Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

GYNECOLOGIC PROCEDURES FOR LEIOMYOMA

Facility

$9,046.71

Service Code	APR-DRG 5192
Min. Negotiated Rate	$8,179.31
Max. Negotiated Rate	$9,046.71
Rate for Payer: BCBS Complete	$9,046.71
Rate for Payer: Mclaren Medicaid	$8,615.92
Rate for Payer: Meridian Medicaid	$9,046.71
Rate for Payer: PHP Medicaid	$8,179.31
Rate for Payer: Priority Health Choice Medicaid	$8,615.92
Rate for Payer: UHC Medicaid	$8,615.92
Rate for Payer: UHCCP Medicaid	$8,615.92

GYNECOLOGIC PROCEDURES FOR LEIOMYOMA

Facility

$6,573.19

Service Code	APR-DRG 5191
Min. Negotiated Rate	$5,942.95
Max. Negotiated Rate	$6,573.19
Rate for Payer: BCBS Complete	$6,573.19
Rate for Payer: Mclaren Medicaid	$6,260.18
Rate for Payer: Meridian Medicaid	$6,573.19
Rate for Payer: PHP Medicaid	$5,942.95
Rate for Payer: Priority Health Choice Medicaid	$6,260.18
Rate for Payer: UHC Medicaid	$6,260.18
Rate for Payer: UHCCP Medicaid	$6,260.18

GYNECOLOGIC PROCEDURES FOR LEIOMYOMA

Facility

$13,487.51

Service Code	APR-DRG 5193
Min. Negotiated Rate	$12,194.33
Max. Negotiated Rate	$13,487.51
Rate for Payer: BCBS Complete	$13,487.51
Rate for Payer: Mclaren Medicaid	$12,845.25
Rate for Payer: Meridian Medicaid	$13,487.51
Rate for Payer: PHP Medicaid	$12,194.33
Rate for Payer: Priority Health Choice Medicaid	$12,845.25
Rate for Payer: UHC Medicaid	$12,845.25
Rate for Payer: UHCCP Medicaid	$12,845.25

GYNECOLOGIC PROCEDURES FOR LEIOMYOMA

Facility

$21,421.44

Service Code	APR-DRG 5194
Min. Negotiated Rate	$19,367.54
Max. Negotiated Rate	$21,421.44
Rate for Payer: BCBS Complete	$21,421.44
Rate for Payer: Mclaren Medicaid	$20,401.37
Rate for Payer: Meridian Medicaid	$21,421.44
Rate for Payer: PHP Medicaid	$19,367.54
Rate for Payer: Priority Health Choice Medicaid	$20,401.37
Rate for Payer: UHC Medicaid	$20,401.37
Rate for Payer: UHCCP Medicaid	$20,401.37

GYNECOLOGIC PROCEDURES FOR MALIGNANCY

Facility

$9,973.67

Service Code	APR-DRG 5112
Min. Negotiated Rate	$9,017.40
Max. Negotiated Rate	$9,973.67
Rate for Payer: BCBS Complete	$9,973.67
Rate for Payer: Mclaren Medicaid	$9,498.74
Rate for Payer: Meridian Medicaid	$9,973.67
Rate for Payer: PHP Medicaid	$9,017.40
Rate for Payer: Priority Health Choice Medicaid	$9,498.74
Rate for Payer: UHC Medicaid	$9,498.74
Rate for Payer: UHCCP Medicaid	$9,498.74

GYNECOLOGIC PROCEDURES FOR MALIGNANCY

Facility

$25,194.67

Service Code	APR-DRG 5114
Min. Negotiated Rate	$22,779.00
Max. Negotiated Rate	$25,194.67
Rate for Payer: BCBS Complete	$25,194.67
Rate for Payer: Mclaren Medicaid	$23,994.93
Rate for Payer: Meridian Medicaid	$25,194.67
Rate for Payer: PHP Medicaid	$22,779.00
Rate for Payer: Priority Health Choice Medicaid	$23,994.93
Rate for Payer: UHC Medicaid	$23,994.93
Rate for Payer: UHCCP Medicaid	$23,994.93

GYNECOLOGIC PROCEDURES FOR MALIGNANCY

Facility

$7,497.97

Service Code	APR-DRG 5111
Min. Negotiated Rate	$6,779.06
Max. Negotiated Rate	$7,497.97
Rate for Payer: BCBS Complete	$7,497.97
Rate for Payer: Mclaren Medicaid	$7,140.92
Rate for Payer: Meridian Medicaid	$7,497.97
Rate for Payer: PHP Medicaid	$6,779.06
Rate for Payer: Priority Health Choice Medicaid	$7,140.92
Rate for Payer: UHC Medicaid	$7,140.92
Rate for Payer: UHCCP Medicaid	$7,140.92

