Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION

Facility

$445.70

Service Code	HCPCS J0675
Hospital Charge Code	9413
Hospital Revenue Code	636
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$445.70
Rate for Payer: Aetna Commercial	$401.13
Rate for Payer: Aetna Medicare	$15.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$19.45
Rate for Payer: Amish Plain Church Group Commercial	$19.45
Rate for Payer: ASR ASR	$432.33
Rate for Payer: BCBS Complete	$8.55
Rate for Payer: BCBS MAPPO	$15.56
Rate for Payer: BCBS Trust/PPO	$367.48
Rate for Payer: BCN Commercial	$367.48
Rate for Payer: BCN Medicare Advantage	$15.56
Rate for Payer: Cash Price	$356.56
Rate for Payer: Cash Price	$356.56
Rate for Payer: Cofinity Commercial	$418.96
Rate for Payer: Encore Health Key Benefits Commercial	$356.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$15.56
Rate for Payer: Healthscope Commercial	$432.33
Rate for Payer: Healthscope Whirlpool	$445.70
Rate for Payer: Humana Choice PPO Medicare	$15.56
Rate for Payer: Mclaren Commercial	$401.13
Rate for Payer: Mclaren Medicaid	$15.56
Rate for Payer: Mclaren Medicare	$15.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.34
Rate for Payer: Meridian Medicaid	$8.55
Rate for Payer: MI Amish Medical Board Commercial	$17.89
Rate for Payer: Molina Medicare/Medicaid	$17.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.85
Rate for Payer: Nomi Health Commercial	$365.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.28
Rate for Payer: PACE Medicare	$14.78
Rate for Payer: PACE SWMI	$15.56
Rate for Payer: PHP Commercial	$17.12
Rate for Payer: PHP Medicaid	$8.34
Rate for Payer: PHP Medicare Advantage	$15.56
Rate for Payer: Priority Health Choice Medicaid	$8.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$30.60
Rate for Payer: Priority Health Medicare	$15.56
Rate for Payer: Priority Health Narrow Network	$24.48
Rate for Payer: Railroad Medicare Medicare	$15.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$392.22
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15.56
Rate for Payer: UHC Exchange	$24.12
Rate for Payer: UHC Medicaid	$8.14
Rate for Payer: UHCCP DNSP	$15.56
Rate for Payer: UHCCP Medicaid	$8.14
Rate for Payer: VA VA	$15.56

CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION

Facility

$445.70

Service Code	HCPCS J0675
Hospital Charge Code	9413
Hospital Revenue Code	636
Min. Negotiated Rate	$334.28
Max. Negotiated Rate	$445.70
Rate for Payer: Aetna Commercial	$401.13
Rate for Payer: ASR ASR	$432.33
Rate for Payer: BCBS Trust/PPO	$366.01
Rate for Payer: BCN Commercial	$366.01
Rate for Payer: Cash Price	$356.56
Rate for Payer: Cofinity Commercial	$418.96
Rate for Payer: Encore Health Key Benefits Commercial	$356.56
Rate for Payer: Healthscope Commercial	$432.33
Rate for Payer: Healthscope Whirlpool	$445.70
Rate for Payer: Mclaren Commercial	$401.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$378.85
Rate for Payer: Nomi Health Commercial	$365.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$334.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$392.22

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS

Facility

$28.25

Service Code	NDC 23920515
Hospital Charge Code	27992
Hospital Revenue Code	637
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$28.25
Rate for Payer: Aetna Commercial	$25.42
Rate for Payer: Aetna Medicare	$10.45
Rate for Payer: ASR ASR	$27.40
Rate for Payer: BCBS Complete	$11.30
Rate for Payer: BCBS Trust/PPO	$23.29
Rate for Payer: BCN Commercial	$23.29
Rate for Payer: Cash Price	$22.60
Rate for Payer: Cofinity Commercial	$26.55
Rate for Payer: Encore Health Key Benefits Commercial	$22.60
Rate for Payer: Healthscope Commercial	$27.40
Rate for Payer: Healthscope Whirlpool	$28.25
Rate for Payer: Mclaren Commercial	$25.42
Rate for Payer: MI Amish Medical Board Commercial	$22.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.01
Rate for Payer: Nomi Health Commercial	$23.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24.75
Rate for Payer: Priority Health Narrow Network	$19.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.86

CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS

Facility

$28.25

Service Code	NDC 23920515
Hospital Charge Code	27992
Hospital Revenue Code	637
Min. Negotiated Rate	$21.18
Max. Negotiated Rate	$28.25
Rate for Payer: Aetna Commercial	$25.42
Rate for Payer: ASR ASR	$27.40
Rate for Payer: BCBS Trust/PPO	$23.19
Rate for Payer: BCN Commercial	$23.19
Rate for Payer: Cash Price	$22.60
Rate for Payer: Cofinity Commercial	$26.55
Rate for Payer: Encore Health Key Benefits Commercial	$22.60
Rate for Payer: Healthscope Commercial	$27.40
Rate for Payer: Healthscope Whirlpool	$28.25
Rate for Payer: Mclaren Commercial	$25.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.01
Rate for Payer: Nomi Health Commercial	$23.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.18
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$24.86

CARDIAC ARREST AND SHOCK

Facility

$3,642.45

Service Code	APR-DRG 1962
Min. Negotiated Rate	$3,293.21
Max. Negotiated Rate	$3,642.45
Rate for Payer: BCBS Complete	$3,642.45
Rate for Payer: Mclaren Medicaid	$3,469.00
Rate for Payer: Meridian Medicaid	$3,642.45
Rate for Payer: PHP Medicaid	$3,293.21
Rate for Payer: Priority Health Choice Medicaid	$3,469.00
Rate for Payer: UHC Medicaid	$3,469.00
Rate for Payer: UHCCP Medicaid	$3,469.00

CARDIAC ARREST AND SHOCK

Facility

$1,882.80

Service Code	APR-DRG 1961
Min. Negotiated Rate	$1,702.28
Max. Negotiated Rate	$1,882.80
Rate for Payer: BCBS Complete	$1,882.80
Rate for Payer: Mclaren Medicaid	$1,793.14
Rate for Payer: Meridian Medicaid	$1,882.80
Rate for Payer: PHP Medicaid	$1,702.28
Rate for Payer: Priority Health Choice Medicaid	$1,793.14
Rate for Payer: UHC Medicaid	$1,793.14
Rate for Payer: UHCCP Medicaid	$1,793.14

CARDIAC ARREST AND SHOCK

Facility

$13,354.54

Service Code	APR-DRG 1964
Min. Negotiated Rate	$12,074.11
Max. Negotiated Rate	$13,354.54
Rate for Payer: BCBS Complete	$13,354.54
Rate for Payer: Mclaren Medicaid	$12,718.61
Rate for Payer: Meridian Medicaid	$13,354.54
Rate for Payer: PHP Medicaid	$12,074.11
Rate for Payer: Priority Health Choice Medicaid	$12,718.61
Rate for Payer: UHC Medicaid	$12,718.61
Rate for Payer: UHCCP Medicaid	$12,718.61

CARDIAC ARREST AND SHOCK

Facility

$7,991.15

Service Code	APR-DRG 1963
Min. Negotiated Rate	$7,224.95
Max. Negotiated Rate	$7,991.15
Rate for Payer: BCBS Complete	$7,991.15
Rate for Payer: Mclaren Medicaid	$7,610.62
Rate for Payer: Meridian Medicaid	$7,991.15
Rate for Payer: PHP Medicaid	$7,224.95
Rate for Payer: Priority Health Choice Medicaid	$7,610.62
Rate for Payer: UHC Medicaid	$7,610.62
Rate for Payer: UHCCP Medicaid	$7,610.62

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$9,796.08

Service Code	MSDRG 297
Min. Negotiated Rate	$6,004.05
Max. Negotiated Rate	$9,796.08
Rate for Payer: Aetna Medicare	$6,320.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,900.06
Rate for Payer: Amish Plain Church Group Commercial	$7,900.06
Rate for Payer: BCBS MAPPO	$6,320.05
Rate for Payer: BCN Medicare Advantage	$6,320.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,320.05
Rate for Payer: Humana Choice PPO Medicare	$6,320.05
Rate for Payer: Mclaren Medicare	$6,320.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,636.05
Rate for Payer: MI Amish Medical Board Commercial	$7,268.06
Rate for Payer: Molina Medicare/Medicaid	$6,952.06
Rate for Payer: PACE Medicare	$6,004.05
Rate for Payer: PACE SWMI	$6,320.05
Rate for Payer: PHP Commercial	$6,952.06
Rate for Payer: PHP Medicare Advantage	$6,320.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$8,710.40
Rate for Payer: Priority Health Medicare	$6,320.05
Rate for Payer: Priority Health Narrow Network	$6,968.32
Rate for Payer: Railroad Medicare Medicare	$6,320.05
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,320.05
Rate for Payer: UHC Exchange	$9,796.08
Rate for Payer: UHCCP DNSP	$6,320.05
Rate for Payer: VA VA	$6,320.05

