Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$21.87

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$21.87
Rate for Payer: Aetna Commercial	$19.68
Rate for Payer: ASR ASR	$21.21
Rate for Payer: BCBS Complete	$8.75
Rate for Payer: BCBS Trust/PPO	$16.96
Rate for Payer: BCN Commercial	$16.96
Rate for Payer: Cash Price	$17.50
Rate for Payer: Cofinity Commercial	$20.56
Rate for Payer: Encore Health Key Benefits Commercial	$17.50
Rate for Payer: Healthscope Commercial	$21.87
Rate for Payer: Healthscope Whirlpool	$21.21
Rate for Payer: Mclaren Commercial	$19.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.59
Rate for Payer: Priority Health Cigna Priority Health	$15.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19.90
Rate for Payer: Priority Health Narrow Network	$15.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.25

HH DRSG MEPILEX BORDER 6X6 EA

Facility

$21.87

Service Code	HCPCS A6212
Hospital Charge Code	62300067
Hospital Revenue Code	623
Min. Negotiated Rate	$15.31
Max. Negotiated Rate	$21.87
Rate for Payer: Aetna Commercial	$19.68
Rate for Payer: ASR ASR	$21.21
Rate for Payer: BCBS Trust/PPO	$16.96
Rate for Payer: BCN Commercial	$16.96
Rate for Payer: Cash Price	$17.50
Rate for Payer: Cofinity Commercial	$20.56
Rate for Payer: Encore Health Key Benefits Commercial	$17.50
Rate for Payer: Healthscope Commercial	$21.87
Rate for Payer: Healthscope Whirlpool	$21.21
Rate for Payer: Mclaren Commercial	$19.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.59
Rate for Payer: Priority Health Cigna Priority Health	$15.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.25

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.47

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$15.73
Max. Negotiated Rate	$22.47
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: ASR ASR	$21.80
Rate for Payer: BCBS Trust/PPO	$17.42
Rate for Payer: BCN Commercial	$17.42
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$17.98
Rate for Payer: Healthscope Commercial	$22.47
Rate for Payer: Healthscope Whirlpool	$21.80
Rate for Payer: Mclaren Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$15.73
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.77

HH DRSG MEPILEX BORDER 6X8 EA

Facility

$22.47

Service Code	HCPCS A6213
Hospital Charge Code	62300053
Hospital Revenue Code	623
Min. Negotiated Rate	$8.99
Max. Negotiated Rate	$22.47
Rate for Payer: Aetna Commercial	$20.22
Rate for Payer: ASR ASR	$21.80
Rate for Payer: BCBS Complete	$8.99
Rate for Payer: BCBS Trust/PPO	$17.42
Rate for Payer: BCN Commercial	$17.42
Rate for Payer: Cash Price	$17.98
Rate for Payer: Cofinity Commercial	$21.12
Rate for Payer: Encore Health Key Benefits Commercial	$17.98
Rate for Payer: Healthscope Commercial	$22.47
Rate for Payer: Healthscope Whirlpool	$21.80
Rate for Payer: Mclaren Commercial	$20.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.10
Rate for Payer: Priority Health Cigna Priority Health	$15.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20.45
Rate for Payer: Priority Health Narrow Network	$15.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.77

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM

Facility

$823.40

Service Code	CPT 97607
Hospital Charge Code	76100035
Hospital Revenue Code	761
Min. Negotiated Rate	$576.38
Max. Negotiated Rate	$823.40
Rate for Payer: Aetna Commercial	$741.06
Rate for Payer: ASR ASR	$798.70
Rate for Payer: BCBS Trust/PPO	$638.38
Rate for Payer: BCN Commercial	$638.38
Rate for Payer: Cash Price	$658.72
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Encore Health Key Benefits Commercial	$658.72
Rate for Payer: Healthscope Commercial	$823.40
Rate for Payer: Healthscope Whirlpool	$798.70
Rate for Payer: Mclaren Commercial	$741.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.89
Rate for Payer: Priority Health Cigna Priority Health	$576.38
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$724.59

