Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

SKIN DEBRIDEMENT WITH MCC

Facility

$47,939.93

Service Code	MSDRG 570
Min. Negotiated Rate	$23,929.04
Max. Negotiated Rate	$47,939.93
Rate for Payer: Aetna Medicare	$26,196.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,485.58
Rate for Payer: Amish Plain Church Group Commercial	$31,485.58
Rate for Payer: BCBS MAPPO	$25,188.46
Rate for Payer: BCBS Trust/PPO	$42,329.44
Rate for Payer: BCN Commercial	$42,329.44
Rate for Payer: BCN Medicare Advantage	$25,188.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,188.46
Rate for Payer: Mclaren Medicare	$25,188.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26,447.88
Rate for Payer: MI Amish Medical Board Commercial	$28,966.73
Rate for Payer: Molina Medicare/Medicaid	$27,707.31
Rate for Payer: Nomi Health Commercial	$37,940.19
Rate for Payer: PACE Medicare	$23,929.04
Rate for Payer: PACE SWMI	$25,188.46
Rate for Payer: PHP Medicare Advantage	$25,188.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$47,416.83
Rate for Payer: Priority Health Medicare	$25,188.46
Rate for Payer: Priority Health Tiered Network	$37,933.45
Rate for Payer: Railroad Medicare Medicare	$25,188.46
Rate for Payer: UHC All Payor (Choice/PPO)	$47,939.93
Rate for Payer: UHC Core	$40,107.78
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25,188.46
Rate for Payer: UHC Exchange	$32,755.03
Rate for Payer: VA VA	$25,188.46

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$22,243.55

Service Code	MSDRG 572
Min. Negotiated Rate	$9,670.16
Max. Negotiated Rate	$22,243.55
Rate for Payer: Aetna Medicare	$10,586.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,723.90
Rate for Payer: Amish Plain Church Group Commercial	$12,723.90
Rate for Payer: BCBS MAPPO	$10,179.12
Rate for Payer: BCBS Trust/PPO	$22,243.55
Rate for Payer: BCN Commercial	$22,243.55
Rate for Payer: BCN Medicare Advantage	$10,179.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,179.12
Rate for Payer: Mclaren Medicare	$10,179.12
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,688.08
Rate for Payer: MI Amish Medical Board Commercial	$11,705.99
Rate for Payer: Molina Medicare/Medicaid	$11,197.03
Rate for Payer: Nomi Health Commercial	$14,787.27
Rate for Payer: PACE Medicare	$9,670.16
Rate for Payer: PACE SWMI	$10,179.12
Rate for Payer: PHP Medicare Advantage	$10,179.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$18,480.81
Rate for Payer: Priority Health Medicare	$10,179.12
Rate for Payer: Priority Health Tiered Network	$14,784.64
Rate for Payer: Railroad Medicare Medicare	$10,179.12
Rate for Payer: UHC All Payor (Choice/PPO)	$18,684.69
Rate for Payer: UHC Core	$15,632.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,179.12
Rate for Payer: UHC Exchange	$12,766.34
Rate for Payer: VA VA	$10,179.12

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$80,206.33

Service Code	MSDRG 577
Min. Negotiated Rate	$21,621.98
Max. Negotiated Rate	$80,206.33
Rate for Payer: Aetna Medicare	$23,670.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$28,449.97
Rate for Payer: Amish Plain Church Group Commercial	$28,449.97
Rate for Payer: BCBS MAPPO	$22,759.98
Rate for Payer: BCBS Trust/PPO	$80,206.33
Rate for Payer: BCN Commercial	$80,206.33
Rate for Payer: BCN Medicare Advantage	$22,759.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$22,759.98
Rate for Payer: Mclaren Medicare	$22,759.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$23,897.98
Rate for Payer: MI Amish Medical Board Commercial	$26,173.98
Rate for Payer: Molina Medicare/Medicaid	$25,035.98
Rate for Payer: Nomi Health Commercial	$34,194.03
Rate for Payer: PACE Medicare	$21,621.98
Rate for Payer: PACE SWMI	$22,759.98
Rate for Payer: PHP Medicare Advantage	$22,759.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$42,734.96
Rate for Payer: Priority Health Medicare	$22,759.98
Rate for Payer: Priority Health Tiered Network	$34,187.96
Rate for Payer: Railroad Medicare Medicare	$22,759.98
Rate for Payer: UHC All Payor (Choice/PPO)	$43,206.41
Rate for Payer: UHC Core	$36,147.60
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$22,759.98
Rate for Payer: UHC Exchange	$29,520.85
Rate for Payer: VA VA	$22,759.98