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$21,458.63

Service Code	MSDRG 296
Min. Negotiated Rate	$12,351.98
Max. Negotiated Rate	$21,458.63
Rate for Payer: Aetna Medicare	$13,002.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,252.60
Rate for Payer: Amish Plain Church Group Commercial	$16,252.60
Rate for Payer: BCBS MAPPO	$13,002.08
Rate for Payer: BCN Medicare Advantage	$13,002.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,002.08
Rate for Payer: Humana Choice PPO Medicare	$13,002.08
Rate for Payer: Mclaren Medicare	$13,002.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,652.18
Rate for Payer: MI Amish Medical Board Commercial	$14,952.39
Rate for Payer: Molina Medicare/Medicaid	$14,302.29
Rate for Payer: PACE Medicare	$12,351.98
Rate for Payer: PACE SWMI	$13,002.08
Rate for Payer: PHP Commercial	$14,302.29
Rate for Payer: PHP Medicare Advantage	$13,002.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,458.63
Rate for Payer: Priority Health Medicare	$13,002.08
Rate for Payer: Priority Health Narrow Network	$17,166.91
Rate for Payer: Railroad Medicare Medicare	$13,002.08
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,002.08
Rate for Payer: UHC Exchange	$20,153.22
Rate for Payer: UHCCP DNSP	$13,002.08
Rate for Payer: VA VA	$13,002.08

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$7,799.20

Service Code	MSDRG 298
Min. Negotiated Rate	$4,780.15
Max. Negotiated Rate	$7,799.20
Rate for Payer: Aetna Medicare	$5,031.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,289.68
Rate for Payer: Amish Plain Church Group Commercial	$6,289.68
Rate for Payer: BCBS MAPPO	$5,031.74
Rate for Payer: BCN Medicare Advantage	$5,031.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,031.74
Rate for Payer: Humana Choice PPO Medicare	$5,031.74
Rate for Payer: Mclaren Medicare	$5,031.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,283.33
Rate for Payer: MI Amish Medical Board Commercial	$5,786.50
Rate for Payer: Molina Medicare/Medicaid	$5,534.91
Rate for Payer: PACE Medicare	$4,780.15
Rate for Payer: PACE SWMI	$5,031.74
Rate for Payer: PHP Commercial	$5,534.91
Rate for Payer: PHP Medicare Advantage	$5,031.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$6,252.53
Rate for Payer: Priority Health Medicare	$5,031.74
Rate for Payer: Priority Health Narrow Network	$5,002.02
Rate for Payer: Railroad Medicare Medicare	$5,031.74
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,031.74
Rate for Payer: UHC Exchange	$7,799.20
Rate for Payer: UHCCP DNSP	$5,031.74
Rate for Payer: VA VA	$5,031.74

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$5,679.47

Service Code	APR-DRG 2013
Min. Negotiated Rate	$5,134.92
Max. Negotiated Rate	$5,679.47
Rate for Payer: BCBS Complete	$5,679.47
Rate for Payer: Mclaren Medicaid	$5,409.02
Rate for Payer: Meridian Medicaid	$5,679.47
Rate for Payer: PHP Medicaid	$5,134.92
Rate for Payer: Priority Health Choice Medicaid	$5,409.02
Rate for Payer: UHC Medicaid	$5,409.02
Rate for Payer: UHCCP Medicaid	$5,409.02

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$9,829.26

Service Code	APR-DRG 2014
Min. Negotiated Rate	$8,886.83
Max. Negotiated Rate	$9,829.26
Rate for Payer: BCBS Complete	$9,829.26
Rate for Payer: Mclaren Medicaid	$9,361.20
Rate for Payer: Meridian Medicaid	$9,829.26
Rate for Payer: PHP Medicaid	$8,886.83
Rate for Payer: Priority Health Choice Medicaid	$9,361.20
Rate for Payer: UHC Medicaid	$9,361.20
Rate for Payer: UHCCP Medicaid	$9,361.20

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$3,994.48

Service Code	APR-DRG 2012
Min. Negotiated Rate	$3,611.49
Max. Negotiated Rate	$3,994.48
Rate for Payer: BCBS Complete	$3,994.48
Rate for Payer: Mclaren Medicaid	$3,804.27
Rate for Payer: Meridian Medicaid	$3,994.48
Rate for Payer: PHP Medicaid	$3,611.49
Rate for Payer: Priority Health Choice Medicaid	$3,804.27
Rate for Payer: UHC Medicaid	$3,804.27
Rate for Payer: UHCCP Medicaid	$3,804.27