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM

Facility

$823.40

Service Code	CPT 97607
Hospital Charge Code	76100035
Hospital Revenue Code	761
Min. Negotiated Rate	$193.87
Max. Negotiated Rate	$823.40
Rate for Payer: Aetna Commercial	$741.06
Rate for Payer: Aetna Medicare	$354.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.04
Rate for Payer: Amish Plain Church Group Commercial	$443.04
Rate for Payer: ASR ASR	$798.70
Rate for Payer: BCBS Complete	$203.58
Rate for Payer: BCBS MAPPO	$354.43
Rate for Payer: BCBS Trust/PPO	$638.38
Rate for Payer: BCN Commercial	$638.38
Rate for Payer: BCN Medicare Advantage	$354.43
Rate for Payer: Cash Price	$658.72
Rate for Payer: Cash Price	$658.72
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Encore Health Key Benefits Commercial	$658.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.43
Rate for Payer: Healthscope Commercial	$823.40
Rate for Payer: Healthscope Whirlpool	$798.70
Rate for Payer: Humana Choice PPO Medicare	$354.43
Rate for Payer: Mclaren Commercial	$741.06
Rate for Payer: Mclaren Medicaid	$193.87
Rate for Payer: Mclaren Medicare	$354.43
Rate for Payer: Meridian Medicaid	$203.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.15
Rate for Payer: MI Amish Medical Board Commercial	$407.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.89
Rate for Payer: PACE Medicare	$336.71
Rate for Payer: PACE SWMI	$354.43
Rate for Payer: PHP Commercial	$389.87
Rate for Payer: PHP Medicaid	$193.87
Rate for Payer: PHP Medicare Advantage	$354.43
Rate for Payer: Priority Health Choice Medicaid	$193.87
Rate for Payer: Priority Health Cigna Priority Health	$576.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$749.29
Rate for Payer: Priority Health Medicare	$354.43
Rate for Payer: Priority Health Narrow Network	$584.61
Rate for Payer: Railroad Medicare Medicare	$354.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$724.59
Rate for Payer: UHC Medicare Advantage	$365.06
Rate for Payer: VA VA	$354.43

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM

Facility

$686.17

Service Code	CPT 97608
Hospital Charge Code	76100036
Hospital Revenue Code	761
Min. Negotiated Rate	$480.32
Max. Negotiated Rate	$686.17
Rate for Payer: Aetna Commercial	$617.55
Rate for Payer: ASR ASR	$665.58
Rate for Payer: BCBS Trust/PPO	$531.99
Rate for Payer: BCN Commercial	$531.99
Rate for Payer: Cash Price	$548.94
Rate for Payer: Cofinity Commercial	$645.00
Rate for Payer: Encore Health Key Benefits Commercial	$548.94
Rate for Payer: Healthscope Commercial	$686.17
Rate for Payer: Healthscope Whirlpool	$665.58
Rate for Payer: Mclaren Commercial	$617.55
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$583.24
Rate for Payer: Priority Health Cigna Priority Health	$480.32
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$603.83

HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM

Facility

$686.17

Service Code	CPT 97608
Hospital Charge Code	76100036
Hospital Revenue Code	761
Min. Negotiated Rate	$193.87
Max. Negotiated Rate	$686.17
Rate for Payer: Aetna Commercial	$617.55
Rate for Payer: Aetna Medicare	$354.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$443.04
Rate for Payer: Amish Plain Church Group Commercial	$443.04
Rate for Payer: ASR ASR	$665.58
Rate for Payer: BCBS Complete	$203.58
Rate for Payer: BCBS MAPPO	$354.43
Rate for Payer: BCBS Trust/PPO	$531.99
Rate for Payer: BCN Commercial	$531.99
Rate for Payer: BCN Medicare Advantage	$354.43
Rate for Payer: Cash Price	$548.94
Rate for Payer: Cash Price	$548.94
Rate for Payer: Cofinity Commercial	$645.00
Rate for Payer: Encore Health Key Benefits Commercial	$548.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$354.43
Rate for Payer: Healthscope Commercial	$686.17
Rate for Payer: Healthscope Whirlpool	$665.58
Rate for Payer: Humana Choice PPO Medicare	$354.43
Rate for Payer: Mclaren Commercial	$617.55
Rate for Payer: Mclaren Medicaid	$193.87
Rate for Payer: Mclaren Medicare	$354.43
Rate for Payer: Meridian Medicaid	$203.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$372.15
Rate for Payer: MI Amish Medical Board Commercial	$407.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$583.24
Rate for Payer: PACE Medicare	$336.71
Rate for Payer: PACE SWMI	$354.43
Rate for Payer: PHP Commercial	$389.87
Rate for Payer: PHP Medicaid	$193.87
Rate for Payer: PHP Medicare Advantage	$354.43
Rate for Payer: Priority Health Choice Medicaid	$193.87
Rate for Payer: Priority Health Cigna Priority Health	$480.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$624.41
Rate for Payer: Priority Health Medicare	$354.43
Rate for Payer: Priority Health Narrow Network	$487.18
Rate for Payer: Railroad Medicare Medicare	$354.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$603.83
Rate for Payer: UHC Medicare Advantage	$365.06
Rate for Payer: VA VA	$354.43

HH POUCH 2.5" CTF HOLL8331 EA

Facility

$6.24

Service Code	HCPCS A5056
Hospital Charge Code	27000597
Hospital Revenue Code	270
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$6.24
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: ASR ASR	$6.05
Rate for Payer: BCBS Complete	$2.50
Rate for Payer: BCBS Trust/PPO	$4.84
Rate for Payer: BCN Commercial	$4.84
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$5.87
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$6.24
Rate for Payer: Healthscope Whirlpool	$6.05
Rate for Payer: Mclaren Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.68
Rate for Payer: Priority Health Narrow Network	$4.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.49

HH POUCH 2.5" CTF HOLL8331 EA

Facility

$6.24

Service Code	HCPCS A5056
Hospital Charge Code	27000597
Hospital Revenue Code	270
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$6.24
Rate for Payer: Aetna Commercial	$5.62
Rate for Payer: ASR ASR	$6.05
Rate for Payer: BCBS Trust/PPO	$4.84
Rate for Payer: BCN Commercial	$4.84
Rate for Payer: Cash Price	$4.99
Rate for Payer: Cofinity Commercial	$5.87
Rate for Payer: Encore Health Key Benefits Commercial	$4.99
Rate for Payer: Healthscope Commercial	$6.24
Rate for Payer: Healthscope Whirlpool	$6.05
Rate for Payer: Mclaren Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.30
Rate for Payer: Priority Health Cigna Priority Health	$4.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.49

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC

Facility

$26,641.72

Service Code	MS-DRG 481
Min. Negotiated Rate	$18,285.47
Max. Negotiated Rate	$26,641.72
Rate for Payer: Aetna Medicare	$19,247.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,059.82
Rate for Payer: Amish Plain Church Group Commercial	$24,059.82
Rate for Payer: BCBS MAPPO	$19,247.86
Rate for Payer: BCN Medicare Advantage	$19,247.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,247.86
Rate for Payer: Humana Choice PPO Medicare	$19,247.86
Rate for Payer: Mclaren Medicare	$19,247.86
Rate for Payer: Meridian Wellcare - Medicare Advantage	$20,210.25
Rate for Payer: MI Amish Medical Board Commercial	$22,135.04
Rate for Payer: PACE Medicare	$18,285.47
Rate for Payer: PACE SWMI	$19,247.86
Rate for Payer: PHP Commercial	$21,172.65
Rate for Payer: PHP Medicare Advantage	$19,247.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$26,641.72
Rate for Payer: Priority Health Medicare	$19,247.86
Rate for Payer: Priority Health Narrow Network	$21,313.38
Rate for Payer: Railroad Medicare Medicare	$19,247.86
Rate for Payer: UHC Medicare Advantage	$19,825.30
Rate for Payer: VA VA	$19,247.86

