Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HC Z VASCULAR CLOSURE

Facility

$1,041.32

Service Code	HCPCS C1760
Hospital Charge Code	27200098
Hospital Revenue Code	272
Min. Negotiated Rate	$780.99
Max. Negotiated Rate	$1,041.32
Rate for Payer: Aetna Commercial	$937.19
Rate for Payer: ASR ASR	$1,010.08
Rate for Payer: BCBS Trust/PPO	$855.13
Rate for Payer: BCN Commercial	$855.13
Rate for Payer: Cash Price	$833.06
Rate for Payer: Cofinity Commercial	$978.84
Rate for Payer: Encore Health Key Benefits Commercial	$833.06
Rate for Payer: Healthscope Commercial	$1,010.08
Rate for Payer: Healthscope Whirlpool	$1,041.32
Rate for Payer: Mclaren Commercial	$937.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$885.12
Rate for Payer: Nomi Health Commercial	$853.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$780.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$916.36

HC Z VENA CAVA FILTER

Facility

$5,988.76

Service Code	HCPCS C1880
Hospital Charge Code	27800042
Hospital Revenue Code	278
Min. Negotiated Rate	$2,215.84
Max. Negotiated Rate	$5,988.76
Rate for Payer: Aetna Commercial	$5,389.88
Rate for Payer: Aetna Medicare	$2,215.84
Rate for Payer: ASR ASR	$5,809.10
Rate for Payer: BCBS Complete	$2,395.50
Rate for Payer: BCBS Trust/PPO	$4,937.73
Rate for Payer: BCN Commercial	$4,937.73
Rate for Payer: Cash Price	$4,791.01
Rate for Payer: Cofinity Commercial	$5,629.43
Rate for Payer: Encore Health Key Benefits Commercial	$4,791.01
Rate for Payer: Healthscope Commercial	$5,809.10
Rate for Payer: Healthscope Whirlpool	$5,988.76
Rate for Payer: Mclaren Commercial	$5,389.88
Rate for Payer: MI Amish Medical Board Commercial	$4,791.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,090.45
Rate for Payer: Nomi Health Commercial	$4,910.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,491.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5,247.35
Rate for Payer: Priority Health Narrow Network	$4,198.12
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,270.11

HC Z VENA CAVA FILTER

Facility

$5,988.76

Service Code	HCPCS C1880
Hospital Charge Code	27800042
Hospital Revenue Code	278
Min. Negotiated Rate	$4,491.57
Max. Negotiated Rate	$5,988.76
Rate for Payer: Aetna Commercial	$5,389.88
Rate for Payer: ASR ASR	$5,809.10
Rate for Payer: BCBS Trust/PPO	$4,917.97
Rate for Payer: BCN Commercial	$4,917.97
Rate for Payer: Cash Price	$4,791.01
Rate for Payer: Cofinity Commercial	$5,629.43
Rate for Payer: Encore Health Key Benefits Commercial	$4,791.01
Rate for Payer: Healthscope Commercial	$5,809.10
Rate for Payer: Healthscope Whirlpool	$5,988.76
Rate for Payer: Mclaren Commercial	$5,389.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,090.45
Rate for Payer: Nomi Health Commercial	$4,910.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,491.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,270.11

HEADACHES WITH MCC

Facility

$15,399.82

Service Code	MSDRG 102
Min. Negotiated Rate	$9,335.02
Max. Negotiated Rate	$15,399.82
Rate for Payer: Aetna Medicare	$9,826.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,282.92
Rate for Payer: Amish Plain Church Group Commercial	$12,282.92
Rate for Payer: BCBS MAPPO	$9,826.34
Rate for Payer: BCN Medicare Advantage	$9,826.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,826.34
Rate for Payer: Humana Choice PPO Medicare	$9,826.34
Rate for Payer: Mclaren Medicare	$9,826.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,317.66
Rate for Payer: MI Amish Medical Board Commercial	$11,300.29
Rate for Payer: Molina Medicare/Medicaid	$10,808.97
Rate for Payer: PACE Medicare	$9,335.02
Rate for Payer: PACE SWMI	$9,826.34
Rate for Payer: PHP Commercial	$10,808.97
Rate for Payer: PHP Medicare Advantage	$9,826.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$15,399.82
Rate for Payer: Priority Health Medicare	$9,826.34
Rate for Payer: Priority Health Narrow Network	$12,319.86
Rate for Payer: Railroad Medicare Medicare	$9,826.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,826.34
Rate for Payer: UHC Exchange	$15,230.83
Rate for Payer: UHCCP DNSP	$9,826.34
Rate for Payer: VA VA	$9,826.34