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS

Facility

$2,950.36

Service Code	APR-DRG 2011
Min. Negotiated Rate	$2,667.48
Max. Negotiated Rate	$2,950.36
Rate for Payer: BCBS Complete	$2,950.36
Rate for Payer: Mclaren Medicaid	$2,809.87
Rate for Payer: Meridian Medicaid	$2,950.36
Rate for Payer: PHP Medicaid	$2,667.48
Rate for Payer: Priority Health Choice Medicaid	$2,809.87
Rate for Payer: UHC Medicaid	$2,809.87
Rate for Payer: UHCCP Medicaid	$2,809.87

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC

Facility

$10,931.25

Service Code	MSDRG 309
Min. Negotiated Rate	$6,699.80
Max. Negotiated Rate	$10,931.25
Rate for Payer: Aetna Medicare	$7,052.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,815.52
Rate for Payer: Amish Plain Church Group Commercial	$8,815.52
Rate for Payer: BCBS MAPPO	$7,052.42
Rate for Payer: BCN Medicare Advantage	$7,052.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,052.42
Rate for Payer: Humana Choice PPO Medicare	$7,052.42
Rate for Payer: Mclaren Medicare	$7,052.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,405.04
Rate for Payer: MI Amish Medical Board Commercial	$8,110.28
Rate for Payer: Molina Medicare/Medicaid	$7,757.66
Rate for Payer: PACE Medicare	$6,699.80
Rate for Payer: PACE SWMI	$7,052.42
Rate for Payer: PHP Commercial	$7,757.66
Rate for Payer: PHP Medicare Advantage	$7,052.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,107.64
Rate for Payer: Priority Health Medicare	$7,052.42
Rate for Payer: Priority Health Narrow Network	$8,086.11
Rate for Payer: Railroad Medicare Medicare	$7,052.42
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,052.42
Rate for Payer: UHC Exchange	$10,931.25
Rate for Payer: UHCCP DNSP	$7,052.42
Rate for Payer: VA VA	$7,052.42

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC

Facility

$16,541.52

Service Code	MSDRG 308
Min. Negotiated Rate	$9,903.52
Max. Negotiated Rate	$16,541.52
Rate for Payer: Aetna Medicare	$10,424.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,030.95
Rate for Payer: Amish Plain Church Group Commercial	$13,030.95
Rate for Payer: BCBS MAPPO	$10,424.76
Rate for Payer: BCN Medicare Advantage	$10,424.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,424.76
Rate for Payer: Humana Choice PPO Medicare	$10,424.76
Rate for Payer: Mclaren Medicare	$10,424.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,946.00
Rate for Payer: MI Amish Medical Board Commercial	$11,988.47
Rate for Payer: Molina Medicare/Medicaid	$11,467.24
Rate for Payer: PACE Medicare	$9,903.52
Rate for Payer: PACE SWMI	$10,424.76
Rate for Payer: PHP Commercial	$11,467.24
Rate for Payer: PHP Medicare Advantage	$10,424.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16,541.52
Rate for Payer: Priority Health Medicare	$10,424.76
Rate for Payer: Priority Health Narrow Network	$13,233.21
Rate for Payer: Railroad Medicare Medicare	$10,424.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,424.76
Rate for Payer: UHC Exchange	$16,158.38
Rate for Payer: UHCCP DNSP	$10,424.76
Rate for Payer: VA VA	$10,424.76

CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC

Facility

$9,038.19

Service Code	MSDRG 310
Min. Negotiated Rate	$5,539.54
Max. Negotiated Rate	$9,038.19
Rate for Payer: Aetna Medicare	$5,831.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,288.86
Rate for Payer: Amish Plain Church Group Commercial	$7,288.86
Rate for Payer: BCBS MAPPO	$5,831.09
Rate for Payer: BCN Medicare Advantage	$5,831.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,831.09
Rate for Payer: Humana Choice PPO Medicare	$5,831.09
Rate for Payer: Mclaren Medicare	$5,831.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,122.64
Rate for Payer: MI Amish Medical Board Commercial	$6,705.75
Rate for Payer: Molina Medicare/Medicaid	$6,414.20
Rate for Payer: PACE Medicare	$5,539.54
Rate for Payer: PACE SWMI	$5,831.09
Rate for Payer: PHP Commercial	$6,414.20
Rate for Payer: PHP Medicare Advantage	$5,831.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7,777.53
Rate for Payer: Priority Health Medicare	$5,831.09
Rate for Payer: Priority Health Narrow Network	$6,222.03
Rate for Payer: Railroad Medicare Medicare	$5,831.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,831.09
Rate for Payer: UHC Exchange	$9,038.19
Rate for Payer: UHCCP DNSP	$5,831.09
Rate for Payer: VA VA	$5,831.09