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC

Facility

$37,863.88

Service Code	MS-DRG 480
Min. Negotiated Rate	$25,315.12
Max. Negotiated Rate	$37,863.88
Rate for Payer: Aetna Medicare	$26,647.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,309.38
Rate for Payer: Amish Plain Church Group Commercial	$33,309.38
Rate for Payer: BCBS MAPPO	$26,647.50
Rate for Payer: BCN Medicare Advantage	$26,647.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,647.50
Rate for Payer: Humana Choice PPO Medicare	$26,647.50
Rate for Payer: Mclaren Medicare	$26,647.50
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27,979.88
Rate for Payer: MI Amish Medical Board Commercial	$30,644.62
Rate for Payer: PACE Medicare	$25,315.12
Rate for Payer: PACE SWMI	$26,647.50
Rate for Payer: PHP Commercial	$29,312.25
Rate for Payer: PHP Medicare Advantage	$26,647.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37,863.88
Rate for Payer: Priority Health Medicare	$26,647.50
Rate for Payer: Priority Health Narrow Network	$30,291.10
Rate for Payer: Railroad Medicare Medicare	$26,647.50
Rate for Payer: UHC Medicare Advantage	$27,446.92
Rate for Payer: VA VA	$26,647.50

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$20,395.06

Service Code	MS-DRG 482
Min. Negotiated Rate	$14,372.53
Max. Negotiated Rate	$20,395.06
Rate for Payer: Aetna Medicare	$15,128.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,911.22
Rate for Payer: Amish Plain Church Group Commercial	$18,911.22
Rate for Payer: BCBS MAPPO	$15,128.98
Rate for Payer: BCN Medicare Advantage	$15,128.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,128.98
Rate for Payer: Humana Choice PPO Medicare	$15,128.98
Rate for Payer: Mclaren Medicare	$15,128.98
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,885.43
Rate for Payer: MI Amish Medical Board Commercial	$17,398.33
Rate for Payer: PACE Medicare	$14,372.53
Rate for Payer: PACE SWMI	$15,128.98
Rate for Payer: PHP Commercial	$16,641.88
Rate for Payer: PHP Medicare Advantage	$15,128.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,395.06
Rate for Payer: Priority Health Medicare	$15,128.98
Rate for Payer: Priority Health Narrow Network	$16,316.05
Rate for Payer: Railroad Medicare Medicare	$15,128.98
Rate for Payer: UHC Medicare Advantage	$15,582.85
Rate for Payer: VA VA	$15,128.98

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$38,445.53

Service Code	MS-DRG 521
Min. Negotiated Rate	$25,679.48
Max. Negotiated Rate	$38,445.53
Rate for Payer: Aetna Medicare	$27,031.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,788.79
Rate for Payer: Amish Plain Church Group Commercial	$33,788.79
Rate for Payer: BCBS MAPPO	$27,031.03
Rate for Payer: BCN Medicare Advantage	$27,031.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,031.03
Rate for Payer: Humana Choice PPO Medicare	$27,031.03
Rate for Payer: Mclaren Medicare	$27,031.03
Rate for Payer: Meridian Wellcare - Medicare Advantage	$28,382.58
Rate for Payer: MI Amish Medical Board Commercial	$31,085.68
Rate for Payer: PACE Medicare	$25,679.48
Rate for Payer: PACE SWMI	$27,031.03
Rate for Payer: PHP Commercial	$29,734.13
Rate for Payer: PHP Medicare Advantage	$27,031.03
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$38,445.53
Rate for Payer: Priority Health Medicare	$27,031.03
Rate for Payer: Priority Health Narrow Network	$30,756.42
Rate for Payer: Railroad Medicare Medicare	$27,031.03
Rate for Payer: UHC Medicare Advantage	$27,841.96
Rate for Payer: VA VA	$27,031.03