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$125,064.01

Service Code	MSDRG 576
Min. Negotiated Rate	$39,501.19
Max. Negotiated Rate	$125,064.01
Rate for Payer: Aetna Medicare	$43,243.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$51,975.25
Rate for Payer: Amish Plain Church Group Commercial	$51,975.25
Rate for Payer: BCBS MAPPO	$41,580.20
Rate for Payer: BCBS Trust/PPO	$125,064.01
Rate for Payer: BCN Commercial	$125,064.01
Rate for Payer: BCN Medicare Advantage	$41,580.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$41,580.20
Rate for Payer: Mclaren Medicare	$41,580.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$43,659.21
Rate for Payer: MI Amish Medical Board Commercial	$47,817.23
Rate for Payer: Molina Medicare/Medicaid	$45,738.22
Rate for Payer: Nomi Health Commercial	$63,225.48
Rate for Payer: PACE Medicare	$39,501.19
Rate for Payer: PACE SWMI	$41,580.20
Rate for Payer: PHP Medicare Advantage	$41,580.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$79,017.83
Rate for Payer: Priority Health Medicare	$41,580.20
Rate for Payer: Priority Health Tiered Network	$63,214.26
Rate for Payer: Railroad Medicare Medicare	$41,580.20
Rate for Payer: UHC All Payor (Choice/PPO)	$79,889.56
Rate for Payer: UHC Core	$66,837.66
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$41,580.20
Rate for Payer: UHC Exchange	$54,584.66
Rate for Payer: VA VA	$41,580.20

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$39,839.64

Service Code	MSDRG 578
Min. Negotiated Rate	$13,325.47
Max. Negotiated Rate	$39,839.64
Rate for Payer: Aetna Medicare	$14,587.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,533.51
Rate for Payer: Amish Plain Church Group Commercial	$17,533.51
Rate for Payer: BCBS MAPPO	$14,026.81
Rate for Payer: BCBS Trust/PPO	$39,839.64
Rate for Payer: BCN Commercial	$39,839.64
Rate for Payer: BCN Medicare Advantage	$14,026.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,026.81
Rate for Payer: Mclaren Medicare	$14,026.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,728.15
Rate for Payer: MI Amish Medical Board Commercial	$16,130.83
Rate for Payer: Molina Medicare/Medicaid	$15,429.49
Rate for Payer: Nomi Health Commercial	$20,722.56
Rate for Payer: PACE Medicare	$13,325.47
Rate for Payer: PACE SWMI	$14,026.81
Rate for Payer: PHP Medicare Advantage	$14,026.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$25,898.61
Rate for Payer: Priority Health Medicare	$14,026.81
Rate for Payer: Priority Health Tiered Network	$20,718.88
Rate for Payer: Railroad Medicare Medicare	$14,026.81
Rate for Payer: UHC All Payor (Choice/PPO)	$26,184.32
Rate for Payer: UHC Core	$21,906.48
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,026.81
Rate for Payer: UHC Exchange	$17,890.48
Rate for Payer: VA VA	$14,026.81

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$21,421.24

Service Code	APR-DRG 3123
Min. Negotiated Rate	$20,401.18
Max. Negotiated Rate	$21,421.24
Rate for Payer: BCBS Complete	$21,421.24
Rate for Payer: Mclaren Medicaid	$20,401.18
Rate for Payer: Meridian Medicaid	$21,421.24
Rate for Payer: Priority Health Choice Medicaid	$20,401.18
Rate for Payer: UHC Medicaid	$20,401.18
Rate for Payer: UHCCP Medicaid	$20,401.18

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$11,245.73

Service Code	APR-DRG 3121
Min. Negotiated Rate	$10,710.22
Max. Negotiated Rate	$11,245.73
Rate for Payer: BCBS Complete	$11,245.73
Rate for Payer: Mclaren Medicaid	$10,710.22
Rate for Payer: Meridian Medicaid	$11,245.73
Rate for Payer: Priority Health Choice Medicaid	$10,710.22
Rate for Payer: UHC Medicaid	$10,710.22
Rate for Payer: UHCCP Medicaid	$10,710.22