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$6,287.63

Service Code	APR-DRG 1912
Min. Negotiated Rate	$5,684.77
Max. Negotiated Rate	$6,287.63
Rate for Payer: BCBS Complete	$6,287.63
Rate for Payer: Mclaren Medicaid	$5,988.22
Rate for Payer: Meridian Medicaid	$6,287.63
Rate for Payer: PHP Medicaid	$5,684.77
Rate for Payer: Priority Health Choice Medicaid	$5,988.22
Rate for Payer: UHC Medicaid	$5,988.22
Rate for Payer: UHCCP Medicaid	$5,988.22

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$11,800.89

Service Code	APR-DRG 1914
Min. Negotiated Rate	$10,669.42
Max. Negotiated Rate	$11,800.89
Rate for Payer: BCBS Complete	$11,800.89
Rate for Payer: Mclaren Medicaid	$11,238.94
Rate for Payer: Meridian Medicaid	$11,800.89
Rate for Payer: PHP Medicaid	$10,669.42
Rate for Payer: Priority Health Choice Medicaid	$11,238.94
Rate for Payer: UHC Medicaid	$11,238.94
Rate for Payer: UHCCP Medicaid	$11,238.94

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$5,040.79

Service Code	APR-DRG 1911
Min. Negotiated Rate	$4,557.48
Max. Negotiated Rate	$5,040.79
Rate for Payer: BCBS Complete	$5,040.79
Rate for Payer: Mclaren Medicaid	$4,800.75
Rate for Payer: Meridian Medicaid	$5,040.79
Rate for Payer: PHP Medicaid	$4,557.48
Rate for Payer: Priority Health Choice Medicaid	$4,800.75
Rate for Payer: UHC Medicaid	$4,800.75
Rate for Payer: UHCCP Medicaid	$4,800.75

CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE

Facility

$8,634.73

Service Code	APR-DRG 1913
Min. Negotiated Rate	$7,806.83
Max. Negotiated Rate	$8,634.73
Rate for Payer: BCBS Complete	$8,634.73
Rate for Payer: Mclaren Medicaid	$8,223.56
Rate for Payer: Meridian Medicaid	$8,634.73
Rate for Payer: PHP Medicaid	$7,806.83
Rate for Payer: Priority Health Choice Medicaid	$8,223.56
Rate for Payer: UHC Medicaid	$8,223.56
Rate for Payer: UHCCP Medicaid	$8,223.56

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$7,921.94

Service Code	APR-DRG 1922
Min. Negotiated Rate	$7,162.38
Max. Negotiated Rate	$7,921.94
Rate for Payer: BCBS Complete	$7,921.94
Rate for Payer: Mclaren Medicaid	$7,544.70
Rate for Payer: Meridian Medicaid	$7,921.94
Rate for Payer: PHP Medicaid	$7,162.38
Rate for Payer: Priority Health Choice Medicaid	$7,544.70
Rate for Payer: UHC Medicaid	$7,544.70
Rate for Payer: UHCCP Medicaid	$7,544.70

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$6,260.39

Service Code	APR-DRG 1921
Min. Negotiated Rate	$5,660.14
Max. Negotiated Rate	$6,260.39
Rate for Payer: BCBS Complete	$6,260.39
Rate for Payer: Mclaren Medicaid	$5,962.27
Rate for Payer: Meridian Medicaid	$6,260.39
Rate for Payer: PHP Medicaid	$5,660.14
Rate for Payer: Priority Health Choice Medicaid	$5,962.27
Rate for Payer: UHC Medicaid	$5,962.27
Rate for Payer: UHCCP Medicaid	$5,962.27

CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS

Facility

$16,793.72

Service Code	APR-DRG 1924
Min. Negotiated Rate	$15,183.54
Max. Negotiated Rate	$16,793.72
Rate for Payer: BCBS Complete	$16,793.72
Rate for Payer: Mclaren Medicaid	$15,994.02
Rate for Payer: Meridian Medicaid	$16,793.72
Rate for Payer: PHP Medicaid	$15,183.54
Rate for Payer: Priority Health Choice Medicaid	$15,994.02
Rate for Payer: UHC Medicaid	$15,994.02
Rate for Payer: UHCCP Medicaid	$15,994.02

Know your out-of-pocket cost for care.

All Charges