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$27,120.65

Service Code	MS-DRG 522
Min. Negotiated Rate	$18,585.48
Max. Negotiated Rate	$27,120.65
Rate for Payer: Aetna Medicare	$19,563.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,454.58
Rate for Payer: Amish Plain Church Group Commercial	$24,454.58
Rate for Payer: BCBS MAPPO	$19,563.66
Rate for Payer: BCN Medicare Advantage	$19,563.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,563.66
Rate for Payer: Humana Choice PPO Medicare	$19,563.66
Rate for Payer: Mclaren Medicare	$19,563.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$20,541.84
Rate for Payer: MI Amish Medical Board Commercial	$22,498.21
Rate for Payer: PACE Medicare	$18,585.48
Rate for Payer: PACE SWMI	$19,563.66
Rate for Payer: PHP Commercial	$21,520.03
Rate for Payer: PHP Medicare Advantage	$19,563.66
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27,120.65
Rate for Payer: Priority Health Medicare	$19,563.66
Rate for Payer: Priority Health Narrow Network	$21,696.52
Rate for Payer: Railroad Medicare Medicare	$19,563.66
Rate for Payer: UHC Medicare Advantage	$20,150.57
Rate for Payer: VA VA	$19,563.66

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$88,244.18

Service Code	MS-DRG 969
Min. Negotiated Rate	$56,873.74
Max. Negotiated Rate	$88,244.18
Rate for Payer: Aetna Medicare	$59,867.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$74,833.88
Rate for Payer: Amish Plain Church Group Commercial	$74,833.88
Rate for Payer: BCBS MAPPO	$59,867.10
Rate for Payer: BCN Medicare Advantage	$59,867.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$59,867.10
Rate for Payer: Humana Choice PPO Medicare	$59,867.10
Rate for Payer: Mclaren Medicare	$59,867.10
Rate for Payer: Meridian Wellcare - Medicare Advantage	$62,860.46
Rate for Payer: MI Amish Medical Board Commercial	$68,847.16
Rate for Payer: PACE Medicare	$56,873.74
Rate for Payer: PACE SWMI	$59,867.10
Rate for Payer: PHP Commercial	$65,853.81
Rate for Payer: PHP Medicare Advantage	$59,867.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$88,244.18
Rate for Payer: Priority Health Medicare	$59,867.10
Rate for Payer: Priority Health Narrow Network	$70,595.34
Rate for Payer: Railroad Medicare Medicare	$59,867.10
Rate for Payer: UHC Medicare Advantage	$61,663.11
Rate for Payer: VA VA	$59,867.10

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$31,517.66

Service Code	MS-DRG 970
Min. Negotiated Rate	$23,953.42
Max. Negotiated Rate	$31,517.66
Rate for Payer: Aetna Medicare	$25,214.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,517.66
Rate for Payer: Amish Plain Church Group Commercial	$31,517.66
Rate for Payer: BCBS MAPPO	$25,214.13
Rate for Payer: BCN Medicare Advantage	$25,214.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,214.13
Rate for Payer: Humana Choice PPO Medicare	$25,214.13
Rate for Payer: Mclaren Medicare	$25,214.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$26,474.84
Rate for Payer: MI Amish Medical Board Commercial	$28,996.25
Rate for Payer: PACE Medicare	$23,953.42
Rate for Payer: PACE SWMI	$25,214.13
Rate for Payer: PHP Commercial	$27,735.54
Rate for Payer: PHP Medicare Advantage	$25,214.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30,872.50
Rate for Payer: Priority Health Medicare	$25,214.13
Rate for Payer: Priority Health Narrow Network	$24,698.00
Rate for Payer: Railroad Medicare Medicare	$25,214.13
Rate for Payer: UHC Medicare Advantage	$25,970.55
Rate for Payer: VA VA	$25,214.13

