Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

BENZONATATE 100 MG CAPSULE

Facility

$335.35

Service Code	NDC 904715361
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$124.08
Max. Negotiated Rate	$335.35
Rate for Payer: Aetna Commercial	$301.81
Rate for Payer: Aetna Medicare	$124.08
Rate for Payer: ASR ASR	$325.29
Rate for Payer: BCBS Complete	$134.14
Rate for Payer: BCBS Trust/PPO	$276.50
Rate for Payer: BCN Commercial	$276.50
Rate for Payer: Cash Price	$268.28
Rate for Payer: Cofinity Commercial	$315.23
Rate for Payer: Encore Health Key Benefits Commercial	$268.28
Rate for Payer: Healthscope Commercial	$325.29
Rate for Payer: Healthscope Whirlpool	$335.35
Rate for Payer: Mclaren Commercial	$301.81
Rate for Payer: MI Amish Medical Board Commercial	$268.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.05
Rate for Payer: Nomi Health Commercial	$274.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$251.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$293.83
Rate for Payer: Priority Health Narrow Network	$235.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$295.11

BENZONATATE 100 MG CAPSULE

Facility

$3.70

Service Code	NDC 68084021411
Hospital Charge Code	988
Hospital Revenue Code	637
Min. Negotiated Rate	$1.37
Max. Negotiated Rate	$3.70
Rate for Payer: Aetna Commercial	$3.33
Rate for Payer: Aetna Medicare	$1.37
Rate for Payer: ASR ASR	$3.59
Rate for Payer: BCBS Complete	$1.48
Rate for Payer: BCBS Trust/PPO	$3.05
Rate for Payer: BCN Commercial	$3.05
Rate for Payer: Cash Price	$2.96
Rate for Payer: Cofinity Commercial	$3.47
Rate for Payer: Encore Health Key Benefits Commercial	$2.96
Rate for Payer: Healthscope Commercial	$3.59
Rate for Payer: Healthscope Whirlpool	$3.70
Rate for Payer: Mclaren Commercial	$3.33
Rate for Payer: MI Amish Medical Board Commercial	$2.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: Nomi Health Commercial	$3.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.24
Rate for Payer: Priority Health Narrow Network	$2.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.25

BENZTROPINE 1 MG TABLET

Facility

$287.85

Service Code	NDC 904679061
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$215.89
Max. Negotiated Rate	$287.85
Rate for Payer: Aetna Commercial	$259.06
Rate for Payer: ASR ASR	$279.21
Rate for Payer: BCBS Trust/PPO	$236.38
Rate for Payer: BCN Commercial	$236.38
Rate for Payer: Cash Price	$230.28
Rate for Payer: Cofinity Commercial	$270.58
Rate for Payer: Encore Health Key Benefits Commercial	$230.28
Rate for Payer: Healthscope Commercial	$279.21
Rate for Payer: Healthscope Whirlpool	$287.85
Rate for Payer: Mclaren Commercial	$259.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.67
Rate for Payer: Nomi Health Commercial	$236.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$253.31

BENZTROPINE 1 MG TABLET

Facility

$360.05

Service Code	NDC 904728961
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$270.04
Max. Negotiated Rate	$360.05
Rate for Payer: Aetna Commercial	$324.05
Rate for Payer: ASR ASR	$349.25
Rate for Payer: BCBS Trust/PPO	$295.67
Rate for Payer: BCN Commercial	$295.67
Rate for Payer: Cash Price	$288.04
Rate for Payer: Cofinity Commercial	$338.45
Rate for Payer: Encore Health Key Benefits Commercial	$288.04
Rate for Payer: Healthscope Commercial	$349.25
Rate for Payer: Healthscope Whirlpool	$360.05
Rate for Payer: Mclaren Commercial	$324.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.04
Rate for Payer: Nomi Health Commercial	$295.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$316.84

