Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PEPTAMEN INTENSE VHP CYCLIC FEED

Facility

$15.72

Service Code	NDC 4390073049
Hospital Charge Code	300422
Hospital Revenue Code	637
Min. Negotiated Rate	$11.00
Max. Negotiated Rate	$15.72
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: ASR ASR	$15.25
Rate for Payer: BCBS Trust/PPO	$12.19
Rate for Payer: BCN Commercial	$12.19
Rate for Payer: Cash Price	$12.58
Rate for Payer: Cofinity Commercial	$14.78
Rate for Payer: Encore Health Key Benefits Commercial	$12.58
Rate for Payer: Healthscope Commercial	$15.72
Rate for Payer: Healthscope Whirlpool	$15.25
Rate for Payer: Mclaren Commercial	$14.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.36
Rate for Payer: Priority Health Cigna Priority Health	$11.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.83

PEPTAMEN INTENSE VHP CYCLIC FEED

Facility

$70.30

Service Code	NDC 4390072395
Hospital Charge Code	300422
Hospital Revenue Code	637
Min. Negotiated Rate	$49.21
Max. Negotiated Rate	$70.30
Rate for Payer: Aetna Commercial	$63.27
Rate for Payer: ASR ASR	$68.19
Rate for Payer: BCBS Trust/PPO	$54.50
Rate for Payer: BCN Commercial	$54.50
Rate for Payer: Cash Price	$56.24
Rate for Payer: Cofinity Commercial	$66.08
Rate for Payer: Encore Health Key Benefits Commercial	$56.24
Rate for Payer: Healthscope Commercial	$70.30
Rate for Payer: Healthscope Whirlpool	$68.19
Rate for Payer: Mclaren Commercial	$63.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$59.76
Rate for Payer: Priority Health Cigna Priority Health	$49.21
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$61.86

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC

Facility

$50,037.48

Service Code	MS-DRG 273
Min. Negotiated Rate	$32,940.76
Max. Negotiated Rate	$50,037.48
Rate for Payer: Aetna Medicare	$34,674.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$43,343.10
Rate for Payer: Amish Plain Church Group Commercial	$43,343.10
Rate for Payer: BCBS MAPPO	$34,674.48
Rate for Payer: BCN Medicare Advantage	$34,674.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$34,674.48
Rate for Payer: Humana Choice PPO Medicare	$34,674.48
Rate for Payer: Mclaren Medicare	$34,674.48
Rate for Payer: Meridian Wellcare - Medicare Advantage	$36,408.20
Rate for Payer: MI Amish Medical Board Commercial	$39,875.65
Rate for Payer: PACE Medicare	$32,940.76
Rate for Payer: PACE SWMI	$34,674.48
Rate for Payer: PHP Commercial	$38,141.93
Rate for Payer: PHP Medicare Advantage	$34,674.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$50,037.48
Rate for Payer: Priority Health Medicare	$34,674.48
Rate for Payer: Priority Health Narrow Network	$40,029.98
Rate for Payer: Railroad Medicare Medicare	$34,674.48
Rate for Payer: UHC Medicare Advantage	$35,714.71
Rate for Payer: VA VA	$34,674.48

PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC

Facility

$41,611.87

Service Code	MS-DRG 274
Min. Negotiated Rate	$27,662.90
Max. Negotiated Rate	$41,611.87
Rate for Payer: Aetna Medicare	$29,118.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$36,398.55
Rate for Payer: Amish Plain Church Group Commercial	$36,398.55
Rate for Payer: BCBS MAPPO	$29,118.84
Rate for Payer: BCN Medicare Advantage	$29,118.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$29,118.84
Rate for Payer: Humana Choice PPO Medicare	$29,118.84
Rate for Payer: Mclaren Medicare	$29,118.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$30,574.78
Rate for Payer: MI Amish Medical Board Commercial	$33,486.67
Rate for Payer: PACE Medicare	$27,662.90
Rate for Payer: PACE SWMI	$29,118.84
Rate for Payer: PHP Commercial	$32,030.72
Rate for Payer: PHP Medicare Advantage	$29,118.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41,611.87
Rate for Payer: Priority Health Medicare	$29,118.84
Rate for Payer: Priority Health Narrow Network	$33,289.50
Rate for Payer: Railroad Medicare Medicare	$29,118.84
Rate for Payer: UHC Medicare Advantage	$29,992.41
Rate for Payer: VA VA	$29,118.84

