Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MISOPROSTOL 200 MCG TABLET

Facility

$431.04

Service Code	NDC 59762500802
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$271.56
Max. Negotiated Rate	$387.94
Rate for Payer: Aetna Commercial	$366.38
Rate for Payer: Aetna New Business (MI Preferred)	$280.18
Rate for Payer: Cash Price	$344.83
Rate for Payer: Cofinity Advantage	$301.73
Rate for Payer: Cofinity Commercial	$370.69
Rate for Payer: Encore Health Key Benefits Commercial	$344.83
Rate for Payer: Healthscope Commercial	$387.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$323.28
Rate for Payer: PHP Commercial	$366.38
Rate for Payer: Priority Health SBD	$271.56

MISOPROSTOL 200 MCG TABLET

Facility

$794.88

Service Code	NDC 68084004101
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$500.77
Max. Negotiated Rate	$715.39
Rate for Payer: Aetna Commercial	$675.65
Rate for Payer: Aetna New Business (MI Preferred)	$516.67
Rate for Payer: Cash Price	$635.90
Rate for Payer: Cofinity Advantage	$556.42
Rate for Payer: Cofinity Commercial	$683.60
Rate for Payer: Encore Health Key Benefits Commercial	$635.90
Rate for Payer: Healthscope Commercial	$715.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$596.16
Rate for Payer: PHP Commercial	$675.65
Rate for Payer: Priority Health SBD	$500.77

MISOPROSTOL 200 MCG TABLET

Facility

$7.98

Service Code	NDC 60687074611
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$5.03
Max. Negotiated Rate	$7.18
Rate for Payer: Aetna Commercial	$6.78
Rate for Payer: Aetna New Business (MI Preferred)	$5.19
Rate for Payer: Cash Price	$6.38
Rate for Payer: Cofinity Advantage	$5.59
Rate for Payer: Cofinity Commercial	$6.86
Rate for Payer: Encore Health Key Benefits Commercial	$6.38
Rate for Payer: Healthscope Commercial	$7.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.99
Rate for Payer: PHP Commercial	$6.78
Rate for Payer: Priority Health SBD	$5.03

MISOPROSTOL 200 MCG TABLET

Facility

$7.95

Service Code	NDC 68084004111
Hospital Charge Code	10629
Hospital Revenue Code	637
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$7.16
Rate for Payer: Aetna Commercial	$6.76
Rate for Payer: Aetna New Business (MI Preferred)	$5.17
Rate for Payer: Cash Price	$6.36
Rate for Payer: Cofinity Advantage	$5.57
Rate for Payer: Cofinity Commercial	$6.84
Rate for Payer: Encore Health Key Benefits Commercial	$6.36
Rate for Payer: Healthscope Commercial	$7.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.96
Rate for Payer: PHP Commercial	$6.76
Rate for Payer: Priority Health SBD	$5.01

MISOPROSTOL 25 MCG CUSTOM TAB

Facility

$1,442.63

Service Code	NDC 09900000016
Hospital Charge Code	150707
Hospital Revenue Code	637
Min. Negotiated Rate	$908.86
Max. Negotiated Rate	$1,298.37
Rate for Payer: Aetna Commercial	$1,226.24
Rate for Payer: Aetna New Business (MI Preferred)	$937.71
Rate for Payer: Cash Price	$1,154.10
Rate for Payer: Cofinity Advantage	$1,009.84
Rate for Payer: Cofinity Commercial	$1,240.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,154.10
Rate for Payer: Healthscope Commercial	$1,298.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,226.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,081.97
Rate for Payer: PHP Commercial	$1,226.24
Rate for Payer: Priority Health SBD	$908.86

