Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

FRACTURE OF PELVIS OR DISLOCATION OF HIP

Facility

$4,380.85

Service Code	APR-DRG 3412
Min. Negotiated Rate	$3,960.82
Max. Negotiated Rate	$4,380.85
Rate for Payer: BCBS Complete	$4,380.85
Rate for Payer: Mclaren Medicaid	$4,172.24
Rate for Payer: Meridian Medicaid	$4,380.85
Rate for Payer: PHP Medicaid	$3,960.82
Rate for Payer: Priority Health Choice Medicaid	$4,172.24
Rate for Payer: UHC Medicaid	$4,172.24
Rate for Payer: UHCCP Medicaid	$4,172.24

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$7,172.09

Service Code	APR-DRG 3423
Min. Negotiated Rate	$6,484.42
Max. Negotiated Rate	$7,172.09
Rate for Payer: BCBS Complete	$7,172.09
Rate for Payer: Mclaren Medicaid	$6,830.56
Rate for Payer: Meridian Medicaid	$7,172.09
Rate for Payer: PHP Medicaid	$6,484.42
Rate for Payer: Priority Health Choice Medicaid	$6,830.56
Rate for Payer: UHC Medicaid	$6,830.56
Rate for Payer: UHCCP Medicaid	$6,830.56

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$5,302.36

Service Code	APR-DRG 3422
Min. Negotiated Rate	$4,793.97
Max. Negotiated Rate	$5,302.36
Rate for Payer: BCBS Complete	$5,302.36
Rate for Payer: Mclaren Medicaid	$5,049.87
Rate for Payer: Meridian Medicaid	$5,302.36
Rate for Payer: PHP Medicaid	$4,793.97
Rate for Payer: Priority Health Choice Medicaid	$5,049.87
Rate for Payer: UHC Medicaid	$5,049.87
Rate for Payer: UHCCP Medicaid	$5,049.87

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$4,362.87

Service Code	APR-DRG 3421
Min. Negotiated Rate	$3,944.56
Max. Negotiated Rate	$4,362.87
Rate for Payer: BCBS Complete	$4,362.87
Rate for Payer: Mclaren Medicaid	$4,155.11
Rate for Payer: Meridian Medicaid	$4,362.87
Rate for Payer: PHP Medicaid	$3,944.56
Rate for Payer: Priority Health Choice Medicaid	$4,155.11
Rate for Payer: UHC Medicaid	$4,155.11
Rate for Payer: UHCCP Medicaid	$4,155.11

FRACTURES AND DISLOCATIONS EXCEPT FEMUR, PELVIS AND BACK

Facility

$12,842.84

Service Code	APR-DRG 3424
Min. Negotiated Rate	$11,611.46
Max. Negotiated Rate	$12,842.84
Rate for Payer: BCBS Complete	$12,842.84
Rate for Payer: Mclaren Medicaid	$12,231.27
Rate for Payer: Meridian Medicaid	$12,842.84
Rate for Payer: PHP Medicaid	$11,611.46
Rate for Payer: Priority Health Choice Medicaid	$12,231.27
Rate for Payer: UHC Medicaid	$12,231.27
Rate for Payer: UHCCP Medicaid	$12,231.27

FRACTURES OF FEMUR WITH MCC

Facility

$21,538.32

Service Code	MSDRG 533
Min. Negotiated Rate	$12,391.67
Max. Negotiated Rate	$21,538.32
Rate for Payer: Aetna Medicare	$13,043.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,304.83
Rate for Payer: Amish Plain Church Group Commercial	$16,304.83
Rate for Payer: BCBS MAPPO	$13,043.86
Rate for Payer: BCN Medicare Advantage	$13,043.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,043.86
Rate for Payer: Humana Choice PPO Medicare	$13,043.86
Rate for Payer: Mclaren Medicare	$13,043.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,696.05
Rate for Payer: MI Amish Medical Board Commercial	$15,000.44
Rate for Payer: Molina Medicare/Medicaid	$14,348.25
Rate for Payer: PACE Medicare	$12,391.67
Rate for Payer: PACE SWMI	$13,043.86
Rate for Payer: PHP Commercial	$14,348.25
Rate for Payer: PHP Medicare Advantage	$13,043.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,538.32
Rate for Payer: Priority Health Medicare	$13,043.86
Rate for Payer: Priority Health Narrow Network	$17,230.65
Rate for Payer: Railroad Medicare Medicare	$13,043.86
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,043.86
Rate for Payer: UHC Exchange	$20,217.98
Rate for Payer: UHCCP DNSP	$13,043.86
Rate for Payer: VA VA	$13,043.86