HEADACHES WITHOUT MCC

Facility

$12,054.13

Service Code	MSDRG 103
Min. Negotiated Rate	$7,388.02
Max. Negotiated Rate	$12,054.13
Rate for Payer: Aetna Medicare	$7,776.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,721.08
Rate for Payer: Amish Plain Church Group Commercial	$9,721.08
Rate for Payer: BCBS MAPPO	$7,776.86
Rate for Payer: BCN Medicare Advantage	$7,776.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,776.86
Rate for Payer: Humana Choice PPO Medicare	$7,776.86
Rate for Payer: Mclaren Medicare	$7,776.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,165.70
Rate for Payer: MI Amish Medical Board Commercial	$8,943.39
Rate for Payer: Molina Medicare/Medicaid	$8,554.55
Rate for Payer: PACE Medicare	$7,388.02
Rate for Payer: PACE SWMI	$7,776.86
Rate for Payer: PHP Commercial	$8,554.55
Rate for Payer: PHP Medicare Advantage	$7,776.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,489.76
Rate for Payer: Priority Health Medicare	$7,776.86
Rate for Payer: Priority Health Narrow Network	$9,191.81
Rate for Payer: Railroad Medicare Medicare	$7,776.86
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,776.86
Rate for Payer: UHC Exchange	$12,054.13
Rate for Payer: UHCCP DNSP	$7,776.86
Rate for Payer: VA VA	$7,776.86

HEAD TRAUMA WITH COMA < 1 HOUR

Facility

$11,786.72

Service Code	APR-DRG 0604
Min. Negotiated Rate	$10,656.61
Max. Negotiated Rate	$11,786.72
Rate for Payer: BCBS Complete	$11,786.72
Rate for Payer: Mclaren Medicaid	$11,225.45
Rate for Payer: Meridian Medicaid	$11,786.72
Rate for Payer: PHP Medicaid	$10,656.61
Rate for Payer: Priority Health Choice Medicaid	$11,225.45
Rate for Payer: UHC Medicaid	$11,225.45
Rate for Payer: UHCCP Medicaid	$11,225.45

HEAD TRAUMA WITH COMA < 1 HOUR

Facility

$3,422.83

Service Code	APR-DRG 0601
Min. Negotiated Rate	$3,094.65
Max. Negotiated Rate	$3,422.83
Rate for Payer: BCBS Complete	$3,422.83
Rate for Payer: Mclaren Medicaid	$3,259.84
Rate for Payer: Meridian Medicaid	$3,422.83
Rate for Payer: PHP Medicaid	$3,094.65
Rate for Payer: Priority Health Choice Medicaid	$3,259.84
Rate for Payer: UHC Medicaid	$3,259.84
Rate for Payer: UHCCP Medicaid	$3,259.84

HEAD TRAUMA WITH COMA < 1 HOUR

Facility

$4,885.48

Service Code	APR-DRG 0602
Min. Negotiated Rate	$4,417.06
Max. Negotiated Rate	$4,885.48
Rate for Payer: BCBS Complete	$4,885.48
Rate for Payer: Mclaren Medicaid	$4,652.84
Rate for Payer: Meridian Medicaid	$4,885.48
Rate for Payer: PHP Medicaid	$4,417.06
Rate for Payer: Priority Health Choice Medicaid	$4,652.84
Rate for Payer: UHC Medicaid	$4,652.84
Rate for Payer: UHCCP Medicaid	$4,652.84

HEAD TRAUMA WITH COMA < 1 HOUR

Facility

$6,960.65

Service Code	APR-DRG 0603
Min. Negotiated Rate	$6,293.26
Max. Negotiated Rate	$6,960.65
Rate for Payer: BCBS Complete	$6,960.65
Rate for Payer: Mclaren Medicaid	$6,629.19
Rate for Payer: Meridian Medicaid	$6,960.65
Rate for Payer: PHP Medicaid	$6,293.26
Rate for Payer: Priority Health Choice Medicaid	$6,629.19
Rate for Payer: UHC Medicaid	$6,629.19
Rate for Payer: UHCCP Medicaid	$6,629.19

