Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES

Professional

Both

$35.00

Service Code	HCPCS 36410
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$1,232.00
Rate for Payer: Aetna Commercial	$12.41
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCBS Trust/PPO	$1,232.00
Rate for Payer: BCN Commercial	$25.41
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Priority Health Cigna Priority Health	$22.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.36
Rate for Payer: Priority Health Narrow Network	$14.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.51
Rate for Payer: UHC Exchange	$11.51

PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN

Professional

Both

$37.00

Service Code	HCPCS 36406
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$25.41
Rate for Payer: Aetna Commercial	$11.51
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$5.82
Rate for Payer: BCN Commercial	$25.41
Rate for Payer: Cash Price	$29.60
Rate for Payer: Cash Price	$29.60
Rate for Payer: Meridian Medicaid	$5.82
Rate for Payer: Priority Health Choice Medicaid	$5.54
Rate for Payer: Priority Health Cigna Priority Health	$24.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.82
Rate for Payer: Priority Health Narrow Network	$13.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$11.95
Rate for Payer: UHC Exchange	$11.95
Rate for Payer: UHCCP Medicaid	$5.54

PR VOID PRESSURE STUDIES INTRAABDOMINAL

Professional

Both

$518.00

Service Code	HCPCS 51797
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$3,594.55
Rate for Payer: Aetna Commercial	$231.52
Rate for Payer: Aetna Medicare	$259.00
Rate for Payer: BCBS Complete	$26.17
Rate for Payer: BCBS Trust/PPO	$3,594.55
Rate for Payer: BCN Commercial	$282.46
Rate for Payer: Cash Price	$414.40
Rate for Payer: Cash Price	$414.40
Rate for Payer: Meridian Medicaid	$26.17
Rate for Payer: Priority Health Choice Medicaid	$24.92
Rate for Payer: Priority Health Cigna Priority Health	$336.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.32
Rate for Payer: Priority Health Narrow Network	$62.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$157.38
Rate for Payer: UHC Exchange	$157.38
Rate for Payer: UHCCP Medicaid	$24.92

PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK

Professional

Both

$140.00

Service Code	HCPCS 92540
Min. Negotiated Rate	$48.35
Max. Negotiated Rate	$1,769.28
Rate for Payer: Aetna Commercial	$119.63
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: BCBS Complete	$50.77
Rate for Payer: BCBS Trust/PPO	$1,769.28
Rate for Payer: BCN Commercial	$158.33
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Meridian Medicaid	$50.77
Rate for Payer: Priority Health Choice Medicaid	$48.35
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.67
Rate for Payer: Priority Health Narrow Network	$102.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$100.35
Rate for Payer: UHC Exchange	$100.35
Rate for Payer: UHCCP Medicaid	$48.35

PR VULVECTOMY RADICAL PARTIAL

Professional

Both

$1,623.00

Service Code	HCPCS 56630
Min. Negotiated Rate	$617.70
Max. Negotiated Rate	$1,855.92
Rate for Payer: Aetna Commercial	$1,132.58
Rate for Payer: Aetna Medicare	$811.50
Rate for Payer: BCBS Complete	$648.58
Rate for Payer: BCBS Trust/PPO	$1,855.92
Rate for Payer: BCN Commercial	$1,408.37
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Meridian Medicaid	$648.58
Rate for Payer: Priority Health Choice Medicaid	$617.70
Rate for Payer: Priority Health Cigna Priority Health	$1,054.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,442.01
Rate for Payer: Priority Health Narrow Network	$1,442.01
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,001.50
Rate for Payer: UHC Exchange	$1,001.50
Rate for Payer: UHCCP Medicaid	$617.70

PR VULVECTOMY SIMPLE PARTIAL

Professional

Both

$1,571.00

Service Code	HCPCS 56620
Min. Negotiated Rate	$377.86
Max. Negotiated Rate	$1,725.43
Rate for Payer: Aetna Commercial	$677.28
Rate for Payer: Aetna Medicare	$785.50
Rate for Payer: BCBS Complete	$396.75
Rate for Payer: BCBS Trust/PPO	$1,725.43
Rate for Payer: BCN Commercial	$862.52
Rate for Payer: Cash Price	$1,256.80
Rate for Payer: Cash Price	$1,256.80
Rate for Payer: Meridian Medicaid	$396.75
Rate for Payer: Priority Health Choice Medicaid	$377.86
Rate for Payer: Priority Health Cigna Priority Health	$1,021.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$883.46
Rate for Payer: Priority Health Narrow Network	$883.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$563.52
Rate for Payer: UHC Exchange	$563.52
Rate for Payer: UHCCP Medicaid	$377.86

