Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION

Facility

$164.15

Service Code	NDC 24208063110
Hospital Charge Code	34814
Hospital Revenue Code	637
Min. Negotiated Rate	$64.51
Max. Negotiated Rate	$147.74
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: Aetna Medicare	$82.08
Rate for Payer: Aetna New Business (MI Preferred)	$106.70
Rate for Payer: BCBS Complete	$65.66
Rate for Payer: Cash Price	$131.32
Rate for Payer: Cofinity Advantage	$114.91
Rate for Payer: Cofinity Commercial	$141.17
Rate for Payer: Encore Health Key Benefits Commercial	$131.32
Rate for Payer: Healthscope Commercial	$147.74
Rate for Payer: MI Amish Medical Board Commercial	$131.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.11
Rate for Payer: PHP Commercial	$139.53
Rate for Payer: Priority Health SBD	$103.41
Rate for Payer: UHC All Payor (Choice/PPO)	$106.70
Rate for Payer: UHC Core	$85.52
Rate for Payer: UHC Exchange	$64.51

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG/ML-10,000 UNIT/ML-1 % EAR SOLUTION

Facility

$164.15

Service Code	NDC 24208063110
Hospital Charge Code	34814
Hospital Revenue Code	637
Min. Negotiated Rate	$103.41
Max. Negotiated Rate	$147.74
Rate for Payer: Aetna Commercial	$139.53
Rate for Payer: Aetna New Business (MI Preferred)	$106.70
Rate for Payer: Cash Price	$131.32
Rate for Payer: Cofinity Advantage	$114.91
Rate for Payer: Cofinity Commercial	$141.17
Rate for Payer: Encore Health Key Benefits Commercial	$131.32
Rate for Payer: Healthscope Commercial	$147.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.11
Rate for Payer: PHP Commercial	$139.53
Rate for Payer: Priority Health SBD	$103.41

NEONATAL AFTERCARE

Facility

$13,563.13

Service Code	APR-DRG 8632
Min. Negotiated Rate	$12,917.27
Max. Negotiated Rate	$13,563.13
Rate for Payer: BCBS Complete	$13,563.13
Rate for Payer: Mclaren Medicaid	$12,917.27
Rate for Payer: Meridian Medicaid	$13,563.13
Rate for Payer: Priority Health Choice Medicaid	$12,917.27
Rate for Payer: UHC Medicaid	$12,917.27
Rate for Payer: UHCCP Medicaid	$12,917.27

NEONATAL AFTERCARE

Facility

$6,965.60

Service Code	APR-DRG 8631
Min. Negotiated Rate	$6,633.90
Max. Negotiated Rate	$6,965.60
Rate for Payer: BCBS Complete	$6,965.60
Rate for Payer: Mclaren Medicaid	$6,633.90
Rate for Payer: Meridian Medicaid	$6,965.60
Rate for Payer: Priority Health Choice Medicaid	$6,633.90
Rate for Payer: UHC Medicaid	$6,633.90
Rate for Payer: UHCCP Medicaid	$6,633.90

NEONATAL AFTERCARE

Facility

$54,988.07

Service Code	APR-DRG 8634
Min. Negotiated Rate	$52,369.59
Max. Negotiated Rate	$54,988.07
Rate for Payer: BCBS Complete	$54,988.07
Rate for Payer: Mclaren Medicaid	$52,369.59
Rate for Payer: Meridian Medicaid	$54,988.07
Rate for Payer: Priority Health Choice Medicaid	$52,369.59
Rate for Payer: UHC Medicaid	$52,369.59
Rate for Payer: UHCCP Medicaid	$52,369.59

NEONATAL AFTERCARE

Facility

$23,225.53

Service Code	APR-DRG 8633
Min. Negotiated Rate	$22,119.55
Max. Negotiated Rate	$23,225.53
Rate for Payer: BCBS Complete	$23,225.53
Rate for Payer: Mclaren Medicaid	$22,119.55
Rate for Payer: Meridian Medicaid	$23,225.53
Rate for Payer: Priority Health Choice Medicaid	$22,119.55
Rate for Payer: UHC Medicaid	$22,119.55
Rate for Payer: UHCCP Medicaid	$22,119.55

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$9,038.65

Service Code	APR-DRG 6031
Min. Negotiated Rate	$8,608.24
Max. Negotiated Rate	$9,038.65
Rate for Payer: BCBS Complete	$9,038.65
Rate for Payer: Mclaren Medicaid	$8,608.24
Rate for Payer: Meridian Medicaid	$9,038.65
Rate for Payer: Priority Health Choice Medicaid	$8,608.24
Rate for Payer: UHC Medicaid	$8,608.24
Rate for Payer: UHCCP Medicaid	$8,608.24