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$17,504.77

Service Code	MS-DRG 975
Min. Negotiated Rate	$12,562.02
Max. Negotiated Rate	$17,504.77
Rate for Payer: Aetna Medicare	$13,223.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,528.98
Rate for Payer: Amish Plain Church Group Commercial	$16,528.98
Rate for Payer: BCBS MAPPO	$13,223.18
Rate for Payer: BCN Medicare Advantage	$13,223.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,223.18
Rate for Payer: Humana Choice PPO Medicare	$13,223.18
Rate for Payer: Mclaren Medicare	$13,223.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$13,884.34
Rate for Payer: MI Amish Medical Board Commercial	$15,206.66
Rate for Payer: PACE Medicare	$12,562.02
Rate for Payer: PACE SWMI	$13,223.18
Rate for Payer: PHP Commercial	$14,545.50
Rate for Payer: PHP Medicare Advantage	$13,223.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17,504.77
Rate for Payer: Priority Health Medicare	$13,223.18
Rate for Payer: Priority Health Narrow Network	$14,003.82
Rate for Payer: Railroad Medicare Medicare	$13,223.18
Rate for Payer: UHC Medicare Advantage	$13,619.88
Rate for Payer: VA VA	$13,223.18

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$37,447.86

Service Code	MS-DRG 974
Min. Negotiated Rate	$25,054.52
Max. Negotiated Rate	$37,447.86
Rate for Payer: Aetna Medicare	$26,373.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$32,966.48
Rate for Payer: Amish Plain Church Group Commercial	$32,966.48
Rate for Payer: BCBS MAPPO	$26,373.18
Rate for Payer: BCN Medicare Advantage	$26,373.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,373.18
Rate for Payer: Humana Choice PPO Medicare	$26,373.18
Rate for Payer: Mclaren Medicare	$26,373.18
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27,691.84
Rate for Payer: MI Amish Medical Board Commercial	$30,329.16
Rate for Payer: PACE Medicare	$25,054.52
Rate for Payer: PACE SWMI	$26,373.18
Rate for Payer: PHP Commercial	$29,010.50
Rate for Payer: PHP Medicare Advantage	$26,373.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37,447.86
Rate for Payer: Priority Health Medicare	$26,373.18
Rate for Payer: Priority Health Narrow Network	$29,958.29
Rate for Payer: Railroad Medicare Medicare	$26,373.18
Rate for Payer: UHC Medicare Advantage	$27,164.38
Rate for Payer: VA VA	$26,373.18

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$11,046.98

Service Code	MS-DRG 976
Min. Negotiated Rate	$8,395.70
Max. Negotiated Rate	$11,046.98
Rate for Payer: Aetna Medicare	$8,837.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,046.98
Rate for Payer: Amish Plain Church Group Commercial	$11,046.98
Rate for Payer: BCBS MAPPO	$8,837.58
Rate for Payer: BCN Medicare Advantage	$8,837.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,837.58
Rate for Payer: Humana Choice PPO Medicare	$8,837.58
Rate for Payer: Mclaren Medicare	$8,837.58
Rate for Payer: Meridian Wellcare - Medicare Advantage	$9,279.46
Rate for Payer: MI Amish Medical Board Commercial	$10,163.22
Rate for Payer: PACE Medicare	$8,395.70
Rate for Payer: PACE SWMI	$8,837.58
Rate for Payer: PHP Commercial	$9,721.34
Rate for Payer: PHP Medicare Advantage	$8,837.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,853.65
Rate for Payer: Priority Health Medicare	$8,837.58
Rate for Payer: Priority Health Narrow Network	$8,682.92
Rate for Payer: Railroad Medicare Medicare	$8,837.58
Rate for Payer: UHC Medicare Advantage	$9,102.71
Rate for Payer: VA VA	$8,837.58