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$40,527.11

Service Code	APR-DRG 3124
Min. Negotiated Rate	$38,597.25
Max. Negotiated Rate	$40,527.11
Rate for Payer: BCBS Complete	$40,527.11
Rate for Payer: Mclaren Medicaid	$38,597.25
Rate for Payer: Meridian Medicaid	$40,527.11
Rate for Payer: Priority Health Choice Medicaid	$38,597.25
Rate for Payer: UHC Medicaid	$38,597.25
Rate for Payer: UHCCP Medicaid	$38,597.25

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$16,291.72

Service Code	APR-DRG 3122
Min. Negotiated Rate	$15,515.92
Max. Negotiated Rate	$16,291.72
Rate for Payer: BCBS Complete	$16,291.72
Rate for Payer: Mclaren Medicaid	$15,515.92
Rate for Payer: Meridian Medicaid	$16,291.72
Rate for Payer: Priority Health Choice Medicaid	$15,515.92
Rate for Payer: UHC Medicaid	$15,515.92
Rate for Payer: UHCCP Medicaid	$15,515.92

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$20,090.74

Service Code	APR-DRG 3613
Min. Negotiated Rate	$19,134.03
Max. Negotiated Rate	$20,090.74
Rate for Payer: BCBS Complete	$20,090.74
Rate for Payer: Mclaren Medicaid	$19,134.03
Rate for Payer: Meridian Medicaid	$20,090.74
Rate for Payer: Priority Health Choice Medicaid	$19,134.03
Rate for Payer: UHC Medicaid	$19,134.03
Rate for Payer: UHCCP Medicaid	$19,134.03

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$37,551.94

Service Code	APR-DRG 3614
Min. Negotiated Rate	$35,763.75
Max. Negotiated Rate	$37,551.94
Rate for Payer: BCBS Complete	$37,551.94
Rate for Payer: Mclaren Medicaid	$35,763.75
Rate for Payer: Meridian Medicaid	$37,551.94
Rate for Payer: Priority Health Choice Medicaid	$35,763.75
Rate for Payer: UHC Medicaid	$35,763.75
Rate for Payer: UHCCP Medicaid	$35,763.75

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$17,602.85

Service Code	APR-DRG 3612
Min. Negotiated Rate	$16,764.62
Max. Negotiated Rate	$17,602.85
Rate for Payer: BCBS Complete	$17,602.85
Rate for Payer: Mclaren Medicaid	$16,764.62
Rate for Payer: Meridian Medicaid	$17,602.85
Rate for Payer: Priority Health Choice Medicaid	$16,764.62
Rate for Payer: UHC Medicaid	$16,764.62
Rate for Payer: UHCCP Medicaid	$16,764.62

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$12,983.62

Service Code	APR-DRG 3611
Min. Negotiated Rate	$12,365.35
Max. Negotiated Rate	$12,983.62
Rate for Payer: BCBS Complete	$12,983.62
Rate for Payer: Mclaren Medicaid	$12,365.35
Rate for Payer: Meridian Medicaid	$12,983.62
Rate for Payer: Priority Health Choice Medicaid	$12,365.35
Rate for Payer: UHC Medicaid	$12,365.35
Rate for Payer: UHCCP Medicaid	$12,365.35

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$56,583.82

Service Code	MSDRG 574
Min. Negotiated Rate	$28,142.06
Max. Negotiated Rate	$56,583.82
Rate for Payer: Aetna Medicare	$30,808.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$37,029.03
Rate for Payer: Amish Plain Church Group Commercial	$37,029.03
Rate for Payer: BCBS MAPPO	$29,623.22
Rate for Payer: BCBS Trust/PPO	$48,648.66
Rate for Payer: BCN Commercial	$48,648.66
Rate for Payer: BCN Medicare Advantage	$29,623.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$29,623.22
Rate for Payer: Mclaren Medicare	$29,623.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$31,104.38
Rate for Payer: MI Amish Medical Board Commercial	$34,066.70
Rate for Payer: Molina Medicare/Medicaid	$32,585.54
Rate for Payer: Nomi Health Commercial	$44,781.06
Rate for Payer: PACE Medicare	$28,142.06
Rate for Payer: PACE SWMI	$29,623.22
Rate for Payer: PHP Medicare Advantage	$29,623.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$55,966.40
Rate for Payer: Priority Health Medicare	$29,623.22
Rate for Payer: Priority Health Tiered Network	$44,773.11
Rate for Payer: Railroad Medicare Medicare	$29,623.22
Rate for Payer: UHC All Payor (Choice/PPO)	$56,583.82
Rate for Payer: UHC Core	$47,339.48
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$29,623.22
Rate for Payer: UHC Exchange	$38,660.98
Rate for Payer: VA VA	$29,623.22