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES

Facility

$36,911.15

Service Code	MS-DRG 321
Min. Negotiated Rate	$24,718.33
Max. Negotiated Rate	$36,911.15
Rate for Payer: Aetna Medicare	$26,019.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$32,524.11
Rate for Payer: Amish Plain Church Group Commercial	$32,524.11
Rate for Payer: BCBS MAPPO	$26,019.29
Rate for Payer: BCN Medicare Advantage	$26,019.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,019.29
Rate for Payer: Humana Choice PPO Medicare	$26,019.29
Rate for Payer: Mclaren Medicare	$26,019.29
Rate for Payer: Meridian Wellcare - Medicare Advantage	$27,320.25
Rate for Payer: MI Amish Medical Board Commercial	$29,922.18
Rate for Payer: PACE Medicare	$24,718.33
Rate for Payer: PACE SWMI	$26,019.29
Rate for Payer: PHP Commercial	$28,621.22
Rate for Payer: PHP Medicare Advantage	$26,019.29
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36,911.15
Rate for Payer: Priority Health Medicare	$26,019.29
Rate for Payer: Priority Health Narrow Network	$29,528.92
Rate for Payer: Railroad Medicare Medicare	$26,019.29
Rate for Payer: UHC Medicare Advantage	$26,799.87
Rate for Payer: VA VA	$26,019.29

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC

Facility

$23,412.46

Service Code	MS-DRG 322
Min. Negotiated Rate	$16,262.63
Max. Negotiated Rate	$23,412.46
Rate for Payer: Aetna Medicare	$17,118.56
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,398.20
Rate for Payer: Amish Plain Church Group Commercial	$21,398.20
Rate for Payer: BCBS MAPPO	$17,118.56
Rate for Payer: BCN Medicare Advantage	$17,118.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,118.56
Rate for Payer: Humana Choice PPO Medicare	$17,118.56
Rate for Payer: Mclaren Medicare	$17,118.56
Rate for Payer: Meridian Wellcare - Medicare Advantage	$17,974.49
Rate for Payer: MI Amish Medical Board Commercial	$19,686.34
Rate for Payer: PACE Medicare	$16,262.63
Rate for Payer: PACE SWMI	$17,118.56
Rate for Payer: PHP Commercial	$18,830.42
Rate for Payer: PHP Medicare Advantage	$17,118.56
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,412.46
Rate for Payer: Priority Health Medicare	$17,118.56
Rate for Payer: Priority Health Narrow Network	$18,729.97
Rate for Payer: Railroad Medicare Medicare	$17,118.56
Rate for Payer: UHC Medicare Advantage	$17,632.12
Rate for Payer: VA VA	$17,118.56

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC

Facility

$30,184.27

Service Code	MS-DRG 250
Min. Negotiated Rate	$20,504.55
Max. Negotiated Rate	$30,184.27
Rate for Payer: Aetna Medicare	$21,583.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,979.68
Rate for Payer: Amish Plain Church Group Commercial	$26,979.68
Rate for Payer: BCBS MAPPO	$21,583.74
Rate for Payer: BCN Medicare Advantage	$21,583.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$21,583.74
Rate for Payer: Humana Choice PPO Medicare	$21,583.74
Rate for Payer: Mclaren Medicare	$21,583.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22,662.93
Rate for Payer: MI Amish Medical Board Commercial	$24,821.30
Rate for Payer: PACE Medicare	$20,504.55
Rate for Payer: PACE SWMI	$21,583.74
Rate for Payer: PHP Commercial	$23,742.11
Rate for Payer: PHP Medicare Advantage	$21,583.74
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$30,184.27
Rate for Payer: Priority Health Medicare	$21,583.74
Rate for Payer: Priority Health Narrow Network	$24,147.42
Rate for Payer: Railroad Medicare Medicare	$21,583.74
Rate for Payer: UHC Medicare Advantage	$22,231.25
Rate for Payer: VA VA	$21,583.74

PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC

Facility

$20,375.80

Service Code	MS-DRG 251
Min. Negotiated Rate	$14,360.45
Max. Negotiated Rate	$20,375.80
Rate for Payer: Aetna Medicare	$15,116.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,895.32
Rate for Payer: Amish Plain Church Group Commercial	$18,895.32
Rate for Payer: BCBS MAPPO	$15,116.26
Rate for Payer: BCN Medicare Advantage	$15,116.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,116.26
Rate for Payer: Humana Choice PPO Medicare	$15,116.26
Rate for Payer: Mclaren Medicare	$15,116.26
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,872.07
Rate for Payer: MI Amish Medical Board Commercial	$17,383.70
Rate for Payer: PACE Medicare	$14,360.45
Rate for Payer: PACE SWMI	$15,116.26
Rate for Payer: PHP Commercial	$16,627.89
Rate for Payer: PHP Medicare Advantage	$15,116.26
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,375.80
Rate for Payer: Priority Health Medicare	$15,116.26
Rate for Payer: Priority Health Narrow Network	$16,300.64
Rate for Payer: Railroad Medicare Medicare	$15,116.26
Rate for Payer: UHC Medicare Advantage	$15,569.75
Rate for Payer: VA VA	$15,116.26

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$28,642.19

Service Code	MS-DRG 041
Min. Negotiated Rate	$19,538.58
Max. Negotiated Rate	$28,642.19
Rate for Payer: Aetna Medicare	$20,566.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$25,708.66
Rate for Payer: Amish Plain Church Group Commercial	$25,708.66
Rate for Payer: BCBS MAPPO	$20,566.93
Rate for Payer: BCN Medicare Advantage	$20,566.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,566.93
Rate for Payer: Humana Choice PPO Medicare	$20,566.93
Rate for Payer: Mclaren Medicare	$20,566.93
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21,595.28
Rate for Payer: MI Amish Medical Board Commercial	$23,651.97
Rate for Payer: PACE Medicare	$19,538.58
Rate for Payer: PACE SWMI	$20,566.93
Rate for Payer: PHP Commercial	$22,623.62
Rate for Payer: PHP Medicare Advantage	$20,566.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$28,642.19
Rate for Payer: Priority Health Medicare	$20,566.93
Rate for Payer: Priority Health Narrow Network	$22,913.75
Rate for Payer: Railroad Medicare Medicare	$20,566.93
Rate for Payer: UHC Medicare Advantage	$21,183.94
Rate for Payer: VA VA	$20,566.93

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$49,440.42

Service Code	MS-DRG 040
Min. Negotiated Rate	$32,566.76
Max. Negotiated Rate	$49,440.42
Rate for Payer: Aetna Medicare	$34,280.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$42,851.00
Rate for Payer: Amish Plain Church Group Commercial	$42,851.00
Rate for Payer: BCBS MAPPO	$34,280.80
Rate for Payer: BCN Medicare Advantage	$34,280.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$34,280.80
Rate for Payer: Humana Choice PPO Medicare	$34,280.80
Rate for Payer: Mclaren Medicare	$34,280.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$35,994.84
Rate for Payer: MI Amish Medical Board Commercial	$39,422.92
Rate for Payer: PACE Medicare	$32,566.76
Rate for Payer: PACE SWMI	$34,280.80
Rate for Payer: PHP Commercial	$37,708.88
Rate for Payer: PHP Medicare Advantage	$34,280.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49,440.42
Rate for Payer: Priority Health Medicare	$34,280.80
Rate for Payer: Priority Health Narrow Network	$39,552.34
Rate for Payer: Railroad Medicare Medicare	$34,280.80
Rate for Payer: UHC Medicare Advantage	$35,309.22
Rate for Payer: VA VA	$34,280.80