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$10,138.79

Service Code	APR-DRG 0553
Min. Negotiated Rate	$9,166.68
Max. Negotiated Rate	$10,138.79
Rate for Payer: BCBS Complete	$10,138.79
Rate for Payer: Mclaren Medicaid	$9,656.00
Rate for Payer: Meridian Medicaid	$10,138.79
Rate for Payer: PHP Medicaid	$9,166.68
Rate for Payer: Priority Health Choice Medicaid	$9,656.00
Rate for Payer: UHC Medicaid	$9,656.00
Rate for Payer: UHCCP Medicaid	$9,656.00

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$4,269.68

Service Code	APR-DRG 0551
Min. Negotiated Rate	$3,860.30
Max. Negotiated Rate	$4,269.68
Rate for Payer: BCBS Complete	$4,269.68
Rate for Payer: Mclaren Medicaid	$4,066.36
Rate for Payer: Meridian Medicaid	$4,269.68
Rate for Payer: PHP Medicaid	$3,860.30
Rate for Payer: Priority Health Choice Medicaid	$4,066.36
Rate for Payer: UHC Medicaid	$4,066.36
Rate for Payer: UHCCP Medicaid	$4,066.36

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$13,979.60

Service Code	APR-DRG 0554
Min. Negotiated Rate	$12,639.23
Max. Negotiated Rate	$13,979.60
Rate for Payer: BCBS Complete	$13,979.60
Rate for Payer: Mclaren Medicaid	$13,313.91
Rate for Payer: Meridian Medicaid	$13,979.60
Rate for Payer: PHP Medicaid	$12,639.23
Rate for Payer: Priority Health Choice Medicaid	$13,313.91
Rate for Payer: UHC Medicaid	$13,313.91
Rate for Payer: UHCCP Medicaid	$13,313.91

HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE

Facility

$6,148.67

Service Code	APR-DRG 0552
Min. Negotiated Rate	$5,559.13
Max. Negotiated Rate	$6,148.67
Rate for Payer: BCBS Complete	$6,148.67
Rate for Payer: Mclaren Medicaid	$5,855.88
Rate for Payer: Meridian Medicaid	$6,148.67
Rate for Payer: PHP Medicaid	$5,559.13
Rate for Payer: Priority Health Choice Medicaid	$5,855.88
Rate for Payer: UHC Medicaid	$5,855.88
Rate for Payer: UHCCP Medicaid	$5,855.88

HEARING AID RESTOCKING FEE

Professional

Both

$137.00

Hospital Revenue Code	990
Min. Negotiated Rate	$54.80
Max. Negotiated Rate	$102.75
Rate for Payer: BCBS Complete	$54.80
Rate for Payer: Cash Price	$109.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.75

HEART FAILURE

Facility

$3,074.61

Service Code	APR-DRG 1941
Min. Negotiated Rate	$2,779.81
Max. Negotiated Rate	$3,074.61
Rate for Payer: BCBS Complete	$3,074.61
Rate for Payer: Mclaren Medicaid	$2,928.20
Rate for Payer: Meridian Medicaid	$3,074.61
Rate for Payer: PHP Medicaid	$2,779.81
Rate for Payer: Priority Health Choice Medicaid	$2,928.20
Rate for Payer: UHC Medicaid	$2,928.20
Rate for Payer: UHCCP Medicaid	$2,928.20

HEART FAILURE

Facility

$4,168.32

Service Code	APR-DRG 1942
Min. Negotiated Rate	$3,768.66
Max. Negotiated Rate	$4,168.32
Rate for Payer: BCBS Complete	$4,168.32
Rate for Payer: Mclaren Medicaid	$3,969.83
Rate for Payer: Meridian Medicaid	$4,168.32
Rate for Payer: PHP Medicaid	$3,768.66
Rate for Payer: Priority Health Choice Medicaid	$3,969.83
Rate for Payer: UHC Medicaid	$3,969.83
Rate for Payer: UHCCP Medicaid	$3,969.83

HEART FAILURE

Facility

$13,242.83

Service Code	APR-DRG 1944
Min. Negotiated Rate	$11,973.10
Max. Negotiated Rate	$13,242.83
Rate for Payer: BCBS Complete	$13,242.83
Rate for Payer: Mclaren Medicaid	$12,612.22
Rate for Payer: Meridian Medicaid	$13,242.83
Rate for Payer: PHP Medicaid	$11,973.10
Rate for Payer: Priority Health Choice Medicaid	$12,612.22
Rate for Payer: UHC Medicaid	$12,612.22
Rate for Payer: UHCCP Medicaid	$12,612.22