BENZTROPINE 1 MG TABLET

Facility

$360.05

Service Code	NDC 904728961
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$133.22
Max. Negotiated Rate	$360.05
Rate for Payer: Aetna Commercial	$324.05
Rate for Payer: Aetna Medicare	$133.22
Rate for Payer: ASR ASR	$349.25
Rate for Payer: BCBS Complete	$144.02
Rate for Payer: BCBS Trust/PPO	$296.86
Rate for Payer: BCN Commercial	$296.86
Rate for Payer: Cash Price	$288.04
Rate for Payer: Cofinity Commercial	$338.45
Rate for Payer: Encore Health Key Benefits Commercial	$288.04
Rate for Payer: Healthscope Commercial	$349.25
Rate for Payer: Healthscope Whirlpool	$360.05
Rate for Payer: Mclaren Commercial	$324.05
Rate for Payer: MI Amish Medical Board Commercial	$288.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.04
Rate for Payer: Nomi Health Commercial	$295.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$315.48
Rate for Payer: Priority Health Narrow Network	$252.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$316.84

BENZTROPINE 1 MG TABLET

Facility

$287.85

Service Code	NDC 904679061
Hospital Charge Code	999
Hospital Revenue Code	637
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$287.85
Rate for Payer: Aetna Commercial	$259.06
Rate for Payer: Aetna Medicare	$106.50
Rate for Payer: ASR ASR	$279.21
Rate for Payer: BCBS Complete	$115.14
Rate for Payer: BCBS Trust/PPO	$237.33
Rate for Payer: BCN Commercial	$237.33
Rate for Payer: Cash Price	$230.28
Rate for Payer: Cofinity Commercial	$270.58
Rate for Payer: Encore Health Key Benefits Commercial	$230.28
Rate for Payer: Healthscope Commercial	$279.21
Rate for Payer: Healthscope Whirlpool	$287.85
Rate for Payer: Mclaren Commercial	$259.06
Rate for Payer: MI Amish Medical Board Commercial	$230.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.67
Rate for Payer: Nomi Health Commercial	$236.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$252.21
Rate for Payer: Priority Health Narrow Network	$201.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$253.31

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION

Facility

$198.69

Service Code	HCPCS J0702
Hospital Charge Code	9266
Hospital Revenue Code	636
Min. Negotiated Rate	$5.74
Max. Negotiated Rate	$198.69
Rate for Payer: Aetna Commercial	$178.82
Rate for Payer: Aetna Commercial	$142.34
Rate for Payer: Aetna Medicare	$58.52
Rate for Payer: Aetna Medicare	$73.52
Rate for Payer: ASR ASR	$192.73
Rate for Payer: ASR ASR	$153.41
Rate for Payer: BCBS Complete	$63.26
Rate for Payer: BCBS Complete	$79.48
Rate for Payer: BCBS Trust/PPO	$163.82
Rate for Payer: BCBS Trust/PPO	$130.40
Rate for Payer: BCN Commercial	$130.40
Rate for Payer: BCN Commercial	$163.82
Rate for Payer: Cash Price	$158.95
Rate for Payer: Cash Price	$126.52
Rate for Payer: Cash Price	$158.95
Rate for Payer: Cash Price	$126.52
Rate for Payer: Cofinity Commercial	$148.66
Rate for Payer: Cofinity Commercial	$186.77
Rate for Payer: Encore Health Key Benefits Commercial	$158.95
Rate for Payer: Encore Health Key Benefits Commercial	$126.52
Rate for Payer: Healthscope Commercial	$192.73
Rate for Payer: Healthscope Commercial	$153.41
Rate for Payer: Healthscope Whirlpool	$198.69
Rate for Payer: Healthscope Whirlpool	$158.15
Rate for Payer: Mclaren Commercial	$178.82
Rate for Payer: Mclaren Commercial	$142.34
Rate for Payer: MI Amish Medical Board Commercial	$158.95
Rate for Payer: MI Amish Medical Board Commercial	$126.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.43
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$168.89
Rate for Payer: Nomi Health Commercial	$129.69
Rate for Payer: Nomi Health Commercial	$162.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7.17
Rate for Payer: Priority Health Narrow Network	$5.74
Rate for Payer: Priority Health Narrow Network	$5.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$139.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.85

