Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR SYNCHRONOUS AUDIO-ONLY VISIT EST HIGH MDM 40 MIN

Professional

Both

$355.00

Service Code	HCPCS 98015
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$230.75
Rate for Payer: Aetna Medicare	$177.50
Rate for Payer: BCBS Complete	$142.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Priority Health Cigna Priority Health	$230.75

PR SYNCHRONOUS AUDIO-ONLY VISIT EST LOW MDM 20 MIN

Professional

Both

$162.00

Service Code	HCPCS 98013
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna Medicare	$81.00
Rate for Payer: BCBS Complete	$64.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Priority Health Cigna Priority Health	$105.30

PR SYNCHRONOUS AUDIO-ONLY VISIT EST MOD MDM 30 MIN

Professional

Both

$241.00

Service Code	HCPCS 98014
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$156.65
Rate for Payer: Aetna Medicare	$120.50
Rate for Payer: BCBS Complete	$96.40
Rate for Payer: Cash Price	$192.80
Rate for Payer: Priority Health Cigna Priority Health	$156.65

PR SYNCHRONOUS AUDIO-ONLY VISIT EST SF MDM 10 MIN

Professional

Both

$89.00

Service Code	HCPCS 98012
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$57.85
Rate for Payer: Aetna Medicare	$44.50
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$57.85

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW HIGH MDM 60 MIN

Professional

Both

$435.00

Service Code	HCPCS 98011
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$282.75
Rate for Payer: Aetna Medicare	$217.50
Rate for Payer: BCBS Complete	$174.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Priority Health Cigna Priority Health	$282.75

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW LOW MDM 30 MIN

Professional

Both

$207.00

Service Code	HCPCS 98009
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$134.55
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCBS Complete	$82.80
Rate for Payer: Cash Price	$165.60
Rate for Payer: Priority Health Cigna Priority Health	$134.55

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW MOD MDM 45 MIN

Professional

Both

$332.00

Service Code	HCPCS 98010
Min. Negotiated Rate	$132.80
Max. Negotiated Rate	$215.80
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: Cash Price	$265.60
Rate for Payer: Priority Health Cigna Priority Health	$215.80

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW SF MDM 15 MIN

Professional

Both

$121.00

Service Code	HCPCS 98008
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$78.65
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$78.65

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST LOW MDM 20 MIN

Professional

Both

$194.00

Service Code	HCPCS 98005
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: Cash Price	$155.20
Rate for Payer: Priority Health Cigna Priority Health	$126.10

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST MOD MDM 30 MIN

Professional

Both

$263.00

Service Code	HCPCS 98006
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$170.95
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Priority Health Cigna Priority Health	$170.95

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST SF MDM 10 MIN

Professional

Both

$111.00

Service Code	HCPCS 98004
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$72.15
Rate for Payer: Aetna Medicare	$55.50
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: Cash Price	$88.80
Rate for Payer: Priority Health Cigna Priority Health	$72.15

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN

Professional

Both

$237.00

Service Code	HCPCS 98001
Min. Negotiated Rate	$94.80
Max. Negotiated Rate	$154.05
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$154.05

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN

Professional

Both

$355.00

Service Code	HCPCS 98002
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$230.75
Rate for Payer: Aetna Medicare	$177.50
Rate for Payer: BCBS Complete	$142.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Priority Health Cigna Priority Health	$230.75

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW SF MDM 15 MIN

Professional

Both

$127.00

Service Code	HCPCS 98000
Min. Negotiated Rate	$50.80
Max. Negotiated Rate	$82.55
Rate for Payer: Aetna Medicare	$63.50
Rate for Payer: BCBS Complete	$50.80
Rate for Payer: Cash Price	$101.60
Rate for Payer: Priority Health Cigna Priority Health	$82.55

PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN

Professional

Both

$355.00

Service Code	HCPCS 98007
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$230.75
Rate for Payer: Aetna Medicare	$177.50
Rate for Payer: BCBS Complete	$142.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Priority Health Cigna Priority Health	$230.75

PR SYNCHRONOUS AUDIO-VIDEO VST NEW HIGH MDM 60 MIN

Professional

Both

$477.00

Service Code	HCPCS 98003
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$310.05
Rate for Payer: Aetna Medicare	$238.50
Rate for Payer: BCBS Complete	$190.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Priority Health Cigna Priority Health	$310.05

PR SYNDACTYLIZATION TOES

Professional

Both

$852.00

Service Code	HCPCS 28280
Min. Negotiated Rate	$221.31
Max. Negotiated Rate	$756.00
Rate for Payer: Aetna Commercial	$457.50
Rate for Payer: Aetna Medicare	$426.00
Rate for Payer: BCBS Complete	$232.38
Rate for Payer: BCBS Trust/PPO	$756.00
Rate for Payer: BCN Commercial	$741.32
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Meridian Medicaid	$232.38
Rate for Payer: Priority Health Choice Medicaid	$221.31
Rate for Payer: Priority Health Cigna Priority Health	$553.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$531.25
Rate for Payer: Priority Health Narrow Network	$531.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$419.95
Rate for Payer: UHC Exchange	$419.95
Rate for Payer: UHCCP Medicaid	$221.31

PR SYNOVECTOMY CARPOMETACARPAL JOINT

Professional

Both

$1,182.00

Service Code	HCPCS 26130
Min. Negotiated Rate	$310.13
Max. Negotiated Rate	$768.30
Rate for Payer: Aetna Commercial	$623.09
Rate for Payer: Aetna Medicare	$591.00
Rate for Payer: BCBS Complete	$325.64
Rate for Payer: BCN Commercial	$696.86
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cash Price	$945.60
Rate for Payer: Meridian Medicaid	$325.64
Rate for Payer: Priority Health Choice Medicaid	$310.13
Rate for Payer: Priority Health Cigna Priority Health	$768.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$734.29
Rate for Payer: Priority Health Narrow Network	$734.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$509.89
Rate for Payer: UHC Exchange	$509.89
Rate for Payer: UHCCP Medicaid	$310.13

PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT

Professional

Both

$1,276.00

Service Code	HCPCS 25118
Min. Negotiated Rate	$145.28
Max. Negotiated Rate	$829.40
Rate for Payer: Aetna Commercial	$506.36
Rate for Payer: Aetna Medicare	$638.00
Rate for Payer: BCBS Complete	$266.82
Rate for Payer: BCBS Trust/PPO	$145.28
Rate for Payer: BCN Commercial	$568.82
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Meridian Medicaid	$266.82
Rate for Payer: Priority Health Choice Medicaid	$254.11
Rate for Payer: Priority Health Cigna Priority Health	$829.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$600.45
Rate for Payer: Priority Health Narrow Network	$600.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$429.59
Rate for Payer: UHC Exchange	$429.59
Rate for Payer: UHCCP Medicaid	$254.11

PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH

Professional

Both

$1,016.00

Service Code	HCPCS 28072
Min. Negotiated Rate	$212.15
Max. Negotiated Rate	$712.98
Rate for Payer: Aetna Commercial	$423.46
Rate for Payer: Aetna Medicare	$508.00
Rate for Payer: BCBS Complete	$222.76
Rate for Payer: BCBS Trust/PPO	$567.39
Rate for Payer: BCN Commercial	$712.98
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Meridian Medicaid	$222.76
Rate for Payer: Priority Health Choice Medicaid	$212.15
Rate for Payer: Priority Health Cigna Priority Health	$660.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$502.25
Rate for Payer: Priority Health Narrow Network	$502.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$397.38
Rate for Payer: UHC Exchange	$397.38
Rate for Payer: UHCCP Medicaid	$212.15

PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD

Professional

Both

$1,726.00

Service Code	HCPCS 26135
Min. Negotiated Rate	$295.85
Max. Negotiated Rate	$1,121.90
Rate for Payer: Aetna Commercial	$736.91
Rate for Payer: Aetna Medicare	$863.00
Rate for Payer: BCBS Complete	$383.56
Rate for Payer: BCBS Trust/PPO	$295.85
Rate for Payer: BCN Commercial	$820.97
Rate for Payer: Cash Price	$1,380.80
Rate for Payer: Cash Price	$1,380.80
Rate for Payer: Meridian Medicaid	$383.56
Rate for Payer: Priority Health Choice Medicaid	$365.30
Rate for Payer: Priority Health Cigna Priority Health	$1,121.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$862.01
Rate for Payer: Priority Health Narrow Network	$862.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$619.27
Rate for Payer: UHC Exchange	$619.27
Rate for Payer: UHCCP Medicaid	$365.30

PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT

Professional

Both

$1,476.00

Service Code	HCPCS 26140
Min. Negotiated Rate	$335.05
Max. Negotiated Rate	$959.40
Rate for Payer: Aetna Commercial	$674.76
Rate for Payer: Aetna Medicare	$738.00
Rate for Payer: BCBS Complete	$351.80
Rate for Payer: BCBS Trust/PPO	$497.66
Rate for Payer: BCN Commercial	$752.56
Rate for Payer: Cash Price	$1,180.80
Rate for Payer: Cash Price	$1,180.80
Rate for Payer: Meridian Medicaid	$351.80
Rate for Payer: Priority Health Choice Medicaid	$335.05
Rate for Payer: Priority Health Cigna Priority Health	$959.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.31
Rate for Payer: Priority Health Narrow Network	$793.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$565.12
Rate for Payer: UHC Exchange	$565.12
Rate for Payer: UHCCP Medicaid	$335.05

PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN

Professional

Both

$1,680.00

Service Code	HCPCS 26145
Min. Negotiated Rate	$273.13
Max. Negotiated Rate	$1,092.00
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare	$840.00
Rate for Payer: BCBS Complete	$357.84
Rate for Payer: BCBS Trust/PPO	$273.13
Rate for Payer: BCN Commercial	$764.78
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Meridian Medicaid	$357.84
Rate for Payer: Priority Health Choice Medicaid	$340.80
Rate for Payer: Priority Health Cigna Priority Health	$1,092.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$805.02
Rate for Payer: Priority Health Narrow Network	$805.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$574.03
Rate for Payer: UHC Exchange	$574.03
Rate for Payer: UHCCP Medicaid	$340.80

PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA

Professional

Both

$1,796.00

Service Code	HCPCS 25119
Min. Negotiated Rate	$39.09
Max. Negotiated Rate	$1,167.40
Rate for Payer: Aetna Commercial	$663.09
Rate for Payer: Aetna Medicare	$898.00
Rate for Payer: BCBS Complete	$348.00
Rate for Payer: BCBS Trust/PPO	$39.09
Rate for Payer: BCN Commercial	$745.24
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Meridian Medicaid	$348.00
Rate for Payer: Priority Health Choice Medicaid	$331.43
Rate for Payer: Priority Health Cigna Priority Health	$1,167.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$784.15
Rate for Payer: Priority Health Narrow Network	$784.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$570.32
Rate for Payer: UHC Exchange	$570.32
Rate for Payer: UHCCP Medicaid	$331.43

PR SYNVISC OR SYNVISC-ONE

Professional

Both

$51.00

Service Code	HCPCS J7325
Min. Negotiated Rate	$8.82
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Commercial	$9.40
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS Trust/PPO	$9.29
Rate for Payer: BCN Commercial	$10.87
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.82
Rate for Payer: UHC Exchange	$8.82

Know your out-of-pocket cost for care.

All Charges