Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$8,639.64

Service Code	APR-DRG 0593
Min. Negotiated Rate	$7,811.27
Max. Negotiated Rate	$8,639.64
Rate for Payer: BCBS Complete	$8,639.64
Rate for Payer: Mclaren Medicaid	$8,228.23
Rate for Payer: Meridian Medicaid	$8,639.64
Rate for Payer: PHP Medicaid	$7,811.27
Rate for Payer: Priority Health Choice Medicaid	$8,228.23
Rate for Payer: UHC Medicaid	$8,228.23
Rate for Payer: UHCCP Medicaid	$8,228.23

ANOXIC AND OTHER SEVERE BRAIN DAMAGE

Facility

$14,267.88

Service Code	APR-DRG 0594
Min. Negotiated Rate	$12,899.87
Max. Negotiated Rate	$14,267.88
Rate for Payer: BCBS Complete	$14,267.88
Rate for Payer: Mclaren Medicaid	$13,588.46
Rate for Payer: Meridian Medicaid	$14,267.88
Rate for Payer: PHP Medicaid	$12,899.87
Rate for Payer: Priority Health Choice Medicaid	$13,588.46
Rate for Payer: UHC Medicaid	$13,588.46
Rate for Payer: UHCCP Medicaid	$13,588.46

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$7,868.53

Service Code	APR-DRG 5473
Min. Negotiated Rate	$7,114.10
Max. Negotiated Rate	$7,868.53
Rate for Payer: BCBS Complete	$7,868.53
Rate for Payer: Mclaren Medicaid	$7,493.84
Rate for Payer: Meridian Medicaid	$7,868.53
Rate for Payer: PHP Medicaid	$7,114.10
Rate for Payer: Priority Health Choice Medicaid	$7,493.84
Rate for Payer: UHC Medicaid	$7,493.84
Rate for Payer: UHCCP Medicaid	$7,493.84

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$2,741.10

Service Code	APR-DRG 5471
Min. Negotiated Rate	$2,478.28
Max. Negotiated Rate	$2,741.10
Rate for Payer: BCBS Complete	$2,741.10
Rate for Payer: Mclaren Medicaid	$2,610.57
Rate for Payer: Meridian Medicaid	$2,741.10
Rate for Payer: PHP Medicaid	$2,478.28
Rate for Payer: Priority Health Choice Medicaid	$2,610.57
Rate for Payer: UHC Medicaid	$2,610.57
Rate for Payer: UHCCP Medicaid	$2,610.57

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$5,194.46

Service Code	APR-DRG 5472
Min. Negotiated Rate	$4,696.42
Max. Negotiated Rate	$5,194.46
Rate for Payer: BCBS Complete	$5,194.46
Rate for Payer: Mclaren Medicaid	$4,947.11
Rate for Payer: Meridian Medicaid	$5,194.46
Rate for Payer: PHP Medicaid	$4,696.42
Rate for Payer: Priority Health Choice Medicaid	$4,947.11
Rate for Payer: UHC Medicaid	$4,947.11
Rate for Payer: UHCCP Medicaid	$4,947.11

ANTEPARTUM WITH O.R. PROCEDURE

Facility

$15,012.83

Service Code	APR-DRG 5474
Min. Negotiated Rate	$13,573.39
Max. Negotiated Rate	$15,012.83
Rate for Payer: BCBS Complete	$15,012.83
Rate for Payer: Mclaren Medicaid	$14,297.93
Rate for Payer: Meridian Medicaid	$15,012.83
Rate for Payer: PHP Medicaid	$13,573.39
Rate for Payer: Priority Health Choice Medicaid	$14,297.93
Rate for Payer: UHC Medicaid	$14,297.93
Rate for Payer: UHCCP Medicaid	$14,297.93