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$42,278.58

Service Code	APR-DRG 6033
Min. Negotiated Rate	$40,265.32
Max. Negotiated Rate	$42,278.58
Rate for Payer: BCBS Complete	$42,278.58
Rate for Payer: Mclaren Medicaid	$40,265.32
Rate for Payer: Meridian Medicaid	$42,278.58
Rate for Payer: Priority Health Choice Medicaid	$40,265.32
Rate for Payer: UHC Medicaid	$40,265.32
Rate for Payer: UHCCP Medicaid	$40,265.32

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$28,899.48

Service Code	APR-DRG 6032
Min. Negotiated Rate	$27,523.31
Max. Negotiated Rate	$28,899.48
Rate for Payer: BCBS Complete	$28,899.48
Rate for Payer: Mclaren Medicaid	$27,523.31
Rate for Payer: Meridian Medicaid	$28,899.48
Rate for Payer: Priority Health Choice Medicaid	$27,523.31
Rate for Payer: UHC Medicaid	$27,523.31
Rate for Payer: UHCCP Medicaid	$27,523.31

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$68,200.91

Service Code	APR-DRG 6034
Min. Negotiated Rate	$64,953.25
Max. Negotiated Rate	$68,200.91
Rate for Payer: BCBS Complete	$68,200.91
Rate for Payer: Mclaren Medicaid	$64,953.25
Rate for Payer: Meridian Medicaid	$68,200.91
Rate for Payer: Priority Health Choice Medicaid	$64,953.25
Rate for Payer: UHC Medicaid	$64,953.25
Rate for Payer: UHCCP Medicaid	$64,953.25

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$60,131.72

Service Code	APR-DRG 6024
Min. Negotiated Rate	$57,268.30
Max. Negotiated Rate	$60,131.72
Rate for Payer: BCBS Complete	$60,131.72
Rate for Payer: Mclaren Medicaid	$57,268.30
Rate for Payer: Meridian Medicaid	$60,131.72
Rate for Payer: Priority Health Choice Medicaid	$57,268.30
Rate for Payer: UHC Medicaid	$57,268.30
Rate for Payer: UHCCP Medicaid	$57,268.30

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$28,194.32

Service Code	APR-DRG 6021
Min. Negotiated Rate	$26,851.73
Max. Negotiated Rate	$28,194.32
Rate for Payer: BCBS Complete	$28,194.32
Rate for Payer: Mclaren Medicaid	$26,851.73
Rate for Payer: Meridian Medicaid	$28,194.32
Rate for Payer: Priority Health Choice Medicaid	$26,851.73
Rate for Payer: UHC Medicaid	$26,851.73
Rate for Payer: UHCCP Medicaid	$26,851.73

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$34,848.61

Service Code	APR-DRG 6022
Min. Negotiated Rate	$33,189.16
Max. Negotiated Rate	$34,848.61
Rate for Payer: BCBS Complete	$34,848.61
Rate for Payer: Mclaren Medicaid	$33,189.16
Rate for Payer: Meridian Medicaid	$34,848.61
Rate for Payer: Priority Health Choice Medicaid	$33,189.16
Rate for Payer: UHC Medicaid	$33,189.16
Rate for Payer: UHCCP Medicaid	$33,189.16

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$44,924.36

Service Code	APR-DRG 6023
Min. Negotiated Rate	$42,785.11
Max. Negotiated Rate	$44,924.36
Rate for Payer: BCBS Complete	$44,924.36
Rate for Payer: Mclaren Medicaid	$42,785.11
Rate for Payer: Meridian Medicaid	$44,924.36
Rate for Payer: Priority Health Choice Medicaid	$42,785.11
Rate for Payer: UHC Medicaid	$42,785.11
Rate for Payer: UHCCP Medicaid	$42,785.11

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$25,796.21

Service Code	APR-DRG 6083
Min. Negotiated Rate	$24,567.82
Max. Negotiated Rate	$25,796.21
Rate for Payer: BCBS Complete	$25,796.21
Rate for Payer: Mclaren Medicaid	$24,567.82
Rate for Payer: Meridian Medicaid	$25,796.21
Rate for Payer: Priority Health Choice Medicaid	$24,567.82
Rate for Payer: UHC Medicaid	$24,567.82
Rate for Payer: UHCCP Medicaid	$24,567.82

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$27,799.32

Service Code	APR-DRG 6084
Min. Negotiated Rate	$26,475.54
Max. Negotiated Rate	$27,799.32
Rate for Payer: BCBS Complete	$27,799.32
Rate for Payer: Mclaren Medicaid	$26,475.54
Rate for Payer: Meridian Medicaid	$27,799.32
Rate for Payer: Priority Health Choice Medicaid	$26,475.54
Rate for Payer: UHC Medicaid	$26,475.54
Rate for Payer: UHCCP Medicaid	$26,475.54