FRACTURES OF FEMUR WITHOUT MCC

Facility

$11,717.04

Service Code	MSDRG 534
Min. Negotiated Rate	$7,181.41
Max. Negotiated Rate	$11,717.04
Rate for Payer: Aetna Medicare	$7,559.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,449.23
Rate for Payer: Amish Plain Church Group Commercial	$9,449.23
Rate for Payer: BCBS MAPPO	$7,559.38
Rate for Payer: BCN Medicare Advantage	$7,559.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,559.38
Rate for Payer: Humana Choice PPO Medicare	$7,559.38
Rate for Payer: Mclaren Medicare	$7,559.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,937.35
Rate for Payer: MI Amish Medical Board Commercial	$8,693.29
Rate for Payer: Molina Medicare/Medicaid	$8,315.32
Rate for Payer: PACE Medicare	$7,181.41
Rate for Payer: PACE SWMI	$7,559.38
Rate for Payer: PHP Commercial	$8,315.32
Rate for Payer: PHP Medicare Advantage	$7,559.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,074.85
Rate for Payer: Priority Health Medicare	$7,559.38
Rate for Payer: Priority Health Narrow Network	$8,859.88
Rate for Payer: Railroad Medicare Medicare	$7,559.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,559.38
Rate for Payer: UHC Exchange	$11,717.04
Rate for Payer: UHCCP DNSP	$7,559.38
Rate for Payer: VA VA	$7,559.38

FRACTURES OF HIP AND PELVIS WITH MCC

Facility

$17,613.14

Service Code	MSDRG 535
Min. Negotiated Rate	$10,437.14
Max. Negotiated Rate	$17,613.14
Rate for Payer: Aetna Medicare	$10,986.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,733.08
Rate for Payer: Amish Plain Church Group Commercial	$13,733.08
Rate for Payer: BCBS MAPPO	$10,986.46
Rate for Payer: BCN Medicare Advantage	$10,986.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,986.46
Rate for Payer: Humana Choice PPO Medicare	$10,986.46
Rate for Payer: Mclaren Medicare	$10,986.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,535.78
Rate for Payer: MI Amish Medical Board Commercial	$12,634.43
Rate for Payer: Molina Medicare/Medicaid	$12,085.11
Rate for Payer: PACE Medicare	$10,437.14
Rate for Payer: PACE SWMI	$10,986.46
Rate for Payer: PHP Commercial	$12,085.11
Rate for Payer: PHP Medicare Advantage	$10,986.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$17,613.14
Rate for Payer: Priority Health Medicare	$10,986.46
Rate for Payer: Priority Health Narrow Network	$14,090.51
Rate for Payer: Railroad Medicare Medicare	$10,986.46
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,986.46
Rate for Payer: UHC Exchange	$17,029.01
Rate for Payer: UHCCP DNSP	$10,986.46
Rate for Payer: VA VA	$10,986.46

FRACTURES OF HIP AND PELVIS WITHOUT MCC

Facility

$11,733.79

Service Code	MSDRG 536
Min. Negotiated Rate	$7,191.68
Max. Negotiated Rate	$11,733.79
Rate for Payer: Aetna Medicare	$7,570.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,462.74
Rate for Payer: Amish Plain Church Group Commercial	$9,462.74
Rate for Payer: BCBS MAPPO	$7,570.19
Rate for Payer: BCN Medicare Advantage	$7,570.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,570.19
Rate for Payer: Humana Choice PPO Medicare	$7,570.19
Rate for Payer: Mclaren Medicare	$7,570.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,948.70
Rate for Payer: MI Amish Medical Board Commercial	$8,705.72
Rate for Payer: Molina Medicare/Medicaid	$8,327.21
Rate for Payer: PACE Medicare	$7,191.68
Rate for Payer: PACE SWMI	$7,570.19
Rate for Payer: PHP Commercial	$8,327.21
Rate for Payer: PHP Medicare Advantage	$7,570.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,095.45
Rate for Payer: Priority Health Medicare	$7,570.19
Rate for Payer: Priority Health Narrow Network	$8,876.36
Rate for Payer: Railroad Medicare Medicare	$7,570.19
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,570.19
Rate for Payer: UHC Exchange	$11,733.79
Rate for Payer: UHCCP DNSP	$7,570.19
Rate for Payer: VA VA	$7,570.19