MISOPROSTOL 25 MCG CUSTOM TAB

Facility

$1,442.63

Service Code	NDC 09900000016
Hospital Charge Code	150707
Hospital Revenue Code	637
Min. Negotiated Rate	$566.95
Max. Negotiated Rate	$1,298.37
Rate for Payer: Aetna Commercial	$1,226.24
Rate for Payer: Aetna Medicare	$721.32
Rate for Payer: Aetna New Business (MI Preferred)	$937.71
Rate for Payer: BCBS Complete	$577.05
Rate for Payer: Cash Price	$1,154.10
Rate for Payer: Cofinity Advantage	$1,009.84
Rate for Payer: Cofinity Commercial	$1,240.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,154.10
Rate for Payer: Healthscope Commercial	$1,298.37
Rate for Payer: MI Amish Medical Board Commercial	$1,154.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,226.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,081.97
Rate for Payer: PHP Commercial	$1,226.24
Rate for Payer: Priority Health SBD	$908.86
Rate for Payer: UHC All Payor (Choice/PPO)	$937.71
Rate for Payer: UHC Core	$751.61
Rate for Payer: UHC Exchange	$566.95

MITOMYCIN 20 MG INTRAVENOUS SOLUTION

Facility

$770.95

Service Code	HCPCS J9280
Hospital Charge Code	10630
Hospital Revenue Code	636
Min. Negotiated Rate	$485.70
Max. Negotiated Rate	$693.86
Rate for Payer: Aetna Commercial	$655.31
Rate for Payer: Aetna New Business (MI Preferred)	$501.12
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cofinity Advantage	$539.66
Rate for Payer: Cofinity Commercial	$663.02
Rate for Payer: Encore Health Key Benefits Commercial	$616.76
Rate for Payer: Healthscope Commercial	$693.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$655.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$578.21
Rate for Payer: PHP Commercial	$655.31
Rate for Payer: Priority Health SBD	$485.70

MITOMYCIN 20 MG INTRAVENOUS SOLUTION

Facility

$770.95

Service Code	HCPCS J9280
Hospital Charge Code	10630
Hospital Revenue Code	636
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$693.86
Rate for Payer: Aetna Commercial	$655.31
Rate for Payer: Aetna Commercial	$394.15
Rate for Payer: Aetna Medicare	$29.60
Rate for Payer: Aetna Medicare	$29.60
Rate for Payer: Aetna New Business (MI Preferred)	$301.41
Rate for Payer: Aetna New Business (MI Preferred)	$501.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$35.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$35.58
Rate for Payer: Amish Plain Church Group Commercial	$35.58
Rate for Payer: Amish Plain Church Group Commercial	$35.58
Rate for Payer: BCBS Complete	$15.63
Rate for Payer: BCBS Complete	$15.63
Rate for Payer: BCBS MAPPO	$28.46
Rate for Payer: BCBS MAPPO	$28.46
Rate for Payer: BCBS Trust/PPO	$65.48
Rate for Payer: BCBS Trust/PPO	$65.48
Rate for Payer: BCN Commercial	$65.48
Rate for Payer: BCN Commercial	$65.48
Rate for Payer: BCN Medicare Advantage	$28.46
Rate for Payer: BCN Medicare Advantage	$28.46
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cash Price	$616.76
Rate for Payer: Cofinity Advantage	$539.66
Rate for Payer: Cofinity Advantage	$324.60
Rate for Payer: Cofinity Commercial	$663.02
Rate for Payer: Cofinity Commercial	$398.79
Rate for Payer: Encore Health Key Benefits Commercial	$370.97
Rate for Payer: Encore Health Key Benefits Commercial	$616.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.46
Rate for Payer: Healthscope Commercial	$417.34
Rate for Payer: Healthscope Commercial	$693.86
Rate for Payer: Mclaren Medicaid	$14.88
Rate for Payer: Mclaren Medicaid	$14.88
Rate for Payer: Mclaren Medicare	$28.46
Rate for Payer: Mclaren Medicare	$28.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29.88
Rate for Payer: Meridian Medicaid	$29.88
Rate for Payer: Meridian Medicaid	$29.88
Rate for Payer: MI Amish Medical Board Commercial	$32.73
Rate for Payer: MI Amish Medical Board Commercial	$32.73
Rate for Payer: Molina Medicare/Medicaid	$31.31
Rate for Payer: Molina Medicare/Medicaid	$31.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$655.31
Rate for Payer: Nomi Health Commercial	$85.38
Rate for Payer: Nomi Health Commercial	$85.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$578.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$347.78
Rate for Payer: PACE Medicare	$27.04
Rate for Payer: PACE Medicare	$27.04
Rate for Payer: PACE SWMI	$28.46
Rate for Payer: PACE SWMI	$28.46
Rate for Payer: PHP Commercial	$394.15
Rate for Payer: PHP Commercial	$655.31
Rate for Payer: PHP Medicare Advantage	$28.46
Rate for Payer: PHP Medicare Advantage	$28.46
Rate for Payer: Priority Health Choice Medicaid	$14.88
Rate for Payer: Priority Health Choice Medicaid	$14.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$64.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$64.18
Rate for Payer: Priority Health Medicare	$28.46
Rate for Payer: Priority Health Medicare	$28.46
Rate for Payer: Priority Health SBD	$485.70
Rate for Payer: Priority Health SBD	$292.14
Rate for Payer: Priority Health Tiered Network	$51.34
Rate for Payer: Priority Health Tiered Network	$51.34
Rate for Payer: Railroad Medicare Medicare	$28.46
Rate for Payer: Railroad Medicare Medicare	$28.46
Rate for Payer: UHC All Payor (Choice/PPO)	$43.07
Rate for Payer: UHC All Payor (Choice/PPO)	$43.07
Rate for Payer: UHC Core	$43.07
Rate for Payer: UHC Core	$43.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$28.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$28.46
Rate for Payer: UHC Exchange	$43.07
Rate for Payer: UHC Exchange	$43.07
Rate for Payer: UHC Medicaid	$14.88
Rate for Payer: UHC Medicaid	$14.88
Rate for Payer: UHCCP Medicaid	$14.88
Rate for Payer: UHCCP Medicaid	$14.88
Rate for Payer: VA VA	$28.46
Rate for Payer: VA VA	$28.46