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$16,578.12

Service Code	APR-DRG 6082
Min. Negotiated Rate	$15,788.68
Max. Negotiated Rate	$16,578.12
Rate for Payer: BCBS Complete	$16,578.12
Rate for Payer: Mclaren Medicaid	$15,788.68
Rate for Payer: Meridian Medicaid	$16,578.12
Rate for Payer: Priority Health Choice Medicaid	$15,788.68
Rate for Payer: UHC Medicaid	$15,788.68
Rate for Payer: UHCCP Medicaid	$15,788.68

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$9,744.38

Service Code	APR-DRG 6081
Min. Negotiated Rate	$9,280.36
Max. Negotiated Rate	$9,744.38
Rate for Payer: UHCCP Medicaid	$9,280.36
Rate for Payer: BCBS Complete	$9,744.38
Rate for Payer: Mclaren Medicaid	$9,280.36
Rate for Payer: Meridian Medicaid	$9,744.38
Rate for Payer: Priority Health Choice Medicaid	$9,280.36
Rate for Payer: UHC Medicaid	$9,280.36

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$14,916.12

Service Code	APR-DRG 6071
Min. Negotiated Rate	$14,205.83
Max. Negotiated Rate	$14,916.12
Rate for Payer: BCBS Complete	$14,916.12
Rate for Payer: Mclaren Medicaid	$14,205.83
Rate for Payer: Meridian Medicaid	$14,916.12
Rate for Payer: Priority Health Choice Medicaid	$14,205.83
Rate for Payer: UHC Medicaid	$14,205.83
Rate for Payer: UHCCP Medicaid	$14,205.83

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$23,339.04

Service Code	APR-DRG 6072
Min. Negotiated Rate	$22,227.66
Max. Negotiated Rate	$23,339.04
Rate for Payer: BCBS Complete	$23,339.04
Rate for Payer: Mclaren Medicaid	$22,227.66
Rate for Payer: Meridian Medicaid	$23,339.04
Rate for Payer: Priority Health Choice Medicaid	$22,227.66
Rate for Payer: UHC Medicaid	$22,227.66
Rate for Payer: UHCCP Medicaid	$22,227.66

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$31,786.62

Service Code	APR-DRG 6073
Min. Negotiated Rate	$30,272.97
Max. Negotiated Rate	$31,786.62
Rate for Payer: BCBS Complete	$31,786.62
Rate for Payer: Mclaren Medicaid	$30,272.97
Rate for Payer: Meridian Medicaid	$31,786.62
Rate for Payer: Priority Health Choice Medicaid	$30,272.97
Rate for Payer: UHC Medicaid	$30,272.97
Rate for Payer: UHCCP Medicaid	$30,272.97

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$41,056.88

Service Code	APR-DRG 6074
Min. Negotiated Rate	$39,101.79
Max. Negotiated Rate	$41,056.88
Rate for Payer: BCBS Complete	$41,056.88
Rate for Payer: Mclaren Medicaid	$39,101.79
Rate for Payer: Meridian Medicaid	$41,056.88
Rate for Payer: Priority Health Choice Medicaid	$39,101.79
Rate for Payer: UHC Medicaid	$39,101.79
Rate for Payer: UHCCP Medicaid	$39,101.79

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$19,432.58

Service Code	APR-DRG 6132
Min. Negotiated Rate	$18,507.22
Max. Negotiated Rate	$19,432.58
Rate for Payer: BCBS Complete	$19,432.58
Rate for Payer: Mclaren Medicaid	$18,507.22
Rate for Payer: Meridian Medicaid	$19,432.58
Rate for Payer: Priority Health Choice Medicaid	$18,507.22
Rate for Payer: UHC Medicaid	$18,507.22
Rate for Payer: UHCCP Medicaid	$18,507.22

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$4,670.10

Service Code	APR-DRG 6131
Min. Negotiated Rate	$4,447.72
Max. Negotiated Rate	$4,670.10
Rate for Payer: BCBS Complete	$4,670.10
Rate for Payer: Mclaren Medicaid	$4,447.72
Rate for Payer: Meridian Medicaid	$4,670.10
Rate for Payer: Priority Health Choice Medicaid	$4,447.72
Rate for Payer: UHC Medicaid	$4,447.72
Rate for Payer: UHCCP Medicaid	$4,447.72

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$29,228.55

Service Code	APR-DRG 6133
Min. Negotiated Rate	$27,836.72
Max. Negotiated Rate	$29,228.55
Rate for Payer: BCBS Complete	$29,228.55
Rate for Payer: Mclaren Medicaid	$27,836.72
Rate for Payer: Meridian Medicaid	$29,228.55
Rate for Payer: Priority Health Choice Medicaid	$27,836.72
Rate for Payer: UHC Medicaid	$27,836.72
Rate for Payer: UHCCP Medicaid	$27,836.72

Know your out-of-pocket cost for care.

All Charges