BETAMETHASONE ACETATE AND SODIUM PHOS 6 MG/ML SUSPENSION FOR INJECTION

Facility

$158.15

Service Code	HCPCS J0702
Hospital Charge Code	9266
Hospital Revenue Code	636
Min. Negotiated Rate	$118.61
Max. Negotiated Rate	$158.15
Rate for Payer: Aetna Commercial	$142.34
Rate for Payer: Aetna Commercial	$178.82
Rate for Payer: ASR ASR	$192.73
Rate for Payer: ASR ASR	$153.41
Rate for Payer: BCBS Trust/PPO	$163.17
Rate for Payer: BCBS Trust/PPO	$129.88
Rate for Payer: BCN Commercial	$163.17
Rate for Payer: BCN Commercial	$129.88
Rate for Payer: Cash Price	$158.95
Rate for Payer: Cash Price	$126.52
Rate for Payer: Cofinity Commercial	$148.66
Rate for Payer: Cofinity Commercial	$186.77
Rate for Payer: Encore Health Key Benefits Commercial	$158.95
Rate for Payer: Encore Health Key Benefits Commercial	$126.52
Rate for Payer: Healthscope Commercial	$153.41
Rate for Payer: Healthscope Commercial	$192.73
Rate for Payer: Healthscope Whirlpool	$198.69
Rate for Payer: Healthscope Whirlpool	$158.15
Rate for Payer: Mclaren Commercial	$178.82
Rate for Payer: Mclaren Commercial	$142.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$168.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.43
Rate for Payer: Nomi Health Commercial	$162.93
Rate for Payer: Nomi Health Commercial	$129.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$149.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$139.17
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$174.85

BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION

Facility

$9,879.90

Service Code	HCPCS J0565
Hospital Charge Code	181631
Hospital Revenue Code	636
Min. Negotiated Rate	$20.83
Max. Negotiated Rate	$9,879.90
Rate for Payer: Aetna Commercial	$8,891.91
Rate for Payer: Aetna Medicare	$39.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$49.79
Rate for Payer: Amish Plain Church Group Commercial	$49.79
Rate for Payer: ASR ASR	$9,583.50
Rate for Payer: BCBS Complete	$21.87
Rate for Payer: BCBS MAPPO	$39.83
Rate for Payer: BCBS Trust/PPO	$8,145.97
Rate for Payer: BCN Commercial	$8,145.97
Rate for Payer: BCN Medicare Advantage	$39.83
Rate for Payer: Cash Price	$7,903.92
Rate for Payer: Cash Price	$7,903.92
Rate for Payer: Cofinity Commercial	$9,287.10
Rate for Payer: Encore Health Key Benefits Commercial	$7,903.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$39.83
Rate for Payer: Healthscope Commercial	$9,583.50
Rate for Payer: Healthscope Whirlpool	$9,879.90
Rate for Payer: Humana Choice PPO Medicare	$39.83
Rate for Payer: Mclaren Commercial	$8,891.91
Rate for Payer: Mclaren Medicaid	$39.83
Rate for Payer: Mclaren Medicare	$39.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$41.82
Rate for Payer: Meridian Medicaid	$21.87
Rate for Payer: MI Amish Medical Board Commercial	$45.80
Rate for Payer: Molina Medicare/Medicaid	$43.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,397.91
Rate for Payer: Nomi Health Commercial	$8,101.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,409.92
Rate for Payer: PACE Medicare	$37.84
Rate for Payer: PACE SWMI	$39.83
Rate for Payer: PHP Commercial	$43.81
Rate for Payer: PHP Medicaid	$21.35
Rate for Payer: PHP Medicare Advantage	$39.83
Rate for Payer: Priority Health Choice Medicaid	$20.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$41.33
Rate for Payer: Priority Health Medicare	$39.83
Rate for Payer: Priority Health Narrow Network	$33.06
Rate for Payer: Railroad Medicare Medicare	$39.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8,694.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$39.83
Rate for Payer: UHC Exchange	$61.74
Rate for Payer: UHC Medicaid	$20.83
Rate for Payer: UHCCP DNSP	$39.83
Rate for Payer: UHCCP Medicaid	$20.83
Rate for Payer: VA VA	$39.83