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$2,752.00

Service Code	APR-DRG 5662
Min. Negotiated Rate	$2,488.14
Max. Negotiated Rate	$2,752.00
Rate for Payer: BCBS Complete	$2,752.00
Rate for Payer: Mclaren Medicaid	$2,620.95
Rate for Payer: Meridian Medicaid	$2,752.00
Rate for Payer: PHP Medicaid	$2,488.14
Rate for Payer: Priority Health Choice Medicaid	$2,620.95
Rate for Payer: UHC Medicaid	$2,620.95
Rate for Payer: UHCCP Medicaid	$2,620.95

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$9,251.62

Service Code	APR-DRG 5664
Min. Negotiated Rate	$8,364.57
Max. Negotiated Rate	$9,251.62
Rate for Payer: BCBS Complete	$9,251.62
Rate for Payer: Mclaren Medicaid	$8,811.06
Rate for Payer: Meridian Medicaid	$9,251.62
Rate for Payer: PHP Medicaid	$8,364.57
Rate for Payer: Priority Health Choice Medicaid	$8,811.06
Rate for Payer: UHC Medicaid	$8,811.06
Rate for Payer: UHCCP Medicaid	$8,811.06

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$4,834.80

Service Code	APR-DRG 5663
Min. Negotiated Rate	$4,371.23
Max. Negotiated Rate	$4,834.80
Rate for Payer: BCBS Complete	$4,834.80
Rate for Payer: Mclaren Medicaid	$4,604.57
Rate for Payer: Meridian Medicaid	$4,834.80
Rate for Payer: PHP Medicaid	$4,371.23
Rate for Payer: Priority Health Choice Medicaid	$4,604.57
Rate for Payer: UHC Medicaid	$4,604.57
Rate for Payer: UHCCP Medicaid	$4,604.57

ANTEPARTUM WITHOUT O.R. PROCEDURE

Facility

$1,917.13

Service Code	APR-DRG 5661
Min. Negotiated Rate	$1,733.32
Max. Negotiated Rate	$1,917.13
Rate for Payer: BCBS Complete	$1,917.13
Rate for Payer: Mclaren Medicaid	$1,825.84
Rate for Payer: Meridian Medicaid	$1,917.13
Rate for Payer: PHP Medicaid	$1,733.32
Rate for Payer: Priority Health Choice Medicaid	$1,825.84
Rate for Payer: UHC Medicaid	$1,825.84
Rate for Payer: UHCCP Medicaid	$1,825.84

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION

Facility

$3.46

Service Code	HCPCS J7192
Hospital Charge Code	78225
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: Aetna Medicare	$1.57
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.96
Rate for Payer: Amish Plain Church Group Commercial	$1.96
Rate for Payer: ASR ASR	$3.35
Rate for Payer: BCBS Complete	$0.86
Rate for Payer: BCBS MAPPO	$1.57
Rate for Payer: BCBS Trust/PPO	$2.85
Rate for Payer: BCN Commercial	$2.85
Rate for Payer: BCN Medicare Advantage	$1.57
Rate for Payer: Cash Price	$2.76
Rate for Payer: Cash Price	$2.76
Rate for Payer: Cofinity Commercial	$3.25
Rate for Payer: Encore Health Key Benefits Commercial	$2.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.57
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Healthscope Whirlpool	$3.46
Rate for Payer: Humana Choice PPO Medicare	$1.57
Rate for Payer: Mclaren Commercial	$3.11
Rate for Payer: Mclaren Medicaid	$1.57
Rate for Payer: Mclaren Medicare	$1.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.65
Rate for Payer: Meridian Medicaid	$0.86
Rate for Payer: MI Amish Medical Board Commercial	$1.81
Rate for Payer: Molina Medicare/Medicaid	$1.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.94
Rate for Payer: Nomi Health Commercial	$2.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.59
Rate for Payer: PACE Medicare	$1.49
Rate for Payer: PACE SWMI	$1.57
Rate for Payer: PHP Commercial	$1.73
Rate for Payer: PHP Medicaid	$0.84
Rate for Payer: PHP Medicare Advantage	$1.57
Rate for Payer: Priority Health Choice Medicaid	$0.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.65
Rate for Payer: Priority Health Medicare	$1.57
Rate for Payer: Priority Health Narrow Network	$1.32
Rate for Payer: Railroad Medicare Medicare	$1.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1.57
Rate for Payer: UHC Exchange	$2.43
Rate for Payer: UHC Medicaid	$0.82
Rate for Payer: UHCCP DNSP	$1.57
Rate for Payer: UHCCP Medicaid	$0.82
Rate for Payer: VA VA	$1.57

ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION

Facility

$3.46

Service Code	HCPCS J7192
Hospital Charge Code	78225
Hospital Revenue Code	636
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: ASR ASR	$3.35
Rate for Payer: BCBS Trust/PPO	$2.84
Rate for Payer: BCN Commercial	$2.84
Rate for Payer: Cash Price	$2.76
Rate for Payer: Cofinity Commercial	$3.25
Rate for Payer: Encore Health Key Benefits Commercial	$2.76
Rate for Payer: Healthscope Commercial	$3.35
Rate for Payer: Healthscope Whirlpool	$3.46
Rate for Payer: Mclaren Commercial	$3.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.94
Rate for Payer: Nomi Health Commercial	$2.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.04

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC

Facility

$94,494.09

Service Code	MSDRG 268
Min. Negotiated Rate	$48,719.71
Max. Negotiated Rate	$94,494.09
Rate for Payer: Aetna Medicare	$51,283.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$64,104.88
Rate for Payer: Amish Plain Church Group Commercial	$64,104.88
Rate for Payer: BCBS MAPPO	$51,283.90
Rate for Payer: BCN Medicare Advantage	$51,283.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$51,283.90
Rate for Payer: Humana Choice PPO Medicare	$51,283.90
Rate for Payer: Mclaren Medicare	$51,283.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$53,848.10
Rate for Payer: MI Amish Medical Board Commercial	$58,976.49
Rate for Payer: Molina Medicare/Medicaid	$56,412.29
Rate for Payer: PACE Medicare	$48,719.71
Rate for Payer: PACE SWMI	$51,283.90
Rate for Payer: PHP Commercial	$56,412.29
Rate for Payer: PHP Medicare Advantage	$51,283.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$94,494.09
Rate for Payer: Priority Health Medicare	$51,283.90
Rate for Payer: Priority Health Narrow Network	$75,595.27
Rate for Payer: Railroad Medicare Medicare	$51,283.90
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$51,283.90
Rate for Payer: UHC Exchange	$79,490.04
Rate for Payer: UHCCP DNSP	$51,283.90
Rate for Payer: VA VA	$51,283.90

AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC

Facility

$58,021.70

Service Code	MSDRG 269
Min. Negotiated Rate	$30,558.42
Max. Negotiated Rate	$58,021.70
Rate for Payer: Aetna Medicare	$32,166.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$40,208.45
Rate for Payer: Amish Plain Church Group Commercial	$40,208.45
Rate for Payer: BCBS MAPPO	$32,166.76
Rate for Payer: BCN Medicare Advantage	$32,166.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$32,166.76
Rate for Payer: Humana Choice PPO Medicare	$32,166.76
Rate for Payer: Mclaren Medicare	$32,166.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$33,775.10
Rate for Payer: MI Amish Medical Board Commercial	$36,991.77
Rate for Payer: Molina Medicare/Medicaid	$35,383.44
Rate for Payer: PACE Medicare	$30,558.42
Rate for Payer: PACE SWMI	$32,166.76
Rate for Payer: PHP Commercial	$35,383.44
Rate for Payer: PHP Medicare Advantage	$32,166.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$58,021.70
Rate for Payer: Priority Health Medicare	$32,166.76
Rate for Payer: Priority Health Narrow Network	$46,417.36
Rate for Payer: Railroad Medicare Medicare	$32,166.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$32,166.76
Rate for Payer: UHC Exchange	$49,858.48
Rate for Payer: UHCCP DNSP	$32,166.76
Rate for Payer: VA VA	$32,166.76

