Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR SUTURE SCIATIC NERVE

Professional

Both

$2,500.00

Service Code	HCPCS 64858
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,629.04
Rate for Payer: Aetna Commercial	$1,515.92
Rate for Payer: Aetna Medicare	$1,131.28
Rate for Payer: BCBS Complete	$1,000.00
Rate for Payer: BCBS MAPPO	$1,131.28
Rate for Payer: BCN Medicare Advantage	$1,131.28
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cofinity Commercial	$1,629.04
Rate for Payer: Cofinity Commercial	$1,515.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,131.28
Rate for Payer: Healthscope Commercial	$1,357.54
Rate for Payer: Healthscope Whirlpool	$1,357.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,187.84
Rate for Payer: Nomi Health Commercial	$1,357.54
Rate for Payer: PACE SWMI	$1,131.28
Rate for Payer: PHP Medicare Advantage	$1,131.28
Rate for Payer: Priority Health Cigna Priority Health	$1,625.00
Rate for Payer: Priority Health Medicare	$1,131.28
Rate for Payer: UHC Dual Complete DSNP	$1,131.28
Rate for Payer: UHC Medicare Advantage	$1,131.28
Rate for Payer: UHCCP DNSP	$1,131.28

PR SUTURE TRACHEAL WOUND/INJURY CERVICAL

Professional

Both

$1,589.00

Service Code	HCPCS 31800
Min. Negotiated Rate	$635.60
Max. Negotiated Rate	$1,032.85
Rate for Payer: Aetna Commercial	$881.96
Rate for Payer: Aetna Medicare	$658.18
Rate for Payer: BCBS Complete	$635.60
Rate for Payer: BCBS MAPPO	$658.18
Rate for Payer: BCN Medicare Advantage	$658.18
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cofinity Commercial	$947.78
Rate for Payer: Cofinity Commercial	$881.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$658.18
Rate for Payer: Healthscope Commercial	$789.82
Rate for Payer: Healthscope Whirlpool	$789.82
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$691.09
Rate for Payer: Nomi Health Commercial	$789.82
Rate for Payer: PACE SWMI	$658.18
Rate for Payer: PHP Medicare Advantage	$658.18
Rate for Payer: Priority Health Cigna Priority Health	$1,032.85
Rate for Payer: Priority Health Medicare	$658.18
Rate for Payer: UHC Dual Complete DSNP	$658.18
Rate for Payer: UHC Medicare Advantage	$658.18
Rate for Payer: UHCCP DNSP	$658.18

PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC

Professional

Both

$1,671.00

Service Code	HCPCS 31805
Min. Negotiated Rate	$668.40
Max. Negotiated Rate	$1,133.16
Rate for Payer: Aetna Commercial	$1,054.47
Rate for Payer: Aetna Medicare	$786.92
Rate for Payer: BCBS Complete	$668.40
Rate for Payer: BCBS MAPPO	$786.92
Rate for Payer: BCN Medicare Advantage	$786.92
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cofinity Commercial	$1,133.16
Rate for Payer: Cofinity Commercial	$1,054.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$786.92
Rate for Payer: Healthscope Commercial	$944.30
Rate for Payer: Healthscope Whirlpool	$944.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$826.27
Rate for Payer: Nomi Health Commercial	$944.30
Rate for Payer: PACE SWMI	$786.92
Rate for Payer: PHP Medicare Advantage	$786.92
Rate for Payer: Priority Health Cigna Priority Health	$1,086.15
Rate for Payer: Priority Health Medicare	$786.92
Rate for Payer: UHC Dual Complete DSNP	$786.92
Rate for Payer: UHC Medicare Advantage	$786.92
Rate for Payer: UHCCP DNSP	$786.92

PR SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS

Professional

Both

$57.00

Service Code	HCPCS 99058
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$37.05
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$37.05

PR SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS

Professional

Both

$60.00

Service Code	HCPCS 99051
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$39.00