BEZLOTOXUMAB 25 MG/ML INTRAVENOUS SOLUTION

Facility

$9,879.90

Service Code	HCPCS J0565
Hospital Charge Code	181631
Hospital Revenue Code	636
Min. Negotiated Rate	$7,409.92
Max. Negotiated Rate	$9,879.90
Rate for Payer: Aetna Commercial	$8,891.91
Rate for Payer: ASR ASR	$9,583.50
Rate for Payer: BCBS Trust/PPO	$8,113.37
Rate for Payer: BCN Commercial	$8,113.37
Rate for Payer: Cash Price	$7,903.92
Rate for Payer: Cofinity Commercial	$9,287.10
Rate for Payer: Encore Health Key Benefits Commercial	$7,903.92
Rate for Payer: Healthscope Commercial	$9,583.50
Rate for Payer: Healthscope Whirlpool	$9,879.90
Rate for Payer: Mclaren Commercial	$8,891.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8,397.91
Rate for Payer: Nomi Health Commercial	$8,101.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,409.92
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8,694.31

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC

Facility

$75,879.39

Service Code	MSDRG 461
Min. Negotiated Rate	$39,450.57
Max. Negotiated Rate	$75,879.39
Rate for Payer: Aetna Medicare	$41,526.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$51,908.65
Rate for Payer: Amish Plain Church Group Commercial	$51,908.65
Rate for Payer: BCBS MAPPO	$41,526.92
Rate for Payer: BCN Medicare Advantage	$41,526.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$41,526.92
Rate for Payer: Humana Choice PPO Medicare	$41,526.92
Rate for Payer: Mclaren Medicare	$41,526.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$43,603.27
Rate for Payer: MI Amish Medical Board Commercial	$47,755.96
Rate for Payer: Molina Medicare/Medicaid	$45,679.61
Rate for Payer: PACE Medicare	$39,450.57
Rate for Payer: PACE SWMI	$41,526.92
Rate for Payer: PHP Commercial	$45,679.61
Rate for Payer: PHP Medicare Advantage	$41,526.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$75,879.39
Rate for Payer: Priority Health Medicare	$41,526.92
Rate for Payer: Priority Health Narrow Network	$60,703.51
Rate for Payer: Railroad Medicare Medicare	$41,526.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$41,526.92
Rate for Payer: UHC Exchange	$64,366.73
Rate for Payer: UHCCP DNSP	$41,526.92
Rate for Payer: VA VA	$41,526.92

BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC

Facility

$36,545.21

Service Code	MSDRG 462
Min. Negotiated Rate	$19,864.27
Max. Negotiated Rate	$36,545.21
Rate for Payer: Aetna Medicare	$20,909.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,137.20
Rate for Payer: Amish Plain Church Group Commercial	$26,137.20
Rate for Payer: BCBS MAPPO	$20,909.76
Rate for Payer: BCN Medicare Advantage	$20,909.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,909.76
Rate for Payer: Humana Choice PPO Medicare	$20,909.76
Rate for Payer: Mclaren Medicare	$20,909.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21,955.25
Rate for Payer: MI Amish Medical Board Commercial	$24,046.22
Rate for Payer: Molina Medicare/Medicaid	$23,000.74
Rate for Payer: PACE Medicare	$19,864.27
Rate for Payer: PACE SWMI	$20,909.76
Rate for Payer: PHP Commercial	$23,000.74
Rate for Payer: PHP Medicare Advantage	$20,909.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36,545.21
Rate for Payer: Priority Health Medicare	$20,909.76
Rate for Payer: Priority Health Narrow Network	$29,236.17
Rate for Payer: Railroad Medicare Medicare	$20,909.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$20,909.76
Rate for Payer: UHC Exchange	$32,410.13
Rate for Payer: UHCCP DNSP	$20,909.76
Rate for Payer: VA VA	$20,909.76

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC

Facility

$29,913.49

Service Code	MSDRG 409
Min. Negotiated Rate	$16,562.04
Max. Negotiated Rate	$29,913.49
Rate for Payer: Aetna Medicare	$17,433.73
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,792.16
Rate for Payer: Amish Plain Church Group Commercial	$21,792.16
Rate for Payer: BCBS MAPPO	$17,433.73
Rate for Payer: BCN Medicare Advantage	$17,433.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,433.73
Rate for Payer: Humana Choice PPO Medicare	$17,433.73
Rate for Payer: Mclaren Medicare	$17,433.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,305.42
Rate for Payer: MI Amish Medical Board Commercial	$20,048.79
Rate for Payer: Molina Medicare/Medicaid	$19,177.10
Rate for Payer: PACE Medicare	$16,562.04
Rate for Payer: PACE SWMI	$17,433.73
Rate for Payer: PHP Commercial	$19,177.10
Rate for Payer: PHP Medicare Advantage	$17,433.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$29,913.49
Rate for Payer: Priority Health Medicare	$17,433.73
Rate for Payer: Priority Health Narrow Network	$23,930.79
Rate for Payer: Railroad Medicare Medicare	$17,433.73
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$17,433.73
Rate for Payer: UHC Exchange	$27,022.28
Rate for Payer: UHCCP DNSP	$17,433.73
Rate for Payer: VA VA	$17,433.73