APIXABAN 5 MG TABLET

Facility

$1,234.32

Service Code	NDC 3089421
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$456.70
Max. Negotiated Rate	$1,234.32
Rate for Payer: Aetna Commercial	$1,110.89
Rate for Payer: Aetna Medicare	$456.70
Rate for Payer: ASR ASR	$1,197.29
Rate for Payer: BCBS Complete	$493.73
Rate for Payer: BCBS Trust/PPO	$1,017.70
Rate for Payer: BCN Commercial	$1,017.70
Rate for Payer: Cash Price	$987.46
Rate for Payer: Cofinity Commercial	$1,160.26
Rate for Payer: Encore Health Key Benefits Commercial	$987.46
Rate for Payer: Healthscope Commercial	$1,197.29
Rate for Payer: Healthscope Whirlpool	$1,234.32
Rate for Payer: Mclaren Commercial	$1,110.89
Rate for Payer: MI Amish Medical Board Commercial	$987.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,049.17
Rate for Payer: Nomi Health Commercial	$1,012.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$925.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,081.51
Rate for Payer: Priority Health Narrow Network	$865.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,086.20

APIXABAN 5 MG TABLET

Facility

$1,234.32

Service Code	NDC 3089421
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$925.74
Max. Negotiated Rate	$1,234.32
Rate for Payer: Aetna Commercial	$1,110.89
Rate for Payer: ASR ASR	$1,197.29
Rate for Payer: BCBS Trust/PPO	$1,013.62
Rate for Payer: BCN Commercial	$1,013.62
Rate for Payer: Cash Price	$987.46
Rate for Payer: Cofinity Commercial	$1,160.26
Rate for Payer: Encore Health Key Benefits Commercial	$987.46
Rate for Payer: Healthscope Commercial	$1,197.29
Rate for Payer: Healthscope Whirlpool	$1,234.32
Rate for Payer: Mclaren Commercial	$1,110.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,049.17
Rate for Payer: Nomi Health Commercial	$1,012.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$925.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,086.20

APIXABAN 5 MG TABLET

Facility

$2,057.20

Service Code	NDC 3089431
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$761.16
Max. Negotiated Rate	$2,057.20
Rate for Payer: Aetna Commercial	$1,851.48
Rate for Payer: Aetna Medicare	$761.16
Rate for Payer: ASR ASR	$1,995.48
Rate for Payer: BCBS Complete	$822.88
Rate for Payer: BCBS Trust/PPO	$1,696.16
Rate for Payer: BCN Commercial	$1,696.16
Rate for Payer: Cash Price	$1,645.76
Rate for Payer: Cofinity Commercial	$1,933.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,645.76
Rate for Payer: Healthscope Commercial	$1,995.48
Rate for Payer: Healthscope Whirlpool	$2,057.20
Rate for Payer: Mclaren Commercial	$1,851.48
Rate for Payer: MI Amish Medical Board Commercial	$1,645.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,748.62
Rate for Payer: Nomi Health Commercial	$1,686.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,542.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,802.52
Rate for Payer: Priority Health Narrow Network	$1,442.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,810.34

APIXABAN 5 MG TABLET

Facility

$2,057.20

Service Code	NDC 3089431
Hospital Charge Code	164098
Hospital Revenue Code	637
Min. Negotiated Rate	$1,542.90
Max. Negotiated Rate	$2,057.20
Rate for Payer: Aetna Commercial	$1,851.48
Rate for Payer: ASR ASR	$1,995.48
Rate for Payer: BCBS Trust/PPO	$1,689.37
Rate for Payer: BCN Commercial	$1,689.37
Rate for Payer: Cash Price	$1,645.76
Rate for Payer: Cofinity Commercial	$1,933.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,645.76
Rate for Payer: Healthscope Commercial	$1,995.48
Rate for Payer: Healthscope Whirlpool	$2,057.20
Rate for Payer: Mclaren Commercial	$1,851.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,748.62
Rate for Payer: Nomi Health Commercial	$1,686.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,542.90
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,810.34

