Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

APIXABAN 5 MG TABLET

Facility

$2,734.30

Service Code	NDC 00003089431
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$1,093.72
Max. Negotiated Rate	$2,734.30
Rate for Payer: Aetna Commercial	$2,460.87
Rate for Payer: Aetna Medicare	$1,367.15
Rate for Payer: ASR ASR	$2,652.27
Rate for Payer: ASR Commercial	$2,652.27
Rate for Payer: BCBS Complete	$1,093.72
Rate for Payer: BCBS Trust/PPO	$2,239.12
Rate for Payer: BCN Commercial	$2,119.90
Rate for Payer: Cash Price	$2,187.44
Rate for Payer: Cofinity Commercial	$2,570.24
Rate for Payer: Encore Health Key Benefits Commercial	$2,187.44
Rate for Payer: Healthscope Commercial	$2,734.30
Rate for Payer: Healthscope Whirlpool	$2,652.27
Rate for Payer: Mclaren Commercial	$2,460.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,324.16
Rate for Payer: Nomi Health Commercial	$2,242.13
Rate for Payer: Priority Health Cigna Priority Health	$1,777.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,395.79
Rate for Payer: Priority Health Narrow Network	$1,916.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,406.18

APIXABAN 5 MG TABLET

Facility

$1,640.36

Service Code	NDC 00003089421
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$1,066.23
Max. Negotiated Rate	$1,640.36
Rate for Payer: Aetna Commercial	$1,476.32
Rate for Payer: ASR ASR	$1,591.15
Rate for Payer: ASR Commercial	$1,591.15
Rate for Payer: BCBS Trust/PPO	$1,336.73
Rate for Payer: BCN Commercial	$1,271.77
Rate for Payer: Cash Price	$1,312.29
Rate for Payer: Cofinity Commercial	$1,541.94
Rate for Payer: Encore Health Key Benefits Commercial	$1,312.29
Rate for Payer: Healthscope Commercial	$1,640.36
Rate for Payer: Healthscope Whirlpool	$1,591.15
Rate for Payer: Mclaren Commercial	$1,476.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,394.31
Rate for Payer: Nomi Health Commercial	$1,345.10
Rate for Payer: Priority Health Cigna Priority Health	$1,066.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,443.52

APIXABAN 5 MG TABLET

Facility

$1,640.36

Service Code	NDC 00003089421
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$656.14
Max. Negotiated Rate	$1,640.36
Rate for Payer: Aetna Commercial	$1,476.32
Rate for Payer: Aetna Medicare	$820.18
Rate for Payer: ASR ASR	$1,591.15
Rate for Payer: ASR Commercial	$1,591.15
Rate for Payer: BCBS Complete	$656.14
Rate for Payer: BCBS Trust/PPO	$1,343.29
Rate for Payer: BCN Commercial	$1,271.77
Rate for Payer: Cash Price	$1,312.29
Rate for Payer: Cofinity Commercial	$1,541.94
Rate for Payer: Encore Health Key Benefits Commercial	$1,312.29
Rate for Payer: Healthscope Commercial	$1,640.36
Rate for Payer: Healthscope Whirlpool	$1,591.15
Rate for Payer: Mclaren Commercial	$1,476.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,394.31
Rate for Payer: Nomi Health Commercial	$1,345.10
Rate for Payer: Priority Health Cigna Priority Health	$1,066.23
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,437.28
Rate for Payer: Priority Health Narrow Network	$1,149.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,443.52

APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA

Facility

$2,777.97

Service Code	CPT 15275
Hospital Revenue Code	361
Min. Negotiated Rate	$960.64
Max. Negotiated Rate	$2,777.97
Rate for Payer: Aetna Medicare	$1,792.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,240.30
Rate for Payer: Amish Plain Church Group Commercial	$2,240.30
Rate for Payer: BCBS Complete	$1,008.67
Rate for Payer: BCBS MAPPO	$1,792.24
Rate for Payer: BCN Medicare Advantage	$1,792.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,792.24
Rate for Payer: Humana Choice PPO Medicare	$1,792.24
Rate for Payer: Mclaren Medicaid	$960.64
Rate for Payer: Mclaren Medicare	$1,792.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,881.85
Rate for Payer: Meridian Medicaid	$1,008.67
Rate for Payer: MI Amish Medical Board Commercial	$2,061.08
Rate for Payer: PACE Medicare	$1,702.63
Rate for Payer: PACE SWMI	$1,792.24
Rate for Payer: PHP Commercial	$1,971.46
Rate for Payer: PHP Medicaid	$960.64
Rate for Payer: PHP Medicare Advantage	$1,792.24
Rate for Payer: Priority Health Choice Medicaid	$960.64
Rate for Payer: Priority Health Medicare	$1,792.24
Rate for Payer: Railroad Medicare Medicare	$1,792.24
Rate for Payer: UHC Dual Complete DSNP	$1,792.24
Rate for Payer: UHC Exchange	$2,777.97
Rate for Payer: UHC Medicare Advantage	$1,792.24
Rate for Payer: UHCCP DNSP	$1,792.24
Rate for Payer: UHCCP Medicaid	$960.64
Rate for Payer: VA VA	$1,792.24

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$4,190.41

Service Code	APR-DRG 2512
Min. Negotiated Rate	$3,990.87
Max. Negotiated Rate	$4,190.41
Rate for Payer: BCBS Complete	$4,190.41
Rate for Payer: Mclaren Medicaid	$3,990.87
Rate for Payer: Meridian Medicaid	$4,190.41
Rate for Payer: PHP Medicaid	$3,990.87
Rate for Payer: Priority Health Choice Medicaid	$3,990.87
Rate for Payer: UHCCP Medicaid	$3,990.87

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$3,517.88

Service Code	APR-DRG 2511
Min. Negotiated Rate	$3,350.36
Max. Negotiated Rate	$3,517.88
Rate for Payer: BCBS Complete	$3,517.88
Rate for Payer: Mclaren Medicaid	$3,350.36
Rate for Payer: Meridian Medicaid	$3,517.88
Rate for Payer: PHP Medicaid	$3,350.36
Rate for Payer: Priority Health Choice Medicaid	$3,350.36
Rate for Payer: UHCCP Medicaid	$3,350.36

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$7,708.29

Service Code	APR-DRG 2514
Min. Negotiated Rate	$7,341.23
Max. Negotiated Rate	$7,708.29
Rate for Payer: BCBS Complete	$7,708.29
Rate for Payer: Mclaren Medicaid	$7,341.23
Rate for Payer: Meridian Medicaid	$7,708.29
Rate for Payer: PHP Medicaid	$7,341.23
Rate for Payer: Priority Health Choice Medicaid	$7,341.23
Rate for Payer: UHCCP Medicaid	$7,341.23

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$5,121.62

Service Code	APR-DRG 2513
Min. Negotiated Rate	$4,877.73
Max. Negotiated Rate	$5,121.62
Rate for Payer: BCBS Complete	$5,121.62
Rate for Payer: Mclaren Medicaid	$4,877.73
Rate for Payer: Meridian Medicaid	$5,121.62
Rate for Payer: PHP Medicaid	$4,877.73
Rate for Payer: Priority Health Choice Medicaid	$4,877.73
Rate for Payer: UHCCP Medicaid	$4,877.73

APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$10,398.43

Service Code	APR-DRG 5434
Min. Negotiated Rate	$9,903.27
Max. Negotiated Rate	$10,398.43
Rate for Payer: BCBS Complete	$10,398.43
Rate for Payer: Mclaren Medicaid	$9,903.27
Rate for Payer: Meridian Medicaid	$10,398.43
Rate for Payer: PHP Medicaid	$9,903.27
Rate for Payer: Priority Health Choice Medicaid	$9,903.27
Rate for Payer: UHCCP Medicaid	$9,903.27

APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,586.68

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,463.50
Max. Negotiated Rate	$2,586.68
Rate for Payer: BCBS Complete	$2,586.68
Rate for Payer: Mclaren Medicaid	$2,463.50
Rate for Payer: Meridian Medicaid	$2,586.68
Rate for Payer: PHP Medicaid	$2,463.50
Rate for Payer: Priority Health Choice Medicaid	$2,463.50
Rate for Payer: UHCCP Medicaid	$2,463.50

APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,380.28

Service Code	APR-DRG 5433
Min. Negotiated Rate	$5,124.08
Max. Negotiated Rate	$5,380.28
Rate for Payer: BCBS Complete	$5,380.28
Rate for Payer: Mclaren Medicaid	$5,124.08
Rate for Payer: Meridian Medicaid	$5,380.28
Rate for Payer: PHP Medicaid	$5,124.08
Rate for Payer: Priority Health Choice Medicaid	$5,124.08
Rate for Payer: UHCCP Medicaid	$5,124.08

APR-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,310.94

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,153.28
Max. Negotiated Rate	$3,310.94
Rate for Payer: BCBS Complete	$3,310.94
Rate for Payer: Mclaren Medicaid	$3,153.28
Rate for Payer: Meridian Medicaid	$3,310.94
Rate for Payer: PHP Medicaid	$3,153.28
Rate for Payer: Priority Health Choice Medicaid	$3,153.28
Rate for Payer: UHCCP Medicaid	$3,153.28

APR-DRG 42.00: ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,017.61

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,921.53
Max. Negotiated Rate	$2,017.61
Rate for Payer: BCBS Complete	$2,017.61
Rate for Payer: Mclaren Medicaid	$1,921.53
Rate for Payer: Meridian Medicaid	$2,017.61
Rate for Payer: PHP Medicaid	$1,921.53
Rate for Payer: Priority Health Choice Medicaid	$1,921.53
Rate for Payer: UHCCP Medicaid	$1,921.53

APR-DRG 42.00: ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,293.88

Service Code	APR-DRG 5643
Min. Negotiated Rate	$4,089.41
Max. Negotiated Rate	$4,293.88
Rate for Payer: BCBS Complete	$4,293.88
Rate for Payer: Mclaren Medicaid	$4,089.41
Rate for Payer: Meridian Medicaid	$4,293.88
Rate for Payer: PHP Medicaid	$4,089.41
Rate for Payer: Priority Health Choice Medicaid	$4,089.41
Rate for Payer: UHCCP Medicaid	$4,089.41

APR-DRG 42.00: ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,000.54

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,857.66
Max. Negotiated Rate	$3,000.54
Rate for Payer: BCBS Complete	$3,000.54
Rate for Payer: Mclaren Medicaid	$2,857.66
Rate for Payer: Meridian Medicaid	$3,000.54
Rate for Payer: PHP Medicaid	$2,857.66
Rate for Payer: Priority Health Choice Medicaid	$2,857.66
Rate for Payer: UHCCP Medicaid	$2,857.66

APR-DRG 42.00: ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$9,156.83

Service Code	APR-DRG 5644
Min. Negotiated Rate	$8,720.79
Max. Negotiated Rate	$9,156.83
Rate for Payer: BCBS Complete	$9,156.83
Rate for Payer: Mclaren Medicaid	$8,720.79
Rate for Payer: Meridian Medicaid	$9,156.83
Rate for Payer: PHP Medicaid	$8,720.79
Rate for Payer: Priority Health Choice Medicaid	$8,720.79
Rate for Payer: UHCCP Medicaid	$8,720.79

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$11,329.64

Service Code	APR-DRG 1934
Min. Negotiated Rate	$10,790.13
Max. Negotiated Rate	$11,329.64
Rate for Payer: BCBS Complete	$11,329.64
Rate for Payer: Mclaren Medicaid	$10,790.13
Rate for Payer: Meridian Medicaid	$11,329.64
Rate for Payer: PHP Medicaid	$10,790.13
Rate for Payer: Priority Health Choice Medicaid	$10,790.13
Rate for Payer: UHCCP Medicaid	$10,790.13

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$6,311.49

Service Code	APR-DRG 1931
Min. Negotiated Rate	$6,010.94
Max. Negotiated Rate	$6,311.49
Rate for Payer: BCBS Complete	$6,311.49
Rate for Payer: Mclaren Medicaid	$6,010.94
Rate for Payer: Meridian Medicaid	$6,311.49
Rate for Payer: PHP Medicaid	$6,010.94
Rate for Payer: Priority Health Choice Medicaid	$6,010.94
Rate for Payer: UHCCP Medicaid	$6,010.94

