Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

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

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

$2,734.30

Service Code	NDC 00003089431
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$1,777.30
Max. Negotiated Rate	$2,734.30
Rate for Payer: Aetna Commercial	$2,460.87
Rate for Payer: ASR ASR	$2,652.27
Rate for Payer: ASR Commercial	$2,652.27
Rate for Payer: BCBS Trust/PPO	$2,228.18
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: UHC All Payor (Choice/PPO) + Core	$2,406.18

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

$2,765.22

Service Code	CPT 15275
Hospital Revenue Code	361
Min. Negotiated Rate	$956.23
Max. Negotiated Rate	$2,765.22
Rate for Payer: Aetna Medicare	$1,784.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$2,230.01
Rate for Payer: Amish Plain Church Group Commercial	$2,230.01
Rate for Payer: BCBS Complete	$1,004.04
Rate for Payer: BCBS MAPPO	$1,784.01
Rate for Payer: BCN Medicare Advantage	$1,784.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,784.01
Rate for Payer: Humana Choice PPO Medicare	$1,784.01
Rate for Payer: Mclaren Medicaid	$956.23
Rate for Payer: Mclaren Medicare	$1,784.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,873.21
Rate for Payer: Meridian Medicaid	$1,004.04
Rate for Payer: MI Amish Medical Board Commercial	$2,051.61
Rate for Payer: PACE Medicare	$1,694.81
Rate for Payer: PACE SWMI	$1,784.01
Rate for Payer: PHP Commercial	$1,962.41
Rate for Payer: PHP Medicaid	$956.23
Rate for Payer: PHP Medicare Advantage	$1,784.01
Rate for Payer: Priority Health Choice Medicaid	$956.23
Rate for Payer: Priority Health Medicare	$1,784.01
Rate for Payer: Railroad Medicare Medicare	$1,784.01
Rate for Payer: UHC Dual Complete DSNP	$1,784.01
Rate for Payer: UHC Exchange	$2,765.22
Rate for Payer: UHC Medicare Advantage	$1,784.01
Rate for Payer: UHCCP DNSP	$1,784.01
Rate for Payer: UHCCP Medicaid	$956.23
Rate for Payer: VA VA	$1,784.01

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$3,724.81

Service Code	APR-DRG 2512
Min. Negotiated Rate	$3,547.44
Max. Negotiated Rate	$3,724.81
Rate for Payer: BCBS Complete	$3,724.81
Rate for Payer: Mclaren Medicaid	$3,547.44
Rate for Payer: Meridian Medicaid	$3,724.81
Rate for Payer: PHP Medicaid	$3,547.44
Rate for Payer: Priority Health Choice Medicaid	$3,547.44
Rate for Payer: UHCCP Medicaid	$3,547.44

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$4,862.95

Service Code	APR-DRG 2513
Min. Negotiated Rate	$4,631.38
Max. Negotiated Rate	$4,862.95
Rate for Payer: BCBS Complete	$4,862.95
Rate for Payer: Mclaren Medicaid	$4,631.38
Rate for Payer: Meridian Medicaid	$4,862.95
Rate for Payer: PHP Medicaid	$4,631.38
Rate for Payer: Priority Health Choice Medicaid	$4,631.38
Rate for Payer: UHCCP Medicaid	$4,631.38

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$7,656.56

Service Code	APR-DRG 2514
Min. Negotiated Rate	$7,291.96
Max. Negotiated Rate	$7,656.56
Rate for Payer: BCBS Complete	$7,656.56
Rate for Payer: Mclaren Medicaid	$7,291.96
Rate for Payer: Meridian Medicaid	$7,656.56
Rate for Payer: PHP Medicaid	$7,291.96
Rate for Payer: Priority Health Choice Medicaid	$7,291.96
Rate for Payer: UHCCP Medicaid	$7,291.96

APR-DRG 42.00: ABDOMINAL PAIN

Facility

$2,948.81

Service Code	APR-DRG 2511
Min. Negotiated Rate	$2,808.39
Max. Negotiated Rate	$2,948.81
Rate for Payer: BCBS Complete	$2,948.81
Rate for Payer: Mclaren Medicaid	$2,808.39
Rate for Payer: Meridian Medicaid	$2,948.81
Rate for Payer: PHP Medicaid	$2,808.39
Rate for Payer: Priority Health Choice Medicaid	$2,808.39
Rate for Payer: UHCCP Medicaid	$2,808.39