PR WEDGE EXCISION SKIN NAIL FOLD

Professional

Both

$272.00

Service Code	HCPCS 11765
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$267.10
Rate for Payer: Aetna Commercial	$94.01
Rate for Payer: Aetna Medicare	$136.00
Rate for Payer: BCBS Complete	$63.07
Rate for Payer: BCBS Trust/PPO	$267.10
Rate for Payer: BCN Commercial	$194.37
Rate for Payer: Cash Price	$217.60
Rate for Payer: Cash Price	$217.60
Rate for Payer: Meridian Medicaid	$63.07
Rate for Payer: Priority Health Choice Medicaid	$60.07
Rate for Payer: Priority Health Cigna Priority Health	$176.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$126.43
Rate for Payer: Priority Health Narrow Network	$126.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$69.62
Rate for Payer: UHC Exchange	$69.62
Rate for Payer: UHCCP Medicaid	$60.07

PR WEDGE RESCJ/BISCTJ OVARY UNI/BI

Professional

Both

$1,929.00

Service Code	HCPCS 58920
Min. Negotiated Rate	$165.36
Max. Negotiated Rate	$1,253.85
Rate for Payer: Aetna Commercial	$854.80
Rate for Payer: Aetna Medicare	$964.50
Rate for Payer: BCBS Complete	$480.85
Rate for Payer: BCBS Trust/PPO	$165.36
Rate for Payer: BCN Commercial	$1,050.17
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Cash Price	$1,543.20
Rate for Payer: Meridian Medicaid	$480.85
Rate for Payer: Priority Health Choice Medicaid	$457.95
Rate for Payer: Priority Health Cigna Priority Health	$1,253.85
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,069.48
Rate for Payer: Priority Health Narrow Network	$1,069.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$798.59
Rate for Payer: UHC Exchange	$798.59
Rate for Payer: UHCCP Medicaid	$457.95

PR WEDGING CAST EXCEPT CLUBFOOT CASTS

Professional

Both

$114.00

Service Code	HCPCS 29740
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$1,753.43
Rate for Payer: Aetna Commercial	$92.51
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$1,753.43
Rate for Payer: BCN Commercial	$144.65
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$104.82
Rate for Payer: Priority Health Narrow Network	$104.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$77.06
Rate for Payer: UHC Exchange	$77.06
Rate for Payer: UHCCP Medicaid	$44.09

PR WESTONE MUSICIAN EAR PLUGS

Professional

Both

$296.00

Service Code	HCPCS 00591
Hospital Revenue Code	990
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$192.40
Rate for Payer: Aetna Medicare	$148.00
Rate for Payer: BCBS Complete	$118.40
Rate for Payer: Cash Price	$236.80
Rate for Payer: Priority Health Cigna Priority Health	$192.40

PR WET MOUNTS/ W PREPARATIONS

Professional

Both

$12.00

Service Code	HCPCS Q0111
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$703.47
Rate for Payer: Aetna Commercial	$14.39
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS Trust/PPO	$703.47
Rate for Payer: BCN Commercial	$12.01
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.11
Rate for Payer: UHC Exchange	$6.11

PR WHFO, RIGID W/O JOINTS

Professional

Both

$333.00

Service Code	HCPCS L3808
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$307.83
Rate for Payer: Aetna Commercial	$195.26
Rate for Payer: Aetna Medicare	$166.50
Rate for Payer: BCBS Complete	$133.20
Rate for Payer: BCN Commercial	$307.83
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Priority Health Cigna Priority Health	$216.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$176.12
Rate for Payer: UHC Exchange	$176.12

PR WHFO W/O JOINTS PRE CST

Professional

Both

$234.00

Service Code	HCPCS L3807
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$216.07
Rate for Payer: Aetna Commercial	$137.06
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCN Commercial	$216.07
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Priority Health Cigna Priority Health	$152.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$123.63
Rate for Payer: UHC Exchange	$123.63

PR WHO COCK-UP NONMOLDE PRE OTS

Professional

Both

$69.00

Service Code	HCPCS L3908
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$63.36
Rate for Payer: Aetna Commercial	$40.19
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCN Commercial	$63.36
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Priority Health Cigna Priority Health	$44.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$36.26
Rate for Payer: UHC Exchange	$36.26

PR WHO W/NONTORSION JNT(S) CF

Professional

Both

$926.00

Service Code	HCPCS L3905
Min. Negotiated Rate	$370.40
Max. Negotiated Rate	$856.95
Rate for Payer: Aetna Commercial	$543.58
Rate for Payer: Aetna Medicare	$463.00
Rate for Payer: BCBS Complete	$370.40
Rate for Payer: BCN Commercial	$856.95
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cash Price	$740.80
Rate for Payer: Priority Health Cigna Priority Health	$601.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$490.32
Rate for Payer: UHC Exchange	$490.32

PR WHO W/O JOINTS CF

Professional

Both

$473.00

Service Code	HCPCS L3906
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$437.92
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna Medicare	$236.50
Rate for Payer: BCBS Complete	$189.20
Rate for Payer: BCN Commercial	$437.92
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cash Price	$378.40
Rate for Payer: Priority Health Cigna Priority Health	$307.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$250.57
Rate for Payer: UHC Exchange	$250.57