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$22,339.03

Service Code	MS-DRG 042
Min. Negotiated Rate	$15,590.24
Max. Negotiated Rate	$22,339.03
Rate for Payer: Aetna Medicare	$16,410.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,513.48
Rate for Payer: Amish Plain Church Group Commercial	$20,513.48
Rate for Payer: BCBS MAPPO	$16,410.78
Rate for Payer: BCN Medicare Advantage	$16,410.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,410.78
Rate for Payer: Humana Choice PPO Medicare	$16,410.78
Rate for Payer: Mclaren Medicare	$16,410.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$17,231.32
Rate for Payer: MI Amish Medical Board Commercial	$18,872.40
Rate for Payer: PACE Medicare	$15,590.24
Rate for Payer: PACE SWMI	$16,410.78
Rate for Payer: PHP Commercial	$18,051.86
Rate for Payer: PHP Medicare Advantage	$16,410.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,339.03
Rate for Payer: Priority Health Medicare	$16,410.78
Rate for Payer: Priority Health Narrow Network	$17,871.22
Rate for Payer: Railroad Medicare Medicare	$16,410.78
Rate for Payer: UHC Medicare Advantage	$16,903.10
Rate for Payer: VA VA	$16,410.78

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$13,700.28

Service Code	MS-DRG 300
Min. Negotiated Rate	$10,178.86
Max. Negotiated Rate	$13,700.28
Rate for Payer: Aetna Medicare	$10,714.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,393.24
Rate for Payer: Amish Plain Church Group Commercial	$13,393.24
Rate for Payer: BCBS MAPPO	$10,714.59
Rate for Payer: BCN Medicare Advantage	$10,714.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,714.59
Rate for Payer: Humana Choice PPO Medicare	$10,714.59
Rate for Payer: Mclaren Medicare	$10,714.59
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,250.32
Rate for Payer: MI Amish Medical Board Commercial	$12,321.78
Rate for Payer: PACE Medicare	$10,178.86
Rate for Payer: PACE SWMI	$10,714.59
Rate for Payer: PHP Commercial	$11,786.05
Rate for Payer: PHP Medicare Advantage	$10,714.59
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13,700.28
Rate for Payer: Priority Health Medicare	$10,714.59
Rate for Payer: Priority Health Narrow Network	$10,960.22
Rate for Payer: Railroad Medicare Medicare	$10,714.59
Rate for Payer: UHC Medicare Advantage	$11,036.03
Rate for Payer: VA VA	$10,714.59

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$20,238.41

Service Code	MS-DRG 299
Min. Negotiated Rate	$14,274.40
Max. Negotiated Rate	$20,238.41
Rate for Payer: Aetna Medicare	$15,025.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,782.10
Rate for Payer: Amish Plain Church Group Commercial	$18,782.10
Rate for Payer: BCBS MAPPO	$15,025.68
Rate for Payer: BCN Medicare Advantage	$15,025.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,025.68
Rate for Payer: Humana Choice PPO Medicare	$15,025.68
Rate for Payer: Mclaren Medicare	$15,025.68
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,776.96
Rate for Payer: MI Amish Medical Board Commercial	$17,279.53
Rate for Payer: PACE Medicare	$14,274.40
Rate for Payer: PACE SWMI	$15,025.68
Rate for Payer: PHP Commercial	$16,528.25
Rate for Payer: PHP Medicare Advantage	$15,025.68
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,238.41
Rate for Payer: Priority Health Medicare	$15,025.68
Rate for Payer: Priority Health Narrow Network	$16,190.73
Rate for Payer: Railroad Medicare Medicare	$15,025.68
Rate for Payer: UHC Medicare Advantage	$15,476.45
Rate for Payer: VA VA	$15,025.68

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$9,612.99

Service Code	MS-DRG 301
Min. Negotiated Rate	$7,291.06
Max. Negotiated Rate	$9,612.99
Rate for Payer: Aetna Medicare	$7,690.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,612.99
Rate for Payer: Amish Plain Church Group Commercial	$9,612.99
Rate for Payer: BCBS MAPPO	$7,690.39
Rate for Payer: BCN Medicare Advantage	$7,690.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,690.39
Rate for Payer: Humana Choice PPO Medicare	$7,690.39
Rate for Payer: Mclaren Medicare	$7,690.39
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,074.91
Rate for Payer: MI Amish Medical Board Commercial	$8,843.95
Rate for Payer: PACE Medicare	$7,305.87
Rate for Payer: PACE SWMI	$7,690.39
Rate for Payer: PHP Commercial	$8,459.43
Rate for Payer: PHP Medicare Advantage	$7,690.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,113.83
Rate for Payer: Priority Health Medicare	$7,690.39
Rate for Payer: Priority Health Narrow Network	$7,291.06
Rate for Payer: Railroad Medicare Medicare	$7,690.39
Rate for Payer: UHC Medicare Advantage	$7,921.10
Rate for Payer: VA VA	$7,690.39