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$6,828.82

Service Code	APR-DRG 1932
Min. Negotiated Rate	$6,503.64
Max. Negotiated Rate	$6,828.82
Rate for Payer: BCBS Complete	$6,828.82
Rate for Payer: Mclaren Medicaid	$6,503.64
Rate for Payer: Meridian Medicaid	$6,828.82
Rate for Payer: PHP Medicaid	$6,503.64
Rate for Payer: Priority Health Choice Medicaid	$6,503.64
Rate for Payer: UHCCP Medicaid	$6,503.64

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$10,553.63

Service Code	APR-DRG 1933
Min. Negotiated Rate	$10,051.08
Max. Negotiated Rate	$10,553.63
Rate for Payer: BCBS Complete	$10,553.63
Rate for Payer: Mclaren Medicaid	$10,051.08
Rate for Payer: Meridian Medicaid	$10,553.63
Rate for Payer: PHP Medicaid	$10,051.08
Rate for Payer: Priority Health Choice Medicaid	$10,051.08
Rate for Payer: UHCCP Medicaid	$10,051.08

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$2,897.08

Service Code	APR-DRG 7561
Min. Negotiated Rate	$2,759.12
Max. Negotiated Rate	$2,897.08
Rate for Payer: BCBS Complete	$2,897.08
Rate for Payer: Mclaren Medicaid	$2,759.12
Rate for Payer: Meridian Medicaid	$2,897.08
Rate for Payer: PHP Medicaid	$2,759.12
Rate for Payer: Priority Health Choice Medicaid	$2,759.12
Rate for Payer: UHCCP Medicaid	$2,759.12

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$11,640.04

Service Code	APR-DRG 7564
Min. Negotiated Rate	$11,085.75
Max. Negotiated Rate	$11,640.04
Rate for Payer: BCBS Complete	$11,640.04
Rate for Payer: Mclaren Medicaid	$11,085.75
Rate for Payer: Meridian Medicaid	$11,640.04
Rate for Payer: PHP Medicaid	$11,085.75
Rate for Payer: Priority Health Choice Medicaid	$11,085.75
Rate for Payer: UHCCP Medicaid	$11,085.75

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$6,673.62

Service Code	APR-DRG 7563
Min. Negotiated Rate	$6,355.83
Max. Negotiated Rate	$6,673.62
Rate for Payer: BCBS Complete	$6,673.62
Rate for Payer: Mclaren Medicaid	$6,355.83
Rate for Payer: Meridian Medicaid	$6,673.62
Rate for Payer: PHP Medicaid	$6,355.83
Rate for Payer: Priority Health Choice Medicaid	$6,355.83
Rate for Payer: UHCCP Medicaid	$6,355.83

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$4,707.75

Service Code	APR-DRG 7562
Min. Negotiated Rate	$4,483.57
Max. Negotiated Rate	$4,707.75
Rate for Payer: BCBS Complete	$4,707.75
Rate for Payer: Mclaren Medicaid	$4,483.57
Rate for Payer: Meridian Medicaid	$4,707.75
Rate for Payer: PHP Medicaid	$4,483.57
Rate for Payer: Priority Health Choice Medicaid	$4,483.57
Rate for Payer: UHCCP Medicaid	$4,483.57

APR-DRG 42.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$4,966.42

Service Code	APR-DRG 1453
Min. Negotiated Rate	$4,729.92
Max. Negotiated Rate	$4,966.42
Rate for Payer: BCBS Complete	$4,966.42
Rate for Payer: Mclaren Medicaid	$4,729.92
Rate for Payer: Meridian Medicaid	$4,966.42
Rate for Payer: PHP Medicaid	$4,729.92
Rate for Payer: Priority Health Choice Medicaid	$4,729.92
Rate for Payer: UHCCP Medicaid	$4,729.92

Know your out-of-pocket cost for care.

All Charges