PR WINDOWING CAST

Professional

Both

$114.00

Service Code	HCPCS 29730
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$1,134.26
Rate for Payer: Aetna Commercial	$58.92
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$29.97
Rate for Payer: BCBS Trust/PPO	$1,134.26
Rate for Payer: BCN Commercial	$93.34
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Meridian Medicaid	$29.97
Rate for Payer: Priority Health Choice Medicaid	$28.54
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.19
Rate for Payer: Priority Health Narrow Network	$68.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$52.76
Rate for Payer: UHC Exchange	$52.76
Rate for Payer: UHCCP Medicaid	$28.54

PR WORK HARDENING/CONDITIONING 1ST 2 HR

Professional

Both

$198.00

Service Code	HCPCS 97545
Min. Negotiated Rate	$77.25
Max. Negotiated Rate	$187.39
Rate for Payer: Aetna Commercial	$119.94
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS Complete	$79.20
Rate for Payer: BCBS Trust/PPO	$116.23
Rate for Payer: BCN Commercial	$187.39
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Priority Health Cigna Priority Health	$128.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.25
Rate for Payer: Priority Health Narrow Network	$77.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$120.58
Rate for Payer: UHC Exchange	$120.58

PR WORK HARDENING/CONDITIONING EACH HOUR

Professional

Both

$99.00

Service Code	HCPCS 97546
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$328.07
Rate for Payer: Aetna Commercial	$47.77
Rate for Payer: Aetna Medicare	$49.50
Rate for Payer: BCBS Complete	$39.60
Rate for Payer: BCBS Trust/PPO	$328.07
Rate for Payer: BCN Commercial	$93.43
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Priority Health Cigna Priority Health	$64.35
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$77.25
Rate for Payer: Priority Health Narrow Network	$77.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$48.01
Rate for Payer: UHC Exchange	$48.01

PR WORK RELATED/MED DBLT XM TREATING PHYS

Professional

Both

$112.00

Service Code	HCPCS 99455
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$165.89
Rate for Payer: Aetna Commercial	$84.95
Rate for Payer: Aetna Medicare	$56.00
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: BCBS Trust/PPO	$165.89
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$72.80

PR WOUND CLOSURE BY ADHESIVE

Professional

Both

$202.00

Service Code	HCPCS G0168
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$181.79
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare	$101.00
Rate for Payer: BCBS Complete	$9.62
Rate for Payer: BCBS Trust/PPO	$63.68
Rate for Payer: BCN Commercial	$181.79
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Meridian Medicaid	$9.62
Rate for Payer: Priority Health Choice Medicaid	$9.16
Rate for Payer: Priority Health Cigna Priority Health	$131.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.87
Rate for Payer: Priority Health Narrow Network	$19.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$28.11
Rate for Payer: UHC Exchange	$28.11
Rate for Payer: UHCCP Medicaid	$9.16

PR XEOMIN

Professional

Both

$10.00

Service Code	HCPCS 00085
Hospital Revenue Code	990
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$80.00

Service Code	HCPCS 94617
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$127.06
Rate for Payer: Aetna Commercial	$100.14
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCBS Trust/PPO	$124.68
Rate for Payer: BCN Commercial	$127.06
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Meridian Medicaid	$20.80
Rate for Payer: Priority Health Choice Medicaid	$19.81
Rate for Payer: Priority Health Cigna Priority Health	$52.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$42.07
Rate for Payer: Priority Health Narrow Network	$42.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$101.83
Rate for Payer: UHC Exchange	$101.83
Rate for Payer: UHCCP Medicaid	$19.81

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$160.00

Service Code	HCPCS 94619
Min. Negotiated Rate	$13.42
Max. Negotiated Rate	$225.12
Rate for Payer: Aetna Commercial	$77.64
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: BCBS Complete	$14.09
Rate for Payer: BCBS Trust/PPO	$225.12
Rate for Payer: BCN Commercial	$111.42
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Meridian Medicaid	$14.09
Rate for Payer: Priority Health Choice Medicaid	$13.42
Rate for Payer: Priority Health Cigna Priority Health	$104.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28.49
Rate for Payer: Priority Health Narrow Network	$28.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$81.35
Rate for Payer: UHC Exchange	$81.35
Rate for Payer: UHCCP Medicaid	$13.42

PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I

Professional

Both

$312.00

Service Code	HCPCS 93241
Min. Negotiated Rate	$99.65
Max. Negotiated Rate	$485.51
Rate for Payer: Aetna Commercial	$142.76
Rate for Payer: Aetna Medicare	$156.00
Rate for Payer: BCBS Complete	$124.80
Rate for Payer: BCBS Trust/PPO	$485.51
Rate for Payer: BCN Commercial	$309.81
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Priority Health Cigna Priority Health	$202.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$364.90
Rate for Payer: Priority Health Narrow Network	$364.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$99.65
Rate for Payer: UHC Exchange	$99.65

Know your out-of-pocket cost for care.

All Charges