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC

Facility

$19,575.04

Service Code	MSDRG 562
Min. Negotiated Rate	$11,414.05
Max. Negotiated Rate	$19,575.04
Rate for Payer: Aetna Medicare	$12,014.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,018.49
Rate for Payer: Amish Plain Church Group Commercial	$15,018.49
Rate for Payer: BCBS MAPPO	$12,014.79
Rate for Payer: BCN Medicare Advantage	$12,014.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,014.79
Rate for Payer: Humana Choice PPO Medicare	$12,014.79
Rate for Payer: Mclaren Medicare	$12,014.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,615.53
Rate for Payer: MI Amish Medical Board Commercial	$13,817.01
Rate for Payer: Molina Medicare/Medicaid	$13,216.27
Rate for Payer: PACE Medicare	$11,414.05
Rate for Payer: PACE SWMI	$12,014.79
Rate for Payer: PHP Commercial	$13,216.27
Rate for Payer: PHP Medicare Advantage	$12,014.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19,575.04
Rate for Payer: Priority Health Medicare	$12,014.79
Rate for Payer: Priority Health Narrow Network	$15,660.03
Rate for Payer: Railroad Medicare Medicare	$12,014.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,014.79
Rate for Payer: UHC Exchange	$18,622.92
Rate for Payer: UHCCP DNSP	$12,014.79
Rate for Payer: VA VA	$12,014.79

FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC

Facility

$12,714.91

Service Code	MSDRG 563
Min. Negotiated Rate	$7,793.01
Max. Negotiated Rate	$12,714.91
Rate for Payer: Aetna Medicare	$8,203.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,253.96
Rate for Payer: Amish Plain Church Group Commercial	$10,253.96
Rate for Payer: BCBS MAPPO	$8,203.17
Rate for Payer: BCN Medicare Advantage	$8,203.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,203.17
Rate for Payer: Humana Choice PPO Medicare	$8,203.17
Rate for Payer: Mclaren Medicare	$8,203.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,613.33
Rate for Payer: MI Amish Medical Board Commercial	$9,433.65
Rate for Payer: Molina Medicare/Medicaid	$9,023.49
Rate for Payer: PACE Medicare	$7,793.01
Rate for Payer: PACE SWMI	$8,203.17
Rate for Payer: PHP Commercial	$9,023.49
Rate for Payer: PHP Medicare Advantage	$8,203.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$12,303.10
Rate for Payer: Priority Health Medicare	$8,203.17
Rate for Payer: Priority Health Narrow Network	$9,842.48
Rate for Payer: Railroad Medicare Medicare	$8,203.17
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,203.17
Rate for Payer: UHC Exchange	$12,714.91
Rate for Payer: UHCCP DNSP	$8,203.17
Rate for Payer: VA VA	$8,203.17

FRAXEL ARMS - BILATERAL

Professional

Both

$1,051.00

Hospital Revenue Code	960
Min. Negotiated Rate	$420.40
Max. Negotiated Rate	$788.25
Rate for Payer: BCBS Complete	$420.40
Rate for Payer: Cash Price	$840.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$788.25

FRAXEL CHEST

Professional

Both

$840.00

Hospital Revenue Code	960
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$630.00
Rate for Payer: BCBS Complete	$336.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.00

FRAXEL FACE & NECK

Professional

Both

$1,051.00

Hospital Revenue Code	960
Min. Negotiated Rate	$420.40
Max. Negotiated Rate	$788.25
Rate for Payer: BCBS Complete	$420.40
Rate for Payer: Cash Price	$840.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$788.25

FRAXEL FULL FACE

Professional

Both

$630.00

Hospital Revenue Code	960
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$252.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.50

FRAXEL HANDS

Professional

Both

$368.00

Hospital Revenue Code	960
Min. Negotiated Rate	$147.20
Max. Negotiated Rate	$276.00
Rate for Payer: BCBS Complete	$147.20
Rate for Payer: Cash Price	$294.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.00

FRAXEL LARGE SCAR

Professional

Both

$840.00

Hospital Revenue Code	960
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$630.00
Rate for Payer: BCBS Complete	$336.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.00

FRAXEL MEDIUM SCAR

Professional

Both

$315.00

Hospital Revenue Code	960
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

FRAXEL NECK

Professional

Both

$420.00

Hospital Revenue Code	960
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$315.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.00

FRAXEL NECK & CHEST

Professional

Both

$1,261.00

Hospital Revenue Code	960
Min. Negotiated Rate	$504.40
Max. Negotiated Rate	$945.75
Rate for Payer: BCBS Complete	$504.40
Rate for Payer: Cash Price	$1,008.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$945.75

FRAXEL PARTIAL TREATMENT - BILATERAL EYES

Professional

Both

$315.00

Hospital Revenue Code	960
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

FRAXEL PARTIAL TREATMENT - PERI-ORAL

Professional

Both

$525.00

Hospital Revenue Code	960
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$393.75
Rate for Payer: BCBS Complete	$210.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.75

FRAXEL PARTIAL TREATMENT - UPPER LIP

Professional

Both

$263.00

Hospital Revenue Code	960
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

FRAXEL RESTORE

Professional

Both

$263.00

Hospital Revenue Code	960
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

FRAXEL SMALL SCAR

Professional

Both

$132.00

Hospital Revenue Code	960
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

Know your out-of-pocket cost for care.

All Charges