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$141,957.36

Service Code	MSDRG 573
Min. Negotiated Rate	$52,611.31
Max. Negotiated Rate	$141,957.36
Rate for Payer: Aetna Medicare	$57,595.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$69,225.41
Rate for Payer: Amish Plain Church Group Commercial	$69,225.41
Rate for Payer: BCBS MAPPO	$55,380.33
Rate for Payer: BCBS Trust/PPO	$141,957.36
Rate for Payer: BCN Commercial	$141,957.36
Rate for Payer: BCN Medicare Advantage	$55,380.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$55,380.33
Rate for Payer: Mclaren Medicare	$55,380.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$58,149.35
Rate for Payer: MI Amish Medical Board Commercial	$63,687.38
Rate for Payer: Molina Medicare/Medicaid	$60,918.36
Rate for Payer: Nomi Health Commercial	$84,513.06
Rate for Payer: PACE Medicare	$52,611.31
Rate for Payer: PACE SWMI	$55,380.33
Rate for Payer: PHP Medicare Advantage	$55,380.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$105,622.59
Rate for Payer: Priority Health Medicare	$55,380.33
Rate for Payer: Priority Health Tiered Network	$84,498.06
Rate for Payer: Railroad Medicare Medicare	$55,380.33
Rate for Payer: UHC All Payor (Choice/PPO)	$106,787.82
Rate for Payer: UHC Core	$89,341.44
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$55,380.33
Rate for Payer: UHC Exchange	$72,962.94
Rate for Payer: VA VA	$55,380.33

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$29,224.33

Service Code	MSDRG 575
Min. Negotiated Rate	$14,839.69
Max. Negotiated Rate	$29,224.33
Rate for Payer: Aetna Medicare	$16,245.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,525.91
Rate for Payer: Amish Plain Church Group Commercial	$19,525.91
Rate for Payer: BCBS MAPPO	$15,620.73
Rate for Payer: BCBS Trust/PPO	$29,224.33
Rate for Payer: BCN Commercial	$29,224.33
Rate for Payer: BCN Medicare Advantage	$15,620.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,620.73
Rate for Payer: Mclaren Medicare	$15,620.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,401.77
Rate for Payer: MI Amish Medical Board Commercial	$17,963.84
Rate for Payer: Molina Medicare/Medicaid	$17,182.80
Rate for Payer: Nomi Health Commercial	$21,073.44
Rate for Payer: PACE Medicare	$14,839.69
Rate for Payer: PACE SWMI	$15,620.73
Rate for Payer: PHP Medicare Advantage	$15,620.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,971.49
Rate for Payer: Priority Health Medicare	$15,620.73
Rate for Payer: Priority Health Tiered Network	$23,177.18
Rate for Payer: Railroad Medicare Medicare	$15,620.73
Rate for Payer: UHC All Payor (Choice/PPO)	$26,627.68
Rate for Payer: UHC Core	$22,277.40
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,620.73
Rate for Payer: UHC Exchange	$18,193.40
Rate for Payer: VA VA	$15,620.73

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$32,038.06

Service Code	MSDRG 623
Min. Negotiated Rate	$14,815.07
Max. Negotiated Rate	$32,038.06
Rate for Payer: Aetna Medicare	$16,218.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,493.51
Rate for Payer: Amish Plain Church Group Commercial	$19,493.51
Rate for Payer: BCBS MAPPO	$15,594.81
Rate for Payer: BCBS Trust/PPO	$32,038.06
Rate for Payer: BCN Commercial	$32,038.06
Rate for Payer: BCN Medicare Advantage	$15,594.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,594.81
Rate for Payer: Mclaren Medicare	$15,594.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,374.55
Rate for Payer: MI Amish Medical Board Commercial	$17,934.03
Rate for Payer: Molina Medicare/Medicaid	$17,154.29
Rate for Payer: Nomi Health Commercial	$23,141.31
Rate for Payer: PACE Medicare	$14,815.07
Rate for Payer: PACE SWMI	$15,594.81
Rate for Payer: PHP Medicare Advantage	$15,594.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$28,921.51
Rate for Payer: Priority Health Medicare	$15,594.81
Rate for Payer: Priority Health Tiered Network	$23,137.20
Rate for Payer: Railroad Medicare Medicare	$15,594.81
Rate for Payer: UHC All Payor (Choice/PPO)	$29,240.57
Rate for Payer: UHC Core	$24,463.41
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,594.81
Rate for Payer: UHC Exchange	$19,978.66
Rate for Payer: VA VA	$15,594.81

