Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

INDOMETHACIN 25 MG CAPSULE

Facility

$128.73

Service Code	NDC 50268043015
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$96.54
Max. Negotiated Rate	$128.72
Rate for Payer: Aetna Commercial	$115.85
Rate for Payer: ASR ASR	$124.86
Rate for Payer: BCBS Trust/PPO	$105.71
Rate for Payer: BCN Commercial	$105.71
Rate for Payer: Cash Price	$102.98
Rate for Payer: Cofinity Commercial	$121.00
Rate for Payer: Encore Health Key Benefits Commercial	$102.98
Rate for Payer: Healthscope Commercial	$124.86
Rate for Payer: Healthscope Whirlpool	$128.72
Rate for Payer: Mclaren Commercial	$115.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.42
Rate for Payer: Nomi Health Commercial	$105.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.54
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$113.28

INDOMETHACIN 25 MG CAPSULE

Facility

$128.73

Service Code	NDC 50268043015
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$128.72
Rate for Payer: Aetna Commercial	$115.85
Rate for Payer: Aetna Medicare	$47.63
Rate for Payer: ASR ASR	$124.86
Rate for Payer: BCBS Complete	$51.49
Rate for Payer: BCBS Trust/PPO	$106.13
Rate for Payer: BCN Commercial	$106.13
Rate for Payer: Cash Price	$102.98
Rate for Payer: Cofinity Commercial	$121.00
Rate for Payer: Encore Health Key Benefits Commercial	$102.98
Rate for Payer: Healthscope Commercial	$124.86
Rate for Payer: Healthscope Whirlpool	$128.72
Rate for Payer: Mclaren Commercial	$115.85
Rate for Payer: MI Amish Medical Board Commercial	$102.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$109.42
Rate for Payer: Nomi Health Commercial	$105.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$112.79
Rate for Payer: Priority Health Narrow Network	$90.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$113.28

INDOMETHACIN 25 MG CAPSULE

Facility

$420.65

Service Code	NDC 23155001001
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$155.64
Max. Negotiated Rate	$420.65
Rate for Payer: Aetna Commercial	$378.58
Rate for Payer: Aetna Medicare	$155.64
Rate for Payer: ASR ASR	$408.03
Rate for Payer: BCBS Complete	$168.26
Rate for Payer: BCBS Trust/PPO	$346.83
Rate for Payer: BCN Commercial	$346.83
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Commercial	$395.41
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$408.03
Rate for Payer: Healthscope Whirlpool	$420.65
Rate for Payer: Mclaren Commercial	$378.58
Rate for Payer: MI Amish Medical Board Commercial	$336.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.55
Rate for Payer: Nomi Health Commercial	$344.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$368.57
Rate for Payer: Priority Health Narrow Network	$294.88
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$370.17

INDOMETHACIN 25 MG CAPSULE

Facility

$2.58

Service Code	NDC 50268043011
Hospital Charge Code	3897
Hospital Revenue Code	637
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.58
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: ASR ASR	$2.50
Rate for Payer: BCBS Trust/PPO	$2.11
Rate for Payer: BCN Commercial	$2.11
Rate for Payer: Cash Price	$2.06
Rate for Payer: Cofinity Commercial	$2.42
Rate for Payer: Encore Health Key Benefits Commercial	$2.06
Rate for Payer: Healthscope Commercial	$2.50
Rate for Payer: Healthscope Whirlpool	$2.58
Rate for Payer: Mclaren Commercial	$2.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.19
Rate for Payer: Nomi Health Commercial	$2.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.27

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC

Facility

$13,646.94

Service Code	MSDRG 758
Min. Negotiated Rate	$8,364.26
Max. Negotiated Rate	$13,646.94
Rate for Payer: Aetna Medicare	$8,804.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,005.60
Rate for Payer: Amish Plain Church Group Commercial	$11,005.60
Rate for Payer: BCBS MAPPO	$8,804.48
Rate for Payer: BCN Medicare Advantage	$8,804.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,804.48
Rate for Payer: Humana Choice PPO Medicare	$8,804.48
Rate for Payer: Mclaren Medicare	$8,804.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,244.70
Rate for Payer: MI Amish Medical Board Commercial	$10,125.15
Rate for Payer: Molina Medicare/Medicaid	$9,684.93
Rate for Payer: PACE Medicare	$8,364.26
Rate for Payer: PACE SWMI	$8,804.48
Rate for Payer: PHP Commercial	$9,684.93
Rate for Payer: PHP Medicare Advantage	$8,804.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,450.29
Rate for Payer: Priority Health Medicare	$8,804.48
Rate for Payer: Priority Health Narrow Network	$10,760.23
Rate for Payer: Railroad Medicare Medicare	$8,804.48
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,804.48
Rate for Payer: UHC Exchange	$13,646.94
Rate for Payer: UHCCP DNSP	$8,804.48
Rate for Payer: VA VA	$8,804.48