HEART FAILURE

Facility

$5,654.40

Service Code	APR-DRG 1943
Min. Negotiated Rate	$5,112.26
Max. Negotiated Rate	$5,654.40
Rate for Payer: BCBS Complete	$5,654.40
Rate for Payer: Mclaren Medicaid	$5,385.14
Rate for Payer: Meridian Medicaid	$5,654.40
Rate for Payer: PHP Medicaid	$5,112.26
Rate for Payer: Priority Health Choice Medicaid	$5,385.14
Rate for Payer: UHC Medicaid	$5,385.14
Rate for Payer: UHCCP Medicaid	$5,385.14

HEART FAILURE AND SHOCK WITH CC

Facility

$12,195.88

Service Code	MSDRG 292
Min. Negotiated Rate	$7,474.89
Max. Negotiated Rate	$12,195.88
Rate for Payer: Aetna Medicare	$7,868.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,835.39
Rate for Payer: Amish Plain Church Group Commercial	$9,835.39
Rate for Payer: BCBS MAPPO	$7,868.31
Rate for Payer: BCN Medicare Advantage	$7,868.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,868.31
Rate for Payer: Humana Choice PPO Medicare	$7,868.31
Rate for Payer: Mclaren Medicare	$7,868.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,261.73
Rate for Payer: MI Amish Medical Board Commercial	$9,048.56
Rate for Payer: Molina Medicare/Medicaid	$8,655.14
Rate for Payer: PACE Medicare	$7,474.89
Rate for Payer: PACE SWMI	$7,868.31
Rate for Payer: PHP Commercial	$8,655.14
Rate for Payer: PHP Medicare Advantage	$7,868.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,664.24
Rate for Payer: Priority Health Medicare	$7,868.31
Rate for Payer: Priority Health Narrow Network	$9,331.39
Rate for Payer: Railroad Medicare Medicare	$7,868.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,868.31
Rate for Payer: UHC Exchange	$12,195.88
Rate for Payer: UHCCP DNSP	$7,868.31
Rate for Payer: VA VA	$7,868.31

HEART FAILURE AND SHOCK WITH MCC

Facility

$17,637.87

Service Code	MSDRG 291
Min. Negotiated Rate	$10,449.45
Max. Negotiated Rate	$17,637.87
Rate for Payer: Aetna Medicare	$10,999.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,749.27
Rate for Payer: Amish Plain Church Group Commercial	$13,749.27
Rate for Payer: BCBS MAPPO	$10,999.42
Rate for Payer: BCN Medicare Advantage	$10,999.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,999.42
Rate for Payer: Humana Choice PPO Medicare	$10,999.42
Rate for Payer: Mclaren Medicare	$10,999.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,549.39
Rate for Payer: MI Amish Medical Board Commercial	$12,649.33
Rate for Payer: Molina Medicare/Medicaid	$12,099.36
Rate for Payer: PACE Medicare	$10,449.45
Rate for Payer: PACE SWMI	$10,999.42
Rate for Payer: PHP Commercial	$12,099.36
Rate for Payer: PHP Medicare Advantage	$10,999.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$17,637.87
Rate for Payer: Priority Health Medicare	$10,999.42
Rate for Payer: Priority Health Narrow Network	$14,110.30
Rate for Payer: Railroad Medicare Medicare	$10,999.42
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,999.42
Rate for Payer: UHC Exchange	$17,049.10
Rate for Payer: UHCCP DNSP	$10,999.42
Rate for Payer: VA VA	$10,999.42

HEART FAILURE AND SHOCK WITHOUT CC/MCC

Facility

$9,037.06

Service Code	MSDRG 293
Min. Negotiated Rate	$5,538.84
Max. Negotiated Rate	$9,037.06
Rate for Payer: Aetna Medicare	$5,830.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,287.95
Rate for Payer: Amish Plain Church Group Commercial	$7,287.95
Rate for Payer: BCBS MAPPO	$5,830.36
Rate for Payer: BCN Medicare Advantage	$5,830.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,830.36
Rate for Payer: Humana Choice PPO Medicare	$5,830.36
Rate for Payer: Mclaren Medicare	$5,830.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,121.88
Rate for Payer: MI Amish Medical Board Commercial	$6,704.91
Rate for Payer: Molina Medicare/Medicaid	$6,413.40
Rate for Payer: PACE Medicare	$5,538.84
Rate for Payer: PACE SWMI	$5,830.36
Rate for Payer: PHP Commercial	$6,413.40
Rate for Payer: PHP Medicare Advantage	$5,830.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7,776.16
Rate for Payer: Priority Health Medicare	$5,830.36
Rate for Payer: Priority Health Narrow Network	$6,220.93
Rate for Payer: Railroad Medicare Medicare	$5,830.36
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,830.36
Rate for Payer: UHC Exchange	$9,037.06
Rate for Payer: UHCCP DNSP	$5,830.36
Rate for Payer: VA VA	$5,830.36