MITOMYCIN 20 MG SOLUTION FOR BLADDER IRRIGATION (CUSTOM)

Facility

$463.71

Service Code	HCPCS J9280
Hospital Charge Code	300956
Hospital Revenue Code	636
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$417.34
Rate for Payer: Aetna Commercial	$394.15
Rate for Payer: Aetna Medicare	$29.60
Rate for Payer: Aetna New Business (MI Preferred)	$301.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$35.58
Rate for Payer: Amish Plain Church Group Commercial	$35.58
Rate for Payer: BCBS Complete	$15.63
Rate for Payer: BCBS MAPPO	$28.46
Rate for Payer: BCBS Trust/PPO	$65.48
Rate for Payer: BCN Commercial	$65.48
Rate for Payer: BCN Medicare Advantage	$28.46
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cash Price	$370.97
Rate for Payer: Cofinity Advantage	$324.60
Rate for Payer: Cofinity Commercial	$398.79
Rate for Payer: Encore Health Key Benefits Commercial	$370.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.46
Rate for Payer: Healthscope Commercial	$417.34
Rate for Payer: Mclaren Medicaid	$14.88
Rate for Payer: Mclaren Medicare	$28.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29.88
Rate for Payer: Meridian Medicaid	$29.88
Rate for Payer: MI Amish Medical Board Commercial	$32.73
Rate for Payer: Molina Medicare/Medicaid	$31.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.15
Rate for Payer: Nomi Health Commercial	$85.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$347.78
Rate for Payer: PACE Medicare	$27.04
Rate for Payer: PACE SWMI	$28.46
Rate for Payer: PHP Commercial	$394.15
Rate for Payer: PHP Medicare Advantage	$28.46
Rate for Payer: Priority Health Choice Medicaid	$14.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$64.18
Rate for Payer: Priority Health Medicare	$28.46
Rate for Payer: Priority Health SBD	$292.14
Rate for Payer: Priority Health Tiered Network	$51.34
Rate for Payer: Railroad Medicare Medicare	$28.46
Rate for Payer: UHC All Payor (Choice/PPO)	$43.07
Rate for Payer: UHC Core	$43.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$28.46
Rate for Payer: UHC Exchange	$43.07
Rate for Payer: UHC Medicaid	$14.88
Rate for Payer: UHCCP Medicaid	$14.88
Rate for Payer: VA VA	$28.46