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC

Facility

$48,987.07

Service Code	MSDRG 408
Min. Negotiated Rate	$26,059.66
Max. Negotiated Rate	$48,987.07
Rate for Payer: Aetna Medicare	$27,431.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,289.03
Rate for Payer: Amish Plain Church Group Commercial	$34,289.03
Rate for Payer: BCBS MAPPO	$27,431.22
Rate for Payer: BCN Medicare Advantage	$27,431.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,431.22
Rate for Payer: Humana Choice PPO Medicare	$27,431.22
Rate for Payer: Mclaren Medicare	$27,431.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,802.78
Rate for Payer: MI Amish Medical Board Commercial	$31,545.90
Rate for Payer: Molina Medicare/Medicaid	$30,174.34
Rate for Payer: PACE Medicare	$26,059.66
Rate for Payer: PACE SWMI	$27,431.22
Rate for Payer: PHP Commercial	$30,174.34
Rate for Payer: PHP Medicare Advantage	$27,431.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$48,987.07
Rate for Payer: Priority Health Medicare	$27,431.22
Rate for Payer: Priority Health Narrow Network	$39,189.65
Rate for Payer: Railroad Medicare Medicare	$27,431.22
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,431.22
Rate for Payer: UHC Exchange	$42,518.39
Rate for Payer: UHCCP DNSP	$27,431.22
Rate for Payer: VA VA	$27,431.22

BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$21,813.09

Service Code	MSDRG 410
Min. Negotiated Rate	$12,528.48
Max. Negotiated Rate	$21,813.09
Rate for Payer: Aetna Medicare	$13,187.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,484.84
Rate for Payer: Amish Plain Church Group Commercial	$16,484.84
Rate for Payer: BCBS MAPPO	$13,187.87
Rate for Payer: BCN Medicare Advantage	$13,187.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,187.87
Rate for Payer: Humana Choice PPO Medicare	$13,187.87
Rate for Payer: Mclaren Medicare	$13,187.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,847.26
Rate for Payer: MI Amish Medical Board Commercial	$15,166.05
Rate for Payer: Molina Medicare/Medicaid	$14,506.66
Rate for Payer: PACE Medicare	$12,528.48
Rate for Payer: PACE SWMI	$13,187.87
Rate for Payer: PHP Commercial	$14,506.66
Rate for Payer: PHP Medicare Advantage	$13,187.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,813.09
Rate for Payer: Priority Health Medicare	$13,187.87
Rate for Payer: Priority Health Narrow Network	$17,450.47
Rate for Payer: Railroad Medicare Medicare	$13,187.87
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,187.87
Rate for Payer: UHC Exchange	$20,441.20
Rate for Payer: UHCCP DNSP	$13,187.87
Rate for Payer: VA VA	$13,187.87

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC

Facility

$33,786.46

Service Code	MSDRG 478
Min. Negotiated Rate	$18,490.56
Max. Negotiated Rate	$33,786.46
Rate for Payer: Aetna Medicare	$19,463.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,329.69
Rate for Payer: Amish Plain Church Group Commercial	$24,329.69
Rate for Payer: BCBS MAPPO	$19,463.75
Rate for Payer: BCN Medicare Advantage	$19,463.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,463.75
Rate for Payer: Humana Choice PPO Medicare	$19,463.75
Rate for Payer: Mclaren Medicare	$19,463.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20,436.94
Rate for Payer: MI Amish Medical Board Commercial	$22,383.31
Rate for Payer: Molina Medicare/Medicaid	$21,410.12
Rate for Payer: PACE Medicare	$18,490.56
Rate for Payer: PACE SWMI	$19,463.75
Rate for Payer: PHP Commercial	$21,410.12
Rate for Payer: PHP Medicare Advantage	$19,463.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$33,786.46
Rate for Payer: Priority Health Medicare	$19,463.75
Rate for Payer: Priority Health Narrow Network	$27,029.17
Rate for Payer: Railroad Medicare Medicare	$19,463.75
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$19,463.75
Rate for Payer: UHC Exchange	$30,168.81
Rate for Payer: UHCCP DNSP	$19,463.75
Rate for Payer: VA VA	$19,463.75