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC

Facility

$385,014.76

Service Code	MSDRG 001
Min. Negotiated Rate	$193,383.31
Max. Negotiated Rate	$385,014.76
Rate for Payer: Aetna Medicare	$203,561.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$254,451.73
Rate for Payer: Amish Plain Church Group Commercial	$254,451.73
Rate for Payer: BCBS MAPPO	$203,561.38
Rate for Payer: BCN Medicare Advantage	$203,561.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$203,561.38
Rate for Payer: Humana Choice PPO Medicare	$203,561.38
Rate for Payer: Mclaren Medicare	$203,561.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$213,739.45
Rate for Payer: MI Amish Medical Board Commercial	$234,095.59
Rate for Payer: Molina Medicare/Medicaid	$223,917.52
Rate for Payer: PACE Medicare	$193,383.31
Rate for Payer: PACE SWMI	$203,561.38
Rate for Payer: PHP Commercial	$223,917.52
Rate for Payer: PHP Medicare Advantage	$203,561.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$385,014.76
Rate for Payer: Priority Health Medicare	$203,561.38
Rate for Payer: Priority Health Narrow Network	$308,011.81
Rate for Payer: Railroad Medicare Medicare	$203,561.38
Rate for Payer: UHCCP DNSP	$203,561.38
Rate for Payer: VA VA	$203,561.38

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC

Facility

$155,685.33

Service Code	MSDRG 002
Min. Negotiated Rate	$79,189.63
Max. Negotiated Rate	$155,685.33
Rate for Payer: Aetna Medicare	$83,357.51
Rate for Payer: Allen County Amish Medical Aid Commercial	$104,196.89
Rate for Payer: Amish Plain Church Group Commercial	$104,196.89
Rate for Payer: BCBS MAPPO	$83,357.51
Rate for Payer: BCN Medicare Advantage	$83,357.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$83,357.51
Rate for Payer: Humana Choice PPO Medicare	$83,357.51
Rate for Payer: Mclaren Medicare	$83,357.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$87,525.39
Rate for Payer: MI Amish Medical Board Commercial	$95,861.14
Rate for Payer: Molina Medicare/Medicaid	$91,693.26
Rate for Payer: PACE Medicare	$79,189.63
Rate for Payer: PACE SWMI	$83,357.51
Rate for Payer: PHP Commercial	$91,693.26
Rate for Payer: PHP Medicare Advantage	$83,357.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$155,685.33
Rate for Payer: Priority Health Medicare	$83,357.51
Rate for Payer: Priority Health Narrow Network	$124,548.27
Rate for Payer: Railroad Medicare Medicare	$83,357.51
Rate for Payer: UHCCP DNSP	$83,357.51
Rate for Payer: VA VA	$83,357.51

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$12,979.62

Service Code	APR-DRG 8104
Min. Negotiated Rate	$11,735.13
Max. Negotiated Rate	$12,979.62
Rate for Payer: BCBS Complete	$12,979.62
Rate for Payer: Mclaren Medicaid	$12,361.54
Rate for Payer: Meridian Medicaid	$12,979.62
Rate for Payer: PHP Medicaid	$11,735.13
Rate for Payer: Priority Health Choice Medicaid	$12,361.54
Rate for Payer: UHC Medicaid	$12,361.54
Rate for Payer: UHCCP Medicaid	$12,361.54

HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION

Facility

$4,403.74

Service Code	APR-DRG 8102
Min. Negotiated Rate	$3,981.51
Max. Negotiated Rate	$4,403.74
Rate for Payer: BCBS Complete	$4,403.74
Rate for Payer: Mclaren Medicaid	$4,194.04
Rate for Payer: Meridian Medicaid	$4,403.74
Rate for Payer: PHP Medicaid	$3,981.51
Rate for Payer: Priority Health Choice Medicaid	$4,194.04
Rate for Payer: UHC Medicaid	$4,194.04
Rate for Payer: UHCCP Medicaid	$4,194.04

Know your out-of-pocket cost for care.

All Charges