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$7,776.44

Service Code	APR-DRG 2332
Min. Negotiated Rate	$7,030.83
Max. Negotiated Rate	$7,776.44
Rate for Payer: BCBS Complete	$7,776.44
Rate for Payer: Mclaren Medicaid	$7,406.13
Rate for Payer: Meridian Medicaid	$7,776.44
Rate for Payer: PHP Medicaid	$7,030.83
Rate for Payer: Priority Health Choice Medicaid	$7,406.13
Rate for Payer: UHC Medicaid	$7,406.13
Rate for Payer: UHCCP Medicaid	$7,406.13

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$11,974.73

Service Code	APR-DRG 2333
Min. Negotiated Rate	$10,826.59
Max. Negotiated Rate	$11,974.73
Rate for Payer: BCBS Complete	$11,974.73
Rate for Payer: Mclaren Medicaid	$11,404.51
Rate for Payer: Meridian Medicaid	$11,974.73
Rate for Payer: PHP Medicaid	$10,826.59
Rate for Payer: Priority Health Choice Medicaid	$11,404.51
Rate for Payer: UHC Medicaid	$11,404.51
Rate for Payer: UHCCP Medicaid	$11,404.51

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$6,189.00

Service Code	APR-DRG 2331
Min. Negotiated Rate	$5,595.59
Max. Negotiated Rate	$6,189.00
Rate for Payer: BCBS Complete	$6,189.00
Rate for Payer: Mclaren Medicaid	$5,894.28
Rate for Payer: Meridian Medicaid	$6,189.00
Rate for Payer: PHP Medicaid	$5,595.59
Rate for Payer: Priority Health Choice Medicaid	$5,894.28
Rate for Payer: UHC Medicaid	$5,894.28
Rate for Payer: UHCCP Medicaid	$5,894.28

APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS

Facility

$19,310.85

Service Code	APR-DRG 2334
Min. Negotiated Rate	$17,459.32
Max. Negotiated Rate	$19,310.85
Rate for Payer: BCBS Complete	$19,310.85
Rate for Payer: Mclaren Medicaid	$18,391.28
Rate for Payer: Meridian Medicaid	$19,310.85
Rate for Payer: PHP Medicaid	$17,459.32
Rate for Payer: Priority Health Choice Medicaid	$18,391.28
Rate for Payer: UHC Medicaid	$18,391.28
Rate for Payer: UHCCP Medicaid	$18,391.28

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$5,902.35

Service Code	APR-DRG 2341
Min. Negotiated Rate	$5,336.43
Max. Negotiated Rate	$5,902.35
Rate for Payer: BCBS Complete	$5,902.35
Rate for Payer: Mclaren Medicaid	$5,621.29
Rate for Payer: Meridian Medicaid	$5,902.35
Rate for Payer: PHP Medicaid	$5,336.43
Rate for Payer: Priority Health Choice Medicaid	$5,621.29
Rate for Payer: UHC Medicaid	$5,621.29
Rate for Payer: UHCCP Medicaid	$5,621.29

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$7,200.97

Service Code	APR-DRG 2342
Min. Negotiated Rate	$6,510.54
Max. Negotiated Rate	$7,200.97
Rate for Payer: BCBS Complete	$7,200.97
Rate for Payer: Mclaren Medicaid	$6,858.07
Rate for Payer: Meridian Medicaid	$7,200.97
Rate for Payer: PHP Medicaid	$6,510.54
Rate for Payer: Priority Health Choice Medicaid	$6,858.07
Rate for Payer: UHC Medicaid	$6,858.07
Rate for Payer: UHCCP Medicaid	$6,858.07

APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS

Facility

$11,188.91

Service Code	APR-DRG 2343
Min. Negotiated Rate	$10,116.12
Max. Negotiated Rate	$11,188.91
Rate for Payer: BCBS Complete	$11,188.91
Rate for Payer: Mclaren Medicaid	$10,656.11
Rate for Payer: Meridian Medicaid	$11,188.91
Rate for Payer: PHP Medicaid	$10,116.12
Rate for Payer: Priority Health Choice Medicaid	$10,656.11
Rate for Payer: UHC Medicaid	$10,656.11
Rate for Payer: UHCCP Medicaid	$10,656.11

Know your out-of-pocket cost for care.

All Charges