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$58,014.96

Service Code	MSDRG 622
Min. Negotiated Rate	$28,839.60
Max. Negotiated Rate	$58,014.96
Rate for Payer: Aetna Medicare	$31,571.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$37,946.84
Rate for Payer: Amish Plain Church Group Commercial	$37,946.84
Rate for Payer: BCBS MAPPO	$30,357.47
Rate for Payer: BCBS Trust/PPO	$47,523.17
Rate for Payer: BCN Commercial	$47,523.17
Rate for Payer: BCN Medicare Advantage	$30,357.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$30,357.47
Rate for Payer: Mclaren Medicare	$30,357.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$31,875.34
Rate for Payer: MI Amish Medical Board Commercial	$34,911.09
Rate for Payer: Molina Medicare/Medicaid	$33,393.22
Rate for Payer: Nomi Health Commercial	$45,913.68
Rate for Payer: PACE Medicare	$28,839.60
Rate for Payer: PACE SWMI	$30,357.47
Rate for Payer: PHP Medicare Advantage	$30,357.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$57,381.92
Rate for Payer: Priority Health Medicare	$30,357.47
Rate for Payer: Priority Health Tiered Network	$45,905.53
Rate for Payer: Railroad Medicare Medicare	$30,357.47
Rate for Payer: UHC All Payor (Choice/PPO)	$58,014.96
Rate for Payer: UHC Core	$48,536.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$30,357.47
Rate for Payer: UHC Exchange	$39,638.81
Rate for Payer: VA VA	$30,357.47

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$22,935.31

Service Code	MSDRG 624
Min. Negotiated Rate	$10,509.11
Max. Negotiated Rate	$22,935.31
Rate for Payer: Aetna Medicare	$11,504.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,827.77
Rate for Payer: Amish Plain Church Group Commercial	$13,827.77
Rate for Payer: BCBS MAPPO	$11,062.22
Rate for Payer: BCBS Trust/PPO	$22,935.31
Rate for Payer: BCN Commercial	$22,935.31
Rate for Payer: BCN Medicare Advantage	$11,062.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,062.22
Rate for Payer: Mclaren Medicare	$11,062.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,615.33
Rate for Payer: MI Amish Medical Board Commercial	$12,721.55
Rate for Payer: Molina Medicare/Medicaid	$12,168.44
Rate for Payer: Nomi Health Commercial	$16,149.51
Rate for Payer: PACE Medicare	$10,509.11
Rate for Payer: PACE SWMI	$11,062.22
Rate for Payer: PHP Medicare Advantage	$11,062.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$20,183.31
Rate for Payer: Priority Health Medicare	$11,062.22
Rate for Payer: Priority Health Tiered Network	$16,146.64
Rate for Payer: Railroad Medicare Medicare	$11,062.22
Rate for Payer: UHC All Payor (Choice/PPO)	$20,405.97
Rate for Payer: UHC Core	$17,072.16
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,062.22
Rate for Payer: UHC Exchange	$13,942.41
Rate for Payer: VA VA	$11,062.22

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$69,316.52

Service Code	MSDRG 904
Min. Negotiated Rate	$29,744.47
Max. Negotiated Rate	$69,316.52
Rate for Payer: Aetna Medicare	$32,562.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$39,137.46
Rate for Payer: Amish Plain Church Group Commercial	$39,137.46
Rate for Payer: BCBS MAPPO	$31,309.97
Rate for Payer: BCBS Trust/PPO	$69,316.52
Rate for Payer: BCN Commercial	$69,316.52
Rate for Payer: BCN Medicare Advantage	$31,309.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$31,309.97
Rate for Payer: Mclaren Medicare	$31,309.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$32,875.47
Rate for Payer: MI Amish Medical Board Commercial	$36,006.47
Rate for Payer: Molina Medicare/Medicaid	$34,440.97
Rate for Payer: Nomi Health Commercial	$47,382.99
Rate for Payer: PACE Medicare	$29,744.47
Rate for Payer: PACE SWMI	$31,309.97
Rate for Payer: PHP Medicare Advantage	$31,309.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$59,218.23
Rate for Payer: Priority Health Medicare	$31,309.97
Rate for Payer: Priority Health Tiered Network	$47,374.58
Rate for Payer: Railroad Medicare Medicare	$31,309.97
Rate for Payer: UHC All Payor (Choice/PPO)	$59,871.53
Rate for Payer: UHC Core	$50,090.06
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$31,309.97
Rate for Payer: UHC Exchange	$40,907.31
Rate for Payer: VA VA	$31,309.97