MODAFINIL 200 MG TABLET

Facility

$716.95

Service Code	NDC 55253080230
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$281.76
Max. Negotiated Rate	$645.25
Rate for Payer: Aetna Commercial	$609.41
Rate for Payer: Aetna Medicare	$358.48
Rate for Payer: Aetna New Business (MI Preferred)	$466.02
Rate for Payer: BCBS Complete	$286.78
Rate for Payer: Cash Price	$573.56
Rate for Payer: Cofinity Advantage	$501.87
Rate for Payer: Cofinity Commercial	$616.58
Rate for Payer: Encore Health Key Benefits Commercial	$573.56
Rate for Payer: Healthscope Commercial	$645.25
Rate for Payer: MI Amish Medical Board Commercial	$573.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$609.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$537.71
Rate for Payer: PHP Commercial	$609.41
Rate for Payer: Priority Health SBD	$451.68
Rate for Payer: UHC All Payor (Choice/PPO)	$466.02
Rate for Payer: UHC Core	$373.53
Rate for Payer: UHC Exchange	$281.76

MODAFINIL 200 MG TABLET

Facility

$107.28

Service Code	NDC 62332038630
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$67.59
Max. Negotiated Rate	$96.55
Rate for Payer: Aetna Commercial	$91.19
Rate for Payer: Aetna New Business (MI Preferred)	$69.73
Rate for Payer: Cash Price	$85.82
Rate for Payer: Cofinity Advantage	$75.10
Rate for Payer: Cofinity Commercial	$92.26
Rate for Payer: Encore Health Key Benefits Commercial	$85.82
Rate for Payer: Healthscope Commercial	$96.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$80.46
Rate for Payer: PHP Commercial	$91.19
Rate for Payer: Priority Health SBD	$67.59

MODAFINIL 200 MG TABLET

Facility

$107.28

Service Code	NDC 62332038630
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$42.16
Max. Negotiated Rate	$96.55
Rate for Payer: Aetna Commercial	$91.19
Rate for Payer: Aetna Medicare	$53.64
Rate for Payer: Aetna New Business (MI Preferred)	$69.73
Rate for Payer: BCBS Complete	$42.91
Rate for Payer: Cash Price	$85.82
Rate for Payer: Cofinity Advantage	$75.10
Rate for Payer: Cofinity Commercial	$92.26
Rate for Payer: Encore Health Key Benefits Commercial	$85.82
Rate for Payer: Healthscope Commercial	$96.55
Rate for Payer: MI Amish Medical Board Commercial	$85.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$80.46
Rate for Payer: PHP Commercial	$91.19
Rate for Payer: Priority Health SBD	$67.59
Rate for Payer: UHC All Payor (Choice/PPO)	$69.73
Rate for Payer: UHC Core	$55.89
Rate for Payer: UHC Exchange	$42.16

MODAFINIL 200 MG TABLET

Facility

$716.95

Service Code	NDC 55253080230
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$451.68
Max. Negotiated Rate	$645.25
Rate for Payer: Aetna Commercial	$609.41
Rate for Payer: Aetna New Business (MI Preferred)	$466.02
Rate for Payer: Cash Price	$573.56
Rate for Payer: Cofinity Advantage	$501.87
Rate for Payer: Cofinity Commercial	$616.58
Rate for Payer: Encore Health Key Benefits Commercial	$573.56
Rate for Payer: Healthscope Commercial	$645.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$609.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$537.71
Rate for Payer: PHP Commercial	$609.41
Rate for Payer: Priority Health SBD	$451.68