GYNECOLOGIC PROCEDURES FOR MALIGNANCY

Facility

$14,298.94

Service Code	APR-DRG 5113
Min. Negotiated Rate	$12,927.96
Max. Negotiated Rate	$14,298.94
Rate for Payer: BCBS Complete	$14,298.94
Rate for Payer: Mclaren Medicaid	$13,618.04
Rate for Payer: Meridian Medicaid	$14,298.94
Rate for Payer: PHP Medicaid	$12,927.96
Rate for Payer: Priority Health Choice Medicaid	$13,618.04
Rate for Payer: UHC Medicaid	$13,618.04
Rate for Payer: UHCCP Medicaid	$13,618.04

GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY

Facility

$14,108.76

Service Code	APR-DRG 5133
Min. Negotiated Rate	$12,756.00
Max. Negotiated Rate	$14,108.76
Rate for Payer: BCBS Complete	$14,108.76
Rate for Payer: Mclaren Medicaid	$13,436.91
Rate for Payer: Meridian Medicaid	$14,108.76
Rate for Payer: PHP Medicaid	$12,756.00
Rate for Payer: Priority Health Choice Medicaid	$13,436.91
Rate for Payer: UHC Medicaid	$13,436.91
Rate for Payer: UHCCP Medicaid	$13,436.91

GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY

Facility

$7,155.74

Service Code	APR-DRG 5131
Min. Negotiated Rate	$6,469.64
Max. Negotiated Rate	$7,155.74
Rate for Payer: BCBS Complete	$7,155.74
Rate for Payer: Mclaren Medicaid	$6,814.99
Rate for Payer: Meridian Medicaid	$7,155.74
Rate for Payer: PHP Medicaid	$6,469.64
Rate for Payer: Priority Health Choice Medicaid	$6,814.99
Rate for Payer: UHC Medicaid	$6,814.99
Rate for Payer: UHCCP Medicaid	$6,814.99

GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY

Facility

$9,278.86

Service Code	APR-DRG 5132
Min. Negotiated Rate	$8,389.20
Max. Negotiated Rate	$9,278.86
Rate for Payer: BCBS Complete	$9,278.86
Rate for Payer: Mclaren Medicaid	$8,837.01
Rate for Payer: Meridian Medicaid	$9,278.86
Rate for Payer: PHP Medicaid	$8,389.20
Rate for Payer: Priority Health Choice Medicaid	$8,837.01
Rate for Payer: UHC Medicaid	$8,837.01
Rate for Payer: UHCCP Medicaid	$8,837.01

GYNECOLOGIC PROCEDURES WITHOUT MALIGNANCY

Facility

$28,131.95

Service Code	APR-DRG 5134
Min. Negotiated Rate	$25,434.65
Max. Negotiated Rate	$28,131.95
Rate for Payer: BCBS Complete	$28,131.95
Rate for Payer: Mclaren Medicaid	$26,792.34
Rate for Payer: Meridian Medicaid	$28,131.95
Rate for Payer: PHP Medicaid	$25,434.65
Rate for Payer: Priority Health Choice Medicaid	$26,792.34
Rate for Payer: UHC Medicaid	$26,792.34
Rate for Payer: UHCCP Medicaid	$26,792.34

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN

Facility

$52.93

Service Code	HCPCS 90648
Hospital Charge Code	11931
Hospital Revenue Code	636
Min. Negotiated Rate	$39.70
Max. Negotiated Rate	$52.93
Rate for Payer: Aetna Commercial	$47.64
Rate for Payer: ASR ASR	$51.34
Rate for Payer: BCBS Trust/PPO	$43.47
Rate for Payer: BCN Commercial	$43.47
Rate for Payer: Cash Price	$42.34
Rate for Payer: Cofinity Commercial	$49.75
Rate for Payer: Encore Health Key Benefits Commercial	$42.34
Rate for Payer: Healthscope Commercial	$51.34
Rate for Payer: Healthscope Whirlpool	$52.93
Rate for Payer: Mclaren Commercial	$47.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.99
Rate for Payer: Nomi Health Commercial	$43.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.58