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$27,032.05

Service Code	MS-DRG 336
Min. Negotiated Rate	$18,529.98
Max. Negotiated Rate	$27,032.05
Rate for Payer: Aetna Medicare	$19,505.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,381.55
Rate for Payer: Amish Plain Church Group Commercial	$24,381.55
Rate for Payer: BCBS MAPPO	$19,505.24
Rate for Payer: BCN Medicare Advantage	$19,505.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,505.24
Rate for Payer: Humana Choice PPO Medicare	$19,505.24
Rate for Payer: Mclaren Medicare	$19,505.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$20,480.50
Rate for Payer: MI Amish Medical Board Commercial	$22,431.03
Rate for Payer: PACE Medicare	$18,529.98
Rate for Payer: PACE SWMI	$19,505.24
Rate for Payer: PHP Commercial	$21,455.76
Rate for Payer: PHP Medicare Advantage	$19,505.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27,032.05
Rate for Payer: Priority Health Medicare	$19,505.24
Rate for Payer: Priority Health Narrow Network	$21,625.64
Rate for Payer: Railroad Medicare Medicare	$19,505.24
Rate for Payer: UHC Medicare Advantage	$20,090.40
Rate for Payer: VA VA	$19,505.24

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$45,903.00

Service Code	MS-DRG 335
Min. Negotiated Rate	$30,350.89
Max. Negotiated Rate	$45,903.00
Rate for Payer: Aetna Medicare	$31,948.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$39,935.39
Rate for Payer: Amish Plain Church Group Commercial	$39,935.39
Rate for Payer: BCBS MAPPO	$31,948.31
Rate for Payer: BCN Medicare Advantage	$31,948.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$31,948.31
Rate for Payer: Humana Choice PPO Medicare	$31,948.31
Rate for Payer: Mclaren Medicare	$31,948.31
Rate for Payer: Meridian Wellcare - Medicare Advantage	$33,545.73
Rate for Payer: MI Amish Medical Board Commercial	$36,740.56
Rate for Payer: PACE Medicare	$30,350.89
Rate for Payer: PACE SWMI	$31,948.31
Rate for Payer: PHP Commercial	$35,143.14
Rate for Payer: PHP Medicare Advantage	$31,948.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45,903.00
Rate for Payer: Priority Health Medicare	$31,948.31
Rate for Payer: Priority Health Narrow Network	$36,722.40
Rate for Payer: Railroad Medicare Medicare	$31,948.31
Rate for Payer: UHC Medicare Advantage	$32,906.76
Rate for Payer: VA VA	$31,948.31

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$19,213.78

Service Code	MS-DRG 337
Min. Negotiated Rate	$13,632.55
Max. Negotiated Rate	$19,213.78
Rate for Payer: Aetna Medicare	$14,350.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,937.56
Rate for Payer: Amish Plain Church Group Commercial	$17,937.56
Rate for Payer: BCBS MAPPO	$14,350.05
Rate for Payer: BCN Medicare Advantage	$14,350.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,350.05
Rate for Payer: Humana Choice PPO Medicare	$14,350.05
Rate for Payer: Mclaren Medicare	$14,350.05
Rate for Payer: Meridian Wellcare - Medicare Advantage	$15,067.55
Rate for Payer: MI Amish Medical Board Commercial	$16,502.56
Rate for Payer: PACE Medicare	$13,632.55
Rate for Payer: PACE SWMI	$14,350.05
Rate for Payer: PHP Commercial	$15,785.06
Rate for Payer: PHP Medicare Advantage	$14,350.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$19,213.78
Rate for Payer: Priority Health Medicare	$14,350.05
Rate for Payer: Priority Health Narrow Network	$15,371.02
Rate for Payer: Railroad Medicare Medicare	$14,350.05
Rate for Payer: UHC Medicare Advantage	$14,780.55
Rate for Payer: VA VA	$14,350.05

PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC

Facility

$29,244.38

Service Code	MS-DRG 243
Min. Negotiated Rate	$19,915.81
Max. Negotiated Rate	$29,244.38
Rate for Payer: Aetna Medicare	$20,964.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,205.01
Rate for Payer: Amish Plain Church Group Commercial	$26,205.01
Rate for Payer: BCBS MAPPO	$20,964.01
Rate for Payer: BCN Medicare Advantage	$20,964.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,964.01
Rate for Payer: Humana Choice PPO Medicare	$20,964.01
Rate for Payer: Mclaren Medicare	$20,964.01
Rate for Payer: Meridian Wellcare - Medicare Advantage	$22,012.21
Rate for Payer: MI Amish Medical Board Commercial	$24,108.61
Rate for Payer: PACE Medicare	$19,915.81
Rate for Payer: PACE SWMI	$20,964.01
Rate for Payer: PHP Commercial	$23,060.41
Rate for Payer: PHP Medicare Advantage	$20,964.01
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29,244.38
Rate for Payer: Priority Health Medicare	$20,964.01
Rate for Payer: Priority Health Narrow Network	$23,395.50
Rate for Payer: Railroad Medicare Medicare	$20,964.01
Rate for Payer: UHC Medicare Advantage	$21,592.93
Rate for Payer: VA VA	$20,964.01

PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC

Facility

$44,363.48

Service Code	MS-DRG 242
Min. Negotiated Rate	$29,386.53
Max. Negotiated Rate	$44,363.48
Rate for Payer: Aetna Medicare	$30,933.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$38,666.49
Rate for Payer: Amish Plain Church Group Commercial	$38,666.49
Rate for Payer: BCBS MAPPO	$30,933.19
Rate for Payer: BCN Medicare Advantage	$30,933.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$30,933.19
Rate for Payer: Humana Choice PPO Medicare	$30,933.19
Rate for Payer: Mclaren Medicare	$30,933.19
Rate for Payer: Meridian Wellcare - Medicare Advantage	$32,479.85
Rate for Payer: MI Amish Medical Board Commercial	$35,573.17
Rate for Payer: PACE Medicare	$29,386.53
Rate for Payer: PACE SWMI	$30,933.19
Rate for Payer: PHP Commercial	$34,026.51
Rate for Payer: PHP Medicare Advantage	$30,933.19
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44,363.48
Rate for Payer: Priority Health Medicare	$30,933.19
Rate for Payer: Priority Health Narrow Network	$35,490.78
Rate for Payer: Railroad Medicare Medicare	$30,933.19
Rate for Payer: UHC Medicare Advantage	$31,861.19
Rate for Payer: VA VA	$30,933.19

PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC

Facility

$23,490.78

Service Code	MS-DRG 244
Min. Negotiated Rate	$16,311.69
Max. Negotiated Rate	$23,490.78
Rate for Payer: Aetna Medicare	$17,170.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,462.75
Rate for Payer: Amish Plain Church Group Commercial	$21,462.75
Rate for Payer: BCBS MAPPO	$17,170.20
Rate for Payer: BCN Medicare Advantage	$17,170.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,170.20
Rate for Payer: Humana Choice PPO Medicare	$17,170.20
Rate for Payer: Mclaren Medicare	$17,170.20
Rate for Payer: Meridian Wellcare - Medicare Advantage	$18,028.71
Rate for Payer: MI Amish Medical Board Commercial	$19,745.73
Rate for Payer: PACE Medicare	$16,311.69
Rate for Payer: PACE SWMI	$17,170.20
Rate for Payer: PHP Commercial	$18,887.22
Rate for Payer: PHP Medicare Advantage	$17,170.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,490.78
Rate for Payer: Priority Health Medicare	$17,170.20
Rate for Payer: Priority Health Narrow Network	$18,792.62
Rate for Payer: Railroad Medicare Medicare	$17,170.20
Rate for Payer: UHC Medicare Advantage	$17,685.31
Rate for Payer: VA VA	$17,170.20