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

Facility

$2,948.81

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,808.39
Max. Negotiated Rate	$2,948.81
Rate for Payer: BCBS Complete	$2,948.81
Rate for Payer: Mclaren Medicaid	$2,808.39
Rate for Payer: Meridian Medicaid	$2,948.81
Rate for Payer: PHP Medicaid	$2,808.39
Rate for Payer: Priority Health Choice Medicaid	$2,808.39
Rate for Payer: UHCCP Medicaid	$2,808.39

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

Facility

$6,052.82

Service Code	APR-DRG 5433
Min. Negotiated Rate	$5,764.59
Max. Negotiated Rate	$6,052.82
Rate for Payer: BCBS Complete	$6,052.82
Rate for Payer: Mclaren Medicaid	$5,764.59
Rate for Payer: Meridian Medicaid	$6,052.82
Rate for Payer: PHP Medicaid	$5,764.59
Rate for Payer: Priority Health Choice Medicaid	$5,764.59
Rate for Payer: UHCCP Medicaid	$5,764.59

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

Facility

$11,691.77

Service Code	APR-DRG 5434
Min. Negotiated Rate	$11,135.02
Max. Negotiated Rate	$11,691.77
Rate for Payer: BCBS Complete	$11,691.77
Rate for Payer: Mclaren Medicaid	$11,135.02
Rate for Payer: Meridian Medicaid	$11,691.77
Rate for Payer: PHP Medicaid	$11,135.02
Rate for Payer: Priority Health Choice Medicaid	$11,135.02
Rate for Payer: UHCCP Medicaid	$11,135.02

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

Facility

$3,724.81

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,547.44
Max. Negotiated Rate	$3,724.81
Rate for Payer: BCBS Complete	$3,724.81
Rate for Payer: Mclaren Medicaid	$3,547.44
Rate for Payer: Meridian Medicaid	$3,724.81
Rate for Payer: PHP Medicaid	$3,547.44
Rate for Payer: Priority Health Choice Medicaid	$3,547.44
Rate for Payer: UHCCP Medicaid	$3,547.44

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

Facility

$2,534.94

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,414.23
Max. Negotiated Rate	$2,534.94
Rate for Payer: BCBS Complete	$2,534.94
Rate for Payer: Mclaren Medicaid	$2,414.23
Rate for Payer: Meridian Medicaid	$2,534.94
Rate for Payer: PHP Medicaid	$2,414.23
Rate for Payer: Priority Health Choice Medicaid	$2,414.23
Rate for Payer: UHCCP Medicaid	$2,414.23

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

Facility

$9,208.56

Service Code	APR-DRG 5644
Min. Negotiated Rate	$8,770.06
Max. Negotiated Rate	$9,208.56
Rate for Payer: BCBS Complete	$9,208.56
Rate for Payer: Mclaren Medicaid	$8,770.06
Rate for Payer: Meridian Medicaid	$9,208.56
Rate for Payer: PHP Medicaid	$8,770.06
Rate for Payer: Priority Health Choice Medicaid	$8,770.06
Rate for Payer: UHCCP Medicaid	$8,770.06

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

Facility

$4,242.15

Service Code	APR-DRG 5643
Min. Negotiated Rate	$4,040.14
Max. Negotiated Rate	$4,242.15
Rate for Payer: BCBS Complete	$4,242.15
Rate for Payer: Mclaren Medicaid	$4,040.14
Rate for Payer: Meridian Medicaid	$4,242.15
Rate for Payer: PHP Medicaid	$4,040.14
Rate for Payer: Priority Health Choice Medicaid	$4,040.14
Rate for Payer: UHCCP Medicaid	$4,040.14

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

Facility

$1,810.67

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,724.45
Max. Negotiated Rate	$1,810.67
Rate for Payer: BCBS Complete	$1,810.67
Rate for Payer: Mclaren Medicaid	$1,724.45
Rate for Payer: Meridian Medicaid	$1,810.67
Rate for Payer: PHP Medicaid	$1,724.45
Rate for Payer: Priority Health Choice Medicaid	$1,724.45
Rate for Payer: UHCCP Medicaid	$1,724.45

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$12,622.97

Service Code	APR-DRG 1934
Min. Negotiated Rate	$12,021.88
Max. Negotiated Rate	$12,622.97
Rate for Payer: BCBS Complete	$12,622.97
Rate for Payer: Mclaren Medicaid	$12,021.88
Rate for Payer: Meridian Medicaid	$12,622.97
Rate for Payer: PHP Medicaid	$12,021.88
Rate for Payer: Priority Health Choice Medicaid	$12,021.88
Rate for Payer: UHCCP Medicaid	$12,021.88