HAEMOPHILUS B POLYSACCHARID CONJ-TETANUS TOX(PF) 10 MCG/0.5 ML IM SOLN

Facility

$52.93

Service Code	HCPCS 90648
Hospital Charge Code	11931
Hospital Revenue Code	636
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$52.93
Rate for Payer: Aetna Commercial	$47.64
Rate for Payer: Aetna Medicare	$19.58
Rate for Payer: ASR ASR	$51.34
Rate for Payer: BCBS Complete	$21.17
Rate for Payer: BCBS Trust/PPO	$43.64
Rate for Payer: BCN Commercial	$43.64
Rate for Payer: Cash Price	$42.34
Rate for Payer: Cash Price	$42.34
Rate for Payer: Cofinity Commercial	$49.75
Rate for Payer: Encore Health Key Benefits Commercial	$42.34
Rate for Payer: Healthscope Commercial	$51.34
Rate for Payer: Healthscope Whirlpool	$52.93
Rate for Payer: Mclaren Commercial	$47.64
Rate for Payer: MI Amish Medical Board Commercial	$42.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.99
Rate for Payer: Nomi Health Commercial	$43.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14.87
Rate for Payer: Priority Health Narrow Network	$11.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$46.58

HAIR REMOVAL

Professional

Both

$84.00

Hospital Revenue Code	960
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$63.00
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00

HALOPERIDOL 0.5 MG TABLET

Facility

$271.70

Service Code	NDC 51079073320
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$203.78
Max. Negotiated Rate	$271.70
Rate for Payer: Aetna Commercial	$244.53
Rate for Payer: ASR ASR	$263.55
Rate for Payer: BCBS Trust/PPO	$223.12
Rate for Payer: BCN Commercial	$223.12
Rate for Payer: Cash Price	$217.36
Rate for Payer: Cofinity Commercial	$255.40
Rate for Payer: Encore Health Key Benefits Commercial	$217.36
Rate for Payer: Healthscope Commercial	$263.55
Rate for Payer: Healthscope Whirlpool	$271.70
Rate for Payer: Mclaren Commercial	$244.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.94
Rate for Payer: Nomi Health Commercial	$222.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$239.10

HALOPERIDOL 0.5 MG TABLET

Facility

$2.72

Service Code	NDC 51079073301
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna Medicare	$1.01
Rate for Payer: ASR ASR	$2.64
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: BCBS Trust/PPO	$2.24
Rate for Payer: BCN Commercial	$2.24
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.64
Rate for Payer: Healthscope Whirlpool	$2.72
Rate for Payer: Mclaren Commercial	$2.45
Rate for Payer: MI Amish Medical Board Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Nomi Health Commercial	$2.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.38
Rate for Payer: Priority Health Narrow Network	$1.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.39

HALOPERIDOL 0.5 MG TABLET

Facility

$236.55

Service Code	NDC 904738961
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$87.52
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$212.90
Rate for Payer: Aetna Medicare	$87.52
Rate for Payer: ASR ASR	$229.45
Rate for Payer: BCBS Complete	$94.62
Rate for Payer: BCBS Trust/PPO	$195.04
Rate for Payer: BCN Commercial	$195.04
Rate for Payer: Cash Price	$189.24
Rate for Payer: Cofinity Commercial	$222.36
Rate for Payer: Encore Health Key Benefits Commercial	$189.24
Rate for Payer: Healthscope Commercial	$229.45
Rate for Payer: Healthscope Whirlpool	$236.55
Rate for Payer: Mclaren Commercial	$212.90
Rate for Payer: MI Amish Medical Board Commercial	$189.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$201.07
Rate for Payer: Nomi Health Commercial	$193.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$207.27
Rate for Payer: Priority Health Narrow Network	$165.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$208.16

HALOPERIDOL 0.5 MG TABLET

Facility

$271.70

Service Code	NDC 51079073320
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$100.53
Max. Negotiated Rate	$271.70
Rate for Payer: Aetna Commercial	$244.53
Rate for Payer: Aetna Medicare	$100.53
Rate for Payer: ASR ASR	$263.55
Rate for Payer: BCBS Complete	$108.68
Rate for Payer: BCBS Trust/PPO	$224.02
Rate for Payer: BCN Commercial	$224.02
Rate for Payer: Cash Price	$217.36
Rate for Payer: Cofinity Commercial	$255.40
Rate for Payer: Encore Health Key Benefits Commercial	$217.36
Rate for Payer: Healthscope Commercial	$263.55
Rate for Payer: Healthscope Whirlpool	$271.70
Rate for Payer: Mclaren Commercial	$244.53
Rate for Payer: MI Amish Medical Board Commercial	$217.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$230.94
Rate for Payer: Nomi Health Commercial	$222.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$238.06
Rate for Payer: Priority Health Narrow Network	$190.46
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$239.10