PERMETHRIN 5 % TOPICAL CREAM

Facility

$60.27

Service Code	NDC 21922-021-07
Hospital Charge Code	10917
Hospital Revenue Code	637
Min. Negotiated Rate	$42.19
Max. Negotiated Rate	$60.27
Rate for Payer: Aetna Commercial	$54.24
Rate for Payer: ASR ASR	$58.46
Rate for Payer: BCBS Trust/PPO	$46.73
Rate for Payer: BCN Commercial	$46.73
Rate for Payer: Cash Price	$48.22
Rate for Payer: Cofinity Commercial	$56.65
Rate for Payer: Encore Health Key Benefits Commercial	$48.22
Rate for Payer: Healthscope Commercial	$60.27
Rate for Payer: Healthscope Whirlpool	$58.46
Rate for Payer: Mclaren Commercial	$54.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.23
Rate for Payer: Priority Health Cigna Priority Health	$42.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$53.04

PERMETHRIN 5 % TOPICAL CREAM

Facility

$322.35

Service Code	NDC 0472-0242-60
Hospital Charge Code	10917
Hospital Revenue Code	637
Min. Negotiated Rate	$225.64
Max. Negotiated Rate	$322.35
Rate for Payer: Aetna Commercial	$290.12
Rate for Payer: ASR ASR	$312.68
Rate for Payer: BCBS Trust/PPO	$249.92
Rate for Payer: BCN Commercial	$249.92
Rate for Payer: Cash Price	$257.88
Rate for Payer: Cofinity Commercial	$303.01
Rate for Payer: Encore Health Key Benefits Commercial	$257.88
Rate for Payer: Healthscope Commercial	$322.35
Rate for Payer: Healthscope Whirlpool	$312.68
Rate for Payer: Mclaren Commercial	$290.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.00
Rate for Payer: Priority Health Cigna Priority Health	$225.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$283.67

PERMETHRIN 5 % TOPICAL CREAM

Facility

$322.35

Service Code	NDC 45802-269-37
Hospital Charge Code	10917
Hospital Revenue Code	637
Min. Negotiated Rate	$225.64
Max. Negotiated Rate	$322.35
Rate for Payer: Aetna Commercial	$290.12
Rate for Payer: ASR ASR	$312.68
Rate for Payer: BCBS Trust/PPO	$249.92
Rate for Payer: BCN Commercial	$249.92
Rate for Payer: Cash Price	$257.88
Rate for Payer: Cofinity Commercial	$303.01
Rate for Payer: Encore Health Key Benefits Commercial	$257.88
Rate for Payer: Healthscope Commercial	$322.35
Rate for Payer: Healthscope Whirlpool	$312.68
Rate for Payer: Mclaren Commercial	$290.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$274.00
Rate for Payer: Priority Health Cigna Priority Health	$225.64
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$283.67

PHENAZOPYRIDINE 200 MG TABLET

Facility

$326.80

Service Code	NDC 75826-115-10
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$228.76
Max. Negotiated Rate	$326.80
Rate for Payer: Aetna Commercial	$294.12
Rate for Payer: ASR ASR	$317.00
Rate for Payer: BCBS Trust/PPO	$253.37
Rate for Payer: BCN Commercial	$253.37
Rate for Payer: Cash Price	$261.44
Rate for Payer: Cofinity Commercial	$307.19
Rate for Payer: Encore Health Key Benefits Commercial	$261.44
Rate for Payer: Healthscope Commercial	$326.80
Rate for Payer: Healthscope Whirlpool	$317.00
Rate for Payer: Mclaren Commercial	$294.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$277.78
Rate for Payer: Priority Health Cigna Priority Health	$228.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$287.58

PHENAZOPYRIDINE 200 MG TABLET

Facility

$345.80

Service Code	NDC 65162-682-10
Hospital Charge Code	6194
Hospital Revenue Code	637
Min. Negotiated Rate	$242.06
Max. Negotiated Rate	$345.80
Rate for Payer: Aetna Commercial	$311.22
Rate for Payer: ASR ASR	$335.43
Rate for Payer: BCBS Trust/PPO	$268.10
Rate for Payer: BCN Commercial	$268.10
Rate for Payer: Cash Price	$276.64
Rate for Payer: Cofinity Commercial	$325.05
Rate for Payer: Encore Health Key Benefits Commercial	$276.64
Rate for Payer: Healthscope Commercial	$345.80
Rate for Payer: Healthscope Whirlpool	$335.43
Rate for Payer: Mclaren Commercial	$311.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$293.93
Rate for Payer: Priority Health Cigna Priority Health	$242.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$304.30

Know your out-of-pocket cost for care.

All Charges