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$30,956.49

Service Code	MSDRG 905
Min. Negotiated Rate	$12,348.28
Max. Negotiated Rate	$30,956.49
Rate for Payer: Aetna Medicare	$13,518.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,247.74
Rate for Payer: Amish Plain Church Group Commercial	$16,247.74
Rate for Payer: BCBS MAPPO	$12,998.19
Rate for Payer: BCBS Trust/PPO	$30,956.49
Rate for Payer: BCN Commercial	$30,956.49
Rate for Payer: BCN Medicare Advantage	$12,998.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,998.19
Rate for Payer: Mclaren Medicare	$12,998.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,648.10
Rate for Payer: MI Amish Medical Board Commercial	$14,947.92
Rate for Payer: Molina Medicare/Medicaid	$14,298.01
Rate for Payer: Nomi Health Commercial	$18,470.22
Rate for Payer: PACE Medicare	$12,348.28
Rate for Payer: PACE SWMI	$12,998.19
Rate for Payer: PHP Medicare Advantage	$12,998.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$23,915.58
Rate for Payer: Priority Health Medicare	$12,998.19
Rate for Payer: Priority Health Tiered Network	$19,132.46
Rate for Payer: Railroad Medicare Medicare	$12,998.19
Rate for Payer: UHC All Payor (Choice/PPO)	$23,338.34
Rate for Payer: UHC Core	$19,525.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,998.19
Rate for Payer: UHC Exchange	$15,945.96
Rate for Payer: VA VA	$12,998.19

SKIN ULCERS

Facility

$8,503.00

Service Code	APR-DRG 3804
Min. Negotiated Rate	$8,098.10
Max. Negotiated Rate	$8,503.00
Rate for Payer: BCBS Complete	$8,503.00
Rate for Payer: Mclaren Medicaid	$8,098.10
Rate for Payer: Meridian Medicaid	$8,503.00
Rate for Payer: Priority Health Choice Medicaid	$8,098.10
Rate for Payer: UHC Medicaid	$8,098.10
Rate for Payer: UHCCP Medicaid	$8,098.10

SKIN ULCERS

Facility

$5,082.31

Service Code	APR-DRG 3802
Min. Negotiated Rate	$4,840.29
Max. Negotiated Rate	$5,082.31
Rate for Payer: BCBS Complete	$5,082.31
Rate for Payer: Mclaren Medicaid	$4,840.29
Rate for Payer: Meridian Medicaid	$5,082.31
Rate for Payer: Priority Health Choice Medicaid	$4,840.29
Rate for Payer: UHC Medicaid	$4,840.29
Rate for Payer: UHCCP Medicaid	$4,840.29

SKIN ULCERS

Facility

$3,513.91

Service Code	APR-DRG 3801
Min. Negotiated Rate	$3,346.58
Max. Negotiated Rate	$3,513.91
Rate for Payer: BCBS Complete	$3,513.91
Rate for Payer: Mclaren Medicaid	$3,346.58
Rate for Payer: Meridian Medicaid	$3,513.91
Rate for Payer: Priority Health Choice Medicaid	$3,346.58
Rate for Payer: UHC Medicaid	$3,346.58
Rate for Payer: UHCCP Medicaid	$3,346.58

SKIN ULCERS

Facility

$6,287.51

Service Code	APR-DRG 3803
Min. Negotiated Rate	$5,988.11
Max. Negotiated Rate	$6,287.51
Rate for Payer: BCBS Complete	$6,287.51
Rate for Payer: Mclaren Medicaid	$5,988.11
Rate for Payer: Meridian Medicaid	$6,287.51
Rate for Payer: Priority Health Choice Medicaid	$5,988.11
Rate for Payer: UHC Medicaid	$5,988.11
Rate for Payer: UHCCP Medicaid	$5,988.11

Know your out-of-pocket cost for care.

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