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$6,259.75

Service Code	APR-DRG 1932
Min. Negotiated Rate	$5,961.67
Max. Negotiated Rate	$6,259.75
Rate for Payer: BCBS Complete	$6,259.75
Rate for Payer: Mclaren Medicaid	$5,961.67
Rate for Payer: Meridian Medicaid	$6,259.75
Rate for Payer: PHP Medicaid	$5,961.67
Rate for Payer: Priority Health Choice Medicaid	$5,961.67
Rate for Payer: UHCCP Medicaid	$5,961.67

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$8,587.76

Service Code	APR-DRG 1933
Min. Negotiated Rate	$8,178.82
Max. Negotiated Rate	$8,587.76
Rate for Payer: BCBS Complete	$8,587.76
Rate for Payer: Mclaren Medicaid	$8,178.82
Rate for Payer: Meridian Medicaid	$8,587.76
Rate for Payer: PHP Medicaid	$8,178.82
Rate for Payer: Priority Health Choice Medicaid	$8,178.82
Rate for Payer: UHCCP Medicaid	$8,178.82

APR-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS

Facility

$5,742.42

Service Code	APR-DRG 1931
Min. Negotiated Rate	$5,468.97
Max. Negotiated Rate	$5,742.42
Rate for Payer: BCBS Complete	$5,742.42
Rate for Payer: Mclaren Medicaid	$5,468.97
Rate for Payer: Meridian Medicaid	$5,742.42
Rate for Payer: PHP Medicaid	$5,468.97
Rate for Payer: Priority Health Choice Medicaid	$5,468.97
Rate for Payer: UHCCP Medicaid	$5,468.97

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$2,379.74

Service Code	APR-DRG 7561
Min. Negotiated Rate	$2,266.42
Max. Negotiated Rate	$2,379.74
Rate for Payer: BCBS Complete	$2,379.74
Rate for Payer: Mclaren Medicaid	$2,266.42
Rate for Payer: Meridian Medicaid	$2,379.74
Rate for Payer: PHP Medicaid	$2,266.42
Rate for Payer: Priority Health Choice Medicaid	$2,266.42
Rate for Payer: UHCCP Medicaid	$2,266.42

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$9,001.63

Service Code	APR-DRG 7564
Min. Negotiated Rate	$8,572.98
Max. Negotiated Rate	$9,001.63
Rate for Payer: BCBS Complete	$9,001.63
Rate for Payer: Mclaren Medicaid	$8,572.98
Rate for Payer: Meridian Medicaid	$9,001.63
Rate for Payer: PHP Medicaid	$8,572.98
Rate for Payer: Priority Health Choice Medicaid	$8,572.98
Rate for Payer: UHCCP Medicaid	$8,572.98

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$3,621.34

Service Code	APR-DRG 7562
Min. Negotiated Rate	$3,448.90
Max. Negotiated Rate	$3,621.34
Rate for Payer: BCBS Complete	$3,621.34
Rate for Payer: Mclaren Medicaid	$3,448.90
Rate for Payer: Meridian Medicaid	$3,621.34
Rate for Payer: PHP Medicaid	$3,448.90
Rate for Payer: Priority Health Choice Medicaid	$3,448.90
Rate for Payer: UHCCP Medicaid	$3,448.90

APR-DRG 42.00: ACUTE ANXIETY AND STRESS SYNDROMES

Facility

$5,069.88

Service Code	APR-DRG 7563
Min. Negotiated Rate	$4,828.46
Max. Negotiated Rate	$5,069.88
Rate for Payer: BCBS Complete	$5,069.88
Rate for Payer: Mclaren Medicaid	$4,828.46
Rate for Payer: Meridian Medicaid	$5,069.88
Rate for Payer: PHP Medicaid	$4,828.46
Rate for Payer: Priority Health Choice Medicaid	$4,828.46
Rate for Payer: UHCCP Medicaid	$4,828.46

APR-DRG 42.00: ACUTE BRONCHITIS AND RELATED SYMPTOMS

Facility

$2,741.88

Service Code	APR-DRG 1451
Min. Negotiated Rate	$2,611.31
Max. Negotiated Rate	$2,741.88
Rate for Payer: BCBS Complete	$2,741.88
Rate for Payer: Mclaren Medicaid	$2,611.31
Rate for Payer: Meridian Medicaid	$2,741.88
Rate for Payer: PHP Medicaid	$2,611.31
Rate for Payer: Priority Health Choice Medicaid	$2,611.31
Rate for Payer: UHCCP Medicaid	$2,611.31

Know your out-of-pocket cost for care.

All Charges