MODAFINIL 200 MG TABLET

Facility

$303.27

Service Code	NDC 62332038690
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$191.06
Max. Negotiated Rate	$272.94
Rate for Payer: Aetna Commercial	$257.78
Rate for Payer: Aetna New Business (MI Preferred)	$197.13
Rate for Payer: Cash Price	$242.62
Rate for Payer: Cofinity Advantage	$212.29
Rate for Payer: Cofinity Commercial	$260.81
Rate for Payer: Encore Health Key Benefits Commercial	$242.62
Rate for Payer: Healthscope Commercial	$272.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$227.45
Rate for Payer: PHP Commercial	$257.78
Rate for Payer: Priority Health SBD	$191.06

MODAFINIL 200 MG TABLET

Facility

$303.27

Service Code	NDC 62332038690
Hospital Charge Code	24703
Hospital Revenue Code	637
Min. Negotiated Rate	$119.19
Max. Negotiated Rate	$272.94
Rate for Payer: Aetna Commercial	$257.78
Rate for Payer: Aetna Medicare	$151.63
Rate for Payer: Aetna New Business (MI Preferred)	$197.13
Rate for Payer: BCBS Complete	$121.31
Rate for Payer: Cash Price	$242.62
Rate for Payer: Cofinity Advantage	$212.29
Rate for Payer: Cofinity Commercial	$260.81
Rate for Payer: Encore Health Key Benefits Commercial	$242.62
Rate for Payer: Healthscope Commercial	$272.94
Rate for Payer: MI Amish Medical Board Commercial	$242.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$227.45
Rate for Payer: PHP Commercial	$257.78
Rate for Payer: Priority Health SBD	$191.06
Rate for Payer: UHC All Payor (Choice/PPO)	$197.13
Rate for Payer: UHC Core	$158.00
Rate for Payer: UHC Exchange	$119.19

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$23,596.45

Service Code	APR-DRG 7934
Min. Negotiated Rate	$22,472.81
Max. Negotiated Rate	$23,596.45
Rate for Payer: BCBS Complete	$23,596.45
Rate for Payer: Mclaren Medicaid	$22,472.81
Rate for Payer: Meridian Medicaid	$23,596.45
Rate for Payer: Priority Health Choice Medicaid	$22,472.81
Rate for Payer: UHC Medicaid	$22,472.81
Rate for Payer: UHCCP Medicaid	$22,472.81

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$13,527.59

Service Code	APR-DRG 7933
Min. Negotiated Rate	$12,883.42
Max. Negotiated Rate	$13,527.59
Rate for Payer: BCBS Complete	$13,527.59
Rate for Payer: Mclaren Medicaid	$12,883.42
Rate for Payer: Meridian Medicaid	$13,527.59
Rate for Payer: Priority Health Choice Medicaid	$12,883.42
Rate for Payer: UHC Medicaid	$12,883.42
Rate for Payer: UHCCP Medicaid	$12,883.42

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$7,090.57

Service Code	APR-DRG 7931
Min. Negotiated Rate	$6,752.93
Max. Negotiated Rate	$7,090.57
Rate for Payer: BCBS Complete	$7,090.57
Rate for Payer: Mclaren Medicaid	$6,752.93
Rate for Payer: Meridian Medicaid	$7,090.57
Rate for Payer: Priority Health Choice Medicaid	$6,752.93
Rate for Payer: UHC Medicaid	$6,752.93
Rate for Payer: UHCCP Medicaid	$6,752.93

MODERATELY EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$9,347.08

Service Code	APR-DRG 7932
Min. Negotiated Rate	$8,901.98
Max. Negotiated Rate	$9,347.08
Rate for Payer: BCBS Complete	$9,347.08
Rate for Payer: Mclaren Medicaid	$8,901.98
Rate for Payer: Meridian Medicaid	$9,347.08
Rate for Payer: Priority Health Choice Medicaid	$8,901.98
Rate for Payer: UHC Medicaid	$8,901.98
Rate for Payer: UHCCP Medicaid	$8,901.98