HIV WITH OR WITHOUT OTHER RELATED CONDITION

Facility

$18,182.72

Service Code	MS-DRG 977
Min. Negotiated Rate	$12,986.69
Max. Negotiated Rate	$18,182.72
Rate for Payer: Aetna Medicare	$13,670.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,087.75
Rate for Payer: Amish Plain Church Group Commercial	$17,087.75
Rate for Payer: BCBS MAPPO	$13,670.20
Rate for Payer: BCN Medicare Advantage	$13,670.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,670.20
Rate for Payer: Humana Choice PPO Medicare	$13,670.20
Rate for Payer: Mclaren Medicare	$13,670.20
Rate for Payer: Meridian Wellcare - Medicare Advantage	$14,353.71
Rate for Payer: MI Amish Medical Board Commercial	$15,720.73
Rate for Payer: PACE Medicare	$12,986.69
Rate for Payer: PACE SWMI	$13,670.20
Rate for Payer: PHP Commercial	$15,037.22
Rate for Payer: PHP Medicare Advantage	$13,670.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18,182.72
Rate for Payer: Priority Health Medicare	$13,670.20
Rate for Payer: Priority Health Narrow Network	$14,546.18
Rate for Payer: Railroad Medicare Medicare	$13,670.20
Rate for Payer: UHC Medicare Advantage	$14,080.31
Rate for Payer: VA VA	$13,670.20

HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION

Facility

$4.93

Service Code	HCPCS J7168
Hospital Charge Code	170850
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$4.93
Rate for Payer: Aetna Commercial	$4.44
Rate for Payer: ASR ASR	$4.78
Rate for Payer: BCBS Trust/PPO	$3.82
Rate for Payer: BCN Commercial	$3.82
Rate for Payer: Cash Price	$3.94
Rate for Payer: Cofinity Commercial	$4.63
Rate for Payer: Encore Health Key Benefits Commercial	$3.94
Rate for Payer: Healthscope Commercial	$4.93
Rate for Payer: Healthscope Whirlpool	$4.78
Rate for Payer: Mclaren Commercial	$4.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.19
Rate for Payer: Priority Health Cigna Priority Health	$3.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.34

HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION

Facility

$212.46

Service Code	HCPCS J3473
Hospital Charge Code	76338
Hospital Revenue Code	636
Min. Negotiated Rate	$148.72
Max. Negotiated Rate	$212.46
Rate for Payer: Aetna Commercial	$191.21
Rate for Payer: ASR ASR	$206.09
Rate for Payer: BCBS Trust/PPO	$164.72
Rate for Payer: BCN Commercial	$164.72
Rate for Payer: Cash Price	$169.97
Rate for Payer: Cofinity Commercial	$199.71
Rate for Payer: Encore Health Key Benefits Commercial	$169.97
Rate for Payer: Healthscope Commercial	$212.46
Rate for Payer: Healthscope Whirlpool	$206.09
Rate for Payer: Mclaren Commercial	$191.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$180.59
Rate for Payer: Priority Health Cigna Priority Health	$148.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$186.96

HYDRALAZINE 20 MG/ML INJECTION SOLUTION

Facility

$23.27

Service Code	HCPCS J0360
Hospital Charge Code	3697
Hospital Revenue Code	636
Min. Negotiated Rate	$16.29
Max. Negotiated Rate	$23.27
Rate for Payer: Aetna Commercial	$20.94
Rate for Payer: ASR ASR	$22.57
Rate for Payer: BCBS Trust/PPO	$18.04
Rate for Payer: BCN Commercial	$18.04
Rate for Payer: Cash Price	$18.61
Rate for Payer: Cofinity Commercial	$21.87
Rate for Payer: Encore Health Key Benefits Commercial	$18.62
Rate for Payer: Healthscope Commercial	$23.27
Rate for Payer: Healthscope Whirlpool	$22.57
Rate for Payer: Mclaren Commercial	$20.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.78
Rate for Payer: Priority Health Cigna Priority Health	$16.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$20.48

HYDRALAZINE 25 MG TABLET

Facility

$4.21

Service Code	NDC 51079-075-01
Hospital Charge Code	3700
Hospital Revenue Code	637
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$4.21
Rate for Payer: Aetna Commercial	$3.79
Rate for Payer: ASR ASR	$4.08
Rate for Payer: BCBS Trust/PPO	$3.26
Rate for Payer: BCN Commercial	$3.26
Rate for Payer: Cash Price	$3.37
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.37
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Healthscope Whirlpool	$4.08
Rate for Payer: Mclaren Commercial	$3.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.58
Rate for Payer: Priority Health Cigna Priority Health	$2.95
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.70

Know your out-of-pocket cost for care.

All Charges