HALOPERIDOL 0.5 MG TABLET

Facility

$236.55

Service Code	NDC 904738961
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$177.41
Max. Negotiated Rate	$236.55
Rate for Payer: Aetna Commercial	$212.90
Rate for Payer: ASR ASR	$229.45
Rate for Payer: BCBS Trust/PPO	$194.25
Rate for Payer: BCN Commercial	$194.25
Rate for Payer: Cash Price	$189.24
Rate for Payer: Cofinity Commercial	$222.36
Rate for Payer: Encore Health Key Benefits Commercial	$189.24
Rate for Payer: Healthscope Commercial	$229.45
Rate for Payer: Healthscope Whirlpool	$236.55
Rate for Payer: Mclaren Commercial	$212.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$201.07
Rate for Payer: Nomi Health Commercial	$193.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$208.16

HALOPERIDOL 0.5 MG TABLET

Facility

$2.72

Service Code	NDC 51079073301
Hospital Charge Code	3578
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$2.72
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: ASR ASR	$2.64
Rate for Payer: BCBS Trust/PPO	$2.23
Rate for Payer: BCN Commercial	$2.23
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.64
Rate for Payer: Healthscope Whirlpool	$2.72
Rate for Payer: Mclaren Commercial	$2.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.31
Rate for Payer: Nomi Health Commercial	$2.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.39

HALOPERIDOL 5 MG TABLET

Facility

$375.36

Service Code	NDC 904678261
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$138.88
Max. Negotiated Rate	$375.36
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: Aetna Medicare	$138.88
Rate for Payer: ASR ASR	$364.10
Rate for Payer: BCBS Complete	$150.14
Rate for Payer: BCBS Trust/PPO	$309.48
Rate for Payer: BCN Commercial	$309.48
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$352.84
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$364.10
Rate for Payer: Healthscope Whirlpool	$375.36
Rate for Payer: Mclaren Commercial	$337.82
Rate for Payer: MI Amish Medical Board Commercial	$300.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: Nomi Health Commercial	$307.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$281.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$328.89
Rate for Payer: Priority Health Narrow Network	$263.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.32

HALOPERIDOL 5 MG TABLET

Facility

$2.71

Service Code	NDC 51079073601
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: ASR ASR	$2.63
Rate for Payer: BCBS Trust/PPO	$2.22
Rate for Payer: BCN Commercial	$2.22
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Healthscope Whirlpool	$2.71
Rate for Payer: Mclaren Commercial	$2.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.30
Rate for Payer: Nomi Health Commercial	$2.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.03
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.38

HALOPERIDOL 5 MG TABLET

Facility

$2.71

Service Code	NDC 51079073601
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$2.71
Rate for Payer: Aetna Commercial	$2.44
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: ASR ASR	$2.63
Rate for Payer: BCBS Complete	$1.08
Rate for Payer: BCBS Trust/PPO	$2.23
Rate for Payer: BCN Commercial	$2.23
Rate for Payer: Cash Price	$2.17
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.17
Rate for Payer: Healthscope Commercial	$2.63
Rate for Payer: Healthscope Whirlpool	$2.71
Rate for Payer: Mclaren Commercial	$2.44
Rate for Payer: MI Amish Medical Board Commercial	$2.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.30
Rate for Payer: Nomi Health Commercial	$2.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2.37
Rate for Payer: Priority Health Narrow Network	$1.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.38

HALOPERIDOL 5 MG TABLET

Facility

$375.36

Service Code	NDC 904678261
Hospital Charge Code	3583
Hospital Revenue Code	637
Min. Negotiated Rate	$281.52
Max. Negotiated Rate	$375.36
Rate for Payer: Aetna Commercial	$337.82
Rate for Payer: ASR ASR	$364.10
Rate for Payer: BCBS Trust/PPO	$308.25
Rate for Payer: BCN Commercial	$308.25
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$352.84
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$364.10
Rate for Payer: Healthscope Whirlpool	$375.36
Rate for Payer: Mclaren Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: Nomi Health Commercial	$307.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$281.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$330.32

Know your out-of-pocket cost for care.

All Charges