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC

Facility

$47,462.06

Service Code	MSDRG 477
Min. Negotiated Rate	$25,300.29
Max. Negotiated Rate	$47,462.06
Rate for Payer: Aetna Medicare	$26,631.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,289.85
Rate for Payer: Amish Plain Church Group Commercial	$33,289.85
Rate for Payer: BCBS MAPPO	$26,631.88
Rate for Payer: BCN Medicare Advantage	$26,631.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,631.88
Rate for Payer: Humana Choice PPO Medicare	$26,631.88
Rate for Payer: Mclaren Medicare	$26,631.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27,963.47
Rate for Payer: MI Amish Medical Board Commercial	$30,626.66
Rate for Payer: Molina Medicare/Medicaid	$29,295.07
Rate for Payer: PACE Medicare	$25,300.29
Rate for Payer: PACE SWMI	$26,631.88
Rate for Payer: PHP Commercial	$29,295.07
Rate for Payer: PHP Medicare Advantage	$26,631.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$47,462.06
Rate for Payer: Priority Health Medicare	$26,631.88
Rate for Payer: Priority Health Narrow Network	$37,969.65
Rate for Payer: Railroad Medicare Medicare	$26,631.88
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,631.88
Rate for Payer: UHC Exchange	$41,279.41
Rate for Payer: UHCCP DNSP	$26,631.88
Rate for Payer: VA VA	$26,631.88

BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC

Facility

$25,539.06

Service Code	MSDRG 479
Min. Negotiated Rate	$14,383.81
Max. Negotiated Rate	$25,539.06
Rate for Payer: Aetna Medicare	$15,140.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,926.06
Rate for Payer: Amish Plain Church Group Commercial	$18,926.06
Rate for Payer: BCBS MAPPO	$15,140.85
Rate for Payer: BCN Medicare Advantage	$15,140.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,140.85
Rate for Payer: Humana Choice PPO Medicare	$15,140.85
Rate for Payer: Mclaren Medicare	$15,140.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,897.89
Rate for Payer: MI Amish Medical Board Commercial	$17,411.98
Rate for Payer: Molina Medicare/Medicaid	$16,654.94
Rate for Payer: PACE Medicare	$14,383.81
Rate for Payer: PACE SWMI	$15,140.85
Rate for Payer: PHP Commercial	$16,654.94
Rate for Payer: PHP Medicare Advantage	$15,140.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25,539.06
Rate for Payer: Priority Health Medicare	$15,140.85
Rate for Payer: Priority Health Narrow Network	$20,431.24
Rate for Payer: Railroad Medicare Medicare	$15,140.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,140.85
Rate for Payer: UHC Exchange	$23,468.32
Rate for Payer: UHCCP DNSP	$15,140.85
Rate for Payer: VA VA	$15,140.85

BIPOLAR DISORDERS

Facility

$3,245.72

Service Code	APR-DRG 7532
Min. Negotiated Rate	$2,934.52
Max. Negotiated Rate	$3,245.72
Rate for Payer: BCBS Complete	$3,245.72
Rate for Payer: Mclaren Medicaid	$3,091.16
Rate for Payer: Meridian Medicaid	$3,245.72
Rate for Payer: PHP Medicaid	$2,934.52
Rate for Payer: Priority Health Choice Medicaid	$3,091.16
Rate for Payer: UHC Medicaid	$3,091.16
Rate for Payer: UHCCP Medicaid	$3,091.16

BIPOLAR DISORDERS

Facility

$6,299.62

Service Code	APR-DRG 7533
Min. Negotiated Rate	$5,695.61
Max. Negotiated Rate	$6,299.62
Rate for Payer: BCBS Complete	$6,299.62
Rate for Payer: Mclaren Medicaid	$5,999.64
Rate for Payer: Meridian Medicaid	$6,299.62
Rate for Payer: PHP Medicaid	$5,695.61
Rate for Payer: Priority Health Choice Medicaid	$5,999.64
Rate for Payer: UHC Medicaid	$5,999.64
Rate for Payer: UHCCP Medicaid	$5,999.64