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,594.51

Service Code	APR-DRG 9511
Min. Negotiated Rate	$7,232.86
Max. Negotiated Rate	$7,594.51
Rate for Payer: BCBS Complete	$7,594.51
Rate for Payer: Mclaren Medicaid	$7,232.86
Rate for Payer: Meridian Medicaid	$7,594.51
Rate for Payer: Priority Health Choice Medicaid	$7,232.86
Rate for Payer: UHC Medicaid	$7,232.86
Rate for Payer: UHCCP Medicaid	$7,232.86

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$13,892.21

Service Code	APR-DRG 9513
Min. Negotiated Rate	$13,230.67
Max. Negotiated Rate	$13,892.21
Rate for Payer: BCBS Complete	$13,892.21
Rate for Payer: Mclaren Medicaid	$13,230.67
Rate for Payer: Meridian Medicaid	$13,892.21
Rate for Payer: Priority Health Choice Medicaid	$13,230.67
Rate for Payer: UHC Medicaid	$13,230.67
Rate for Payer: UHCCP Medicaid	$13,230.67

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$22,661.98

Service Code	APR-DRG 9514
Min. Negotiated Rate	$21,582.83
Max. Negotiated Rate	$22,661.98
Rate for Payer: BCBS Complete	$22,661.98
Rate for Payer: Mclaren Medicaid	$21,582.83
Rate for Payer: Meridian Medicaid	$22,661.98
Rate for Payer: Priority Health Choice Medicaid	$21,582.83
Rate for Payer: UHC Medicaid	$21,582.83
Rate for Payer: UHCCP Medicaid	$21,582.83

MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$10,059.12

Service Code	APR-DRG 9512
Min. Negotiated Rate	$9,580.12
Max. Negotiated Rate	$10,059.12
Rate for Payer: BCBS Complete	$10,059.12
Rate for Payer: Mclaren Medicaid	$9,580.12
Rate for Payer: Meridian Medicaid	$10,059.12
Rate for Payer: Priority Health Choice Medicaid	$9,580.12
Rate for Payer: UHC Medicaid	$9,580.12
Rate for Payer: UHCCP Medicaid	$9,580.12

MOLASSES

Facility

$23.94

Service Code	NDC 00990000075
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$20.35
Rate for Payer: Aetna New Business (MI Preferred)	$15.56
Rate for Payer: Cash Price	$19.15
Rate for Payer: Cofinity Advantage	$16.76
Rate for Payer: Cofinity Commercial	$20.59
Rate for Payer: Encore Health Key Benefits Commercial	$19.15
Rate for Payer: Healthscope Commercial	$21.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.95
Rate for Payer: PHP Commercial	$20.35
Rate for Payer: Priority Health SBD	$15.08

MOLASSES

Facility

$23.94

Service Code	NDC 00990000075
Hospital Charge Code	500563
Hospital Revenue Code	637
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$21.55
Rate for Payer: Aetna Commercial	$20.35
Rate for Payer: Aetna Medicare	$11.97
Rate for Payer: Aetna New Business (MI Preferred)	$15.56
Rate for Payer: BCBS Complete	$9.58
Rate for Payer: Cash Price	$19.15
Rate for Payer: Cofinity Advantage	$16.76
Rate for Payer: Cofinity Commercial	$20.59
Rate for Payer: Encore Health Key Benefits Commercial	$19.15
Rate for Payer: Healthscope Commercial	$21.55
Rate for Payer: MI Amish Medical Board Commercial	$19.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.95
Rate for Payer: PHP Commercial	$20.35
Rate for Payer: Priority Health SBD	$15.08
Rate for Payer: UHC All Payor (Choice/PPO)	$15.56
Rate for Payer: UHC Core	$12.47
Rate for Payer: UHC Exchange	$9.41

Know your out-of-pocket cost for care.

All Charges