PR SYMPATHECTOMY CERVICAL

Professional

Both

$1,729.00

Service Code	HCPCS 64802
Min. Negotiated Rate	$691.60
Max. Negotiated Rate	$1,205.15
Rate for Payer: Aetna Commercial	$1,121.46
Rate for Payer: Aetna Medicare	$836.91
Rate for Payer: BCBS Complete	$691.60
Rate for Payer: BCBS MAPPO	$836.91
Rate for Payer: BCN Medicare Advantage	$836.91
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cofinity Commercial	$1,205.15
Rate for Payer: Cofinity Commercial	$1,121.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$836.91
Rate for Payer: Healthscope Commercial	$1,004.29
Rate for Payer: Healthscope Whirlpool	$1,004.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$878.76
Rate for Payer: Nomi Health Commercial	$1,004.29
Rate for Payer: PACE SWMI	$836.91
Rate for Payer: PHP Medicare Advantage	$836.91
Rate for Payer: Priority Health Cigna Priority Health	$1,123.85
Rate for Payer: Priority Health Medicare	$836.91
Rate for Payer: UHC Dual Complete DSNP	$836.91
Rate for Payer: UHC Medicare Advantage	$836.91
Rate for Payer: UHCCP DNSP	$836.91

PR SYMPATHECTOMY LUMBAR

Professional

Both

$319.00

Service Code	HCPCS 64818
Min. Negotiated Rate	$127.60
Max. Negotiated Rate	$1,081.73
Rate for Payer: Aetna Commercial	$1,006.61
Rate for Payer: Aetna Medicare	$751.20
Rate for Payer: BCBS Complete	$127.60
Rate for Payer: BCBS MAPPO	$751.20
Rate for Payer: BCN Medicare Advantage	$751.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cofinity Commercial	$1,081.73
Rate for Payer: Cofinity Commercial	$1,006.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$751.20
Rate for Payer: Healthscope Commercial	$901.44
Rate for Payer: Healthscope Whirlpool	$901.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$788.76
Rate for Payer: Nomi Health Commercial	$901.44
Rate for Payer: PACE SWMI	$751.20
Rate for Payer: PHP Medicare Advantage	$751.20
Rate for Payer: Priority Health Cigna Priority Health	$207.35
Rate for Payer: Priority Health Medicare	$751.20
Rate for Payer: UHC Dual Complete DSNP	$751.20
Rate for Payer: UHC Medicare Advantage	$751.20
Rate for Payer: UHCCP DNSP	$751.20

PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI

Professional

Both

$2,168.00

Service Code	HCPCS 50540
Min. Negotiated Rate	$867.20
Max. Negotiated Rate	$1,574.48
Rate for Payer: Aetna Commercial	$1,465.14
Rate for Payer: Aetna Medicare	$1,093.39
Rate for Payer: BCBS Complete	$867.20
Rate for Payer: BCBS MAPPO	$1,093.39
Rate for Payer: BCN Medicare Advantage	$1,093.39
Rate for Payer: Cash Price	$1,734.40
Rate for Payer: Cash Price	$1,734.40
Rate for Payer: Cofinity Commercial	$1,574.48
Rate for Payer: Cofinity Commercial	$1,465.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,093.39
Rate for Payer: Healthscope Commercial	$1,312.07
Rate for Payer: Healthscope Whirlpool	$1,312.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,148.06
Rate for Payer: Nomi Health Commercial	$1,312.07
Rate for Payer: PACE SWMI	$1,093.39
Rate for Payer: PHP Medicare Advantage	$1,093.39
Rate for Payer: Priority Health Cigna Priority Health	$1,409.20
Rate for Payer: Priority Health Medicare	$1,093.39
Rate for Payer: UHC Dual Complete DSNP	$1,093.39
Rate for Payer: UHC Medicare Advantage	$1,093.39
Rate for Payer: UHCCP DNSP	$1,093.39

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	$325.92
Max. Negotiated Rate	$553.80
Rate for Payer: Aetna Commercial	$436.73
Rate for Payer: Aetna Medicare	$325.92
Rate for Payer: BCBS Complete	$340.80
Rate for Payer: BCBS MAPPO	$325.92
Rate for Payer: BCN Medicare Advantage	$325.92
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cofinity Commercial	$469.32
Rate for Payer: Cofinity Commercial	$436.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$325.92
Rate for Payer: Healthscope Commercial	$391.10
Rate for Payer: Healthscope Whirlpool	$391.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$342.22
Rate for Payer: Nomi Health Commercial	$391.10
Rate for Payer: PACE SWMI	$325.92
Rate for Payer: PHP Medicare Advantage	$325.92
Rate for Payer: Priority Health Cigna Priority Health	$553.80
Rate for Payer: Priority Health Medicare	$325.92
Rate for Payer: UHC Dual Complete DSNP	$325.92
Rate for Payer: UHC Medicare Advantage	$325.92
Rate for Payer: UHCCP DNSP	$325.92

Know your out-of-pocket cost for care.

All Charges