BIPOLAR DISORDERS

Facility

$11,943.12

Service Code	APR-DRG 7534
Min. Negotiated Rate	$10,798.01
Max. Negotiated Rate	$11,943.12
Rate for Payer: BCBS Complete	$11,943.12
Rate for Payer: Mclaren Medicaid	$11,374.40
Rate for Payer: Meridian Medicaid	$11,943.12
Rate for Payer: PHP Medicaid	$10,798.01
Rate for Payer: Priority Health Choice Medicaid	$11,374.40
Rate for Payer: UHC Medicaid	$11,374.40
Rate for Payer: UHCCP Medicaid	$11,374.40

BIPOLAR DISORDERS

Facility

$2,583.06

Service Code	APR-DRG 7531
Min. Negotiated Rate	$2,335.40
Max. Negotiated Rate	$2,583.06
Rate for Payer: BCBS Complete	$2,583.06
Rate for Payer: Mclaren Medicaid	$2,460.06
Rate for Payer: Meridian Medicaid	$2,583.06
Rate for Payer: PHP Medicaid	$2,335.40
Rate for Payer: Priority Health Choice Medicaid	$2,460.06
Rate for Payer: UHC Medicaid	$2,460.06
Rate for Payer: UHCCP Medicaid	$2,460.06

BISACODYL 10 MG RECTAL SUPPOSITORY

Facility

$26.22

Service Code	NDC 574705012
Hospital Charge Code	1080
Hospital Revenue Code	637
Min. Negotiated Rate	$9.70
Max. Negotiated Rate	$26.22
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: Aetna Medicare	$9.70
Rate for Payer: ASR ASR	$25.43
Rate for Payer: BCBS Complete	$10.49
Rate for Payer: BCBS Trust/PPO	$21.62
Rate for Payer: BCN Commercial	$21.62
Rate for Payer: Cash Price	$20.98
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Encore Health Key Benefits Commercial	$20.98
Rate for Payer: Healthscope Commercial	$25.43
Rate for Payer: Healthscope Whirlpool	$26.22
Rate for Payer: Mclaren Commercial	$23.60
Rate for Payer: MI Amish Medical Board Commercial	$20.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.29
Rate for Payer: Nomi Health Commercial	$21.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22.97
Rate for Payer: Priority Health Narrow Network	$18.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.07

BISACODYL 10 MG RECTAL SUPPOSITORY

Facility

$26.22

Service Code	NDC 574705012
Hospital Charge Code	1080
Hospital Revenue Code	637
Min. Negotiated Rate	$19.66
Max. Negotiated Rate	$26.22
Rate for Payer: Aetna Commercial	$23.60
Rate for Payer: ASR ASR	$25.43
Rate for Payer: BCBS Trust/PPO	$21.53
Rate for Payer: BCN Commercial	$21.53
Rate for Payer: Cash Price	$20.98
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Encore Health Key Benefits Commercial	$20.98
Rate for Payer: Healthscope Commercial	$25.43
Rate for Payer: Healthscope Whirlpool	$26.22
Rate for Payer: Mclaren Commercial	$23.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.29
Rate for Payer: Nomi Health Commercial	$21.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$23.07

BISACODYL 5 MG TABLET,DELAYED RELEASE

Facility

$6.35

Service Code	NDC 904640761
Hospital Charge Code	1079
Hospital Revenue Code	637
Min. Negotiated Rate	$4.76
Max. Negotiated Rate	$6.34
Rate for Payer: Aetna Commercial	$5.71
Rate for Payer: ASR ASR	$6.15
Rate for Payer: BCBS Trust/PPO	$5.21
Rate for Payer: BCN Commercial	$5.21
Rate for Payer: Cash Price	$5.08
Rate for Payer: Cofinity Commercial	$5.96
Rate for Payer: Encore Health Key Benefits Commercial	$5.08
Rate for Payer: Healthscope Commercial	$6.15
Rate for Payer: Healthscope Whirlpool	$6.34
Rate for Payer: Mclaren Commercial	$5.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.39
Rate for Payer: Nomi Health Commercial	$5.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.58

Know your out-of-pocket cost for care.

All Charges