253.50
Rate for Payer: Priority Health Medicare	$112.34
Rate for Payer: UHC Dual Complete DSNP	$112.34
Rate for Payer: UHC Medicare Advantage	$112.34
Rate for Payer: UHCCP DNSP	$112.34

PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR

Professional

Both

$681.00

Service Code	HCPCS 34709
Min. Negotiated Rate	$272.40
Max. Negotiated Rate	$444.86
Rate for Payer: Aetna Commercial	$413.97
Rate for Payer: Aetna Medicare	$308.93
Rate for Payer: BCBS Complete	$272.40
Rate for Payer: BCBS MAPPO	$308.93
Rate for Payer: BCN Medicare Advantage	$308.93
Rate for Payer: Cash Price	$544.80
Rate for Payer: Cash Price	$544.80
Rate for Payer: Cofinity Commercial	$444.86
Rate for Payer: Cofinity Commercial	$413.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$308.93
Rate for Payer: Healthscope Commercial	$370.72
Rate for Payer: Healthscope Whirlpool	$370.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$324.38
Rate for Payer: Nomi Health Commercial	$370.72
Rate for Payer: PACE SWMI	$308.93
Rate for Payer: PHP Medicare Advantage	$308.93
Rate for Payer: Priority Health Cigna Priority Health	$442.65
Rate for Payer: Priority Health Medicare	$308.93
Rate for Payer: UHC Dual Complete DSNP	$308.93
Rate for Payer: UHC Medicare Advantage	$308.93
Rate for Payer: UHCCP DNSP	$308.93

Know your out-of-pocket cost for care.

All Charges