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$19,672.59

Service Code	MSDRG 757
Min. Negotiated Rate	$11,462.63
Max. Negotiated Rate	$19,672.59
Rate for Payer: Aetna Medicare	$12,065.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,082.41
Rate for Payer: Amish Plain Church Group Commercial	$15,082.41
Rate for Payer: BCBS MAPPO	$12,065.93
Rate for Payer: BCN Medicare Advantage	$12,065.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,065.93
Rate for Payer: Humana Choice PPO Medicare	$12,065.93
Rate for Payer: Mclaren Medicare	$12,065.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,669.23
Rate for Payer: MI Amish Medical Board Commercial	$13,875.82
Rate for Payer: Molina Medicare/Medicaid	$13,272.52
Rate for Payer: PACE Medicare	$11,462.63
Rate for Payer: PACE SWMI	$12,065.93
Rate for Payer: PHP Commercial	$13,272.52
Rate for Payer: PHP Medicare Advantage	$12,065.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19,672.59
Rate for Payer: Priority Health Medicare	$12,065.93
Rate for Payer: Priority Health Narrow Network	$15,738.07
Rate for Payer: Railroad Medicare Medicare	$12,065.93
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,065.93
Rate for Payer: UHC Exchange	$18,702.19
Rate for Payer: UHCCP DNSP	$12,065.93
Rate for Payer: VA VA	$12,065.93

INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC

Facility

$10,126.46

Service Code	MSDRG 759
Min. Negotiated Rate	$6,206.54
Max. Negotiated Rate	$10,126.46
Rate for Payer: Aetna Medicare	$6,533.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,166.50
Rate for Payer: Amish Plain Church Group Commercial	$8,166.50
Rate for Payer: BCBS MAPPO	$6,533.20
Rate for Payer: BCN Medicare Advantage	$6,533.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,533.20
Rate for Payer: Humana Choice PPO Medicare	$6,533.20
Rate for Payer: Mclaren Medicare	$6,533.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,859.86
Rate for Payer: MI Amish Medical Board Commercial	$7,513.18
Rate for Payer: Molina Medicare/Medicaid	$7,186.52
Rate for Payer: PACE Medicare	$6,206.54
Rate for Payer: PACE SWMI	$6,533.20
Rate for Payer: PHP Commercial	$7,186.52
Rate for Payer: PHP Medicare Advantage	$6,533.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,117.07
Rate for Payer: Priority Health Medicare	$6,533.20
Rate for Payer: Priority Health Narrow Network	$7,293.65
Rate for Payer: Railroad Medicare Medicare	$6,533.20
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,533.20
Rate for Payer: UHC Exchange	$10,126.46
Rate for Payer: UHCCP DNSP	$6,533.20
Rate for Payer: VA VA	$6,533.20

INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$4,667.50

Service Code	APR-DRG 1133
Min. Negotiated Rate	$4,219.98
Max. Negotiated Rate	$4,667.50
Rate for Payer: BCBS Complete	$4,667.50
Rate for Payer: Mclaren Medicaid	$4,445.23
Rate for Payer: Meridian Medicaid	$4,667.50
Rate for Payer: PHP Medicaid	$4,219.98
Rate for Payer: Priority Health Choice Medicaid	$4,445.23
Rate for Payer: UHC Medicaid	$4,445.23
Rate for Payer: UHCCP Medicaid	$4,445.23

INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$2,246.83

Service Code	APR-DRG 1131
Min. Negotiated Rate	$2,031.40
Max. Negotiated Rate	$2,246.83
Rate for Payer: BCBS Complete	$2,246.83
Rate for Payer: Mclaren Medicaid	$2,139.84
Rate for Payer: Meridian Medicaid	$2,246.83
Rate for Payer: PHP Medicaid	$2,031.40
Rate for Payer: Priority Health Choice Medicaid	$2,139.84
Rate for Payer: UHC Medicaid	$2,139.84
Rate for Payer: UHCCP Medicaid	$2,139.84

INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$8,533.92

Service Code	APR-DRG 1134
Min. Negotiated Rate	$7,715.68
Max. Negotiated Rate	$8,533.92
Rate for Payer: BCBS Complete	$8,533.92
Rate for Payer: Mclaren Medicaid	$8,127.54
Rate for Payer: Meridian Medicaid	$8,533.92
Rate for Payer: PHP Medicaid	$7,715.68
Rate for Payer: Priority Health Choice Medicaid	$8,127.54
Rate for Payer: UHC Medicaid	$8,127.54
Rate for Payer: UHCCP Medicaid	$8,127.54

INFECTIONS OF UPPER RESPIRATORY TRACT

Facility

$2,975.43

Service Code	APR-DRG 1132
Min. Negotiated Rate	$2,690.14
Max. Negotiated Rate	$2,975.43
Rate for Payer: BCBS Complete	$2,975.43
Rate for Payer: Mclaren Medicaid	$2,833.74
Rate for Payer: Meridian Medicaid	$2,975.43
Rate for Payer: PHP Medicaid	$2,690.14
Rate for Payer: Priority Health Choice Medicaid	$2,833.74
Rate for Payer: UHC Medicaid	$2,833.74
Rate for Payer: UHCCP Medicaid	$2,833.74

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$8,246.18

Service Code	APR-DRG 7102
Min. Negotiated Rate	$7,455.54
Max. Negotiated Rate	$8,246.18
Rate for Payer: BCBS Complete	$8,246.18
Rate for Payer: Mclaren Medicaid	$7,853.51
Rate for Payer: Meridian Medicaid	$8,246.18
Rate for Payer: PHP Medicaid	$7,455.54
Rate for Payer: Priority Health Choice Medicaid	$7,853.51
Rate for Payer: UHC Medicaid	$7,853.51
Rate for Payer: UHCCP Medicaid	$7,853.51

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$7,697.42

Service Code	APR-DRG 7101
Min. Negotiated Rate	$6,959.39
Max. Negotiated Rate	$7,697.42
Rate for Payer: BCBS Complete	$7,697.42
Rate for Payer: Mclaren Medicaid	$7,330.88
Rate for Payer: Meridian Medicaid	$7,697.42
Rate for Payer: PHP Medicaid	$6,959.39
Rate for Payer: Priority Health Choice Medicaid	$7,330.88
Rate for Payer: UHC Medicaid	$7,330.88
Rate for Payer: UHCCP Medicaid	$7,330.88

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$13,632.47

Service Code	APR-DRG 7103
Min. Negotiated Rate	$12,325.38
Max. Negotiated Rate	$13,632.47
Rate for Payer: BCBS Complete	$13,632.47
Rate for Payer: Mclaren Medicaid	$12,983.30
Rate for Payer: Meridian Medicaid	$13,632.47
Rate for Payer: PHP Medicaid	$12,325.38
Rate for Payer: Priority Health Choice Medicaid	$12,983.30
Rate for Payer: UHC Medicaid	$12,983.30
Rate for Payer: UHCCP Medicaid	$12,983.30

INFECTIOUS AND PARASITIC DISEASES INCLUDING HIV WITH O.R. PROCEDURE

Facility

$20,290.12

Service Code	APR-DRG 7104
Min. Negotiated Rate	$18,344.70
Max. Negotiated Rate	$20,290.12
Rate for Payer: BCBS Complete	$20,290.12
Rate for Payer: Mclaren Medicaid	$19,323.93
Rate for Payer: Meridian Medicaid	$20,290.12
Rate for Payer: PHP Medicaid	$18,344.70
Rate for Payer: Priority Health Choice Medicaid	$19,323.93
Rate for Payer: UHC Medicaid	$19,323.93
Rate for Payer: UHCCP Medicaid	$19,323.93

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC

Facility

$27,451.50

Service Code	MSDRG 854
Min. Negotiated Rate	$15,336.10
Max. Negotiated Rate	$27,451.50
Rate for Payer: Aetna Medicare	$16,143.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,179.08
Rate for Payer: Amish Plain Church Group Commercial	$20,179.08
Rate for Payer: BCBS MAPPO	$16,143.26
Rate for Payer: BCN Medicare Advantage	$16,143.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,143.26
Rate for Payer: Humana Choice PPO Medicare	$16,143.26
Rate for Payer: Mclaren Medicare	$16,143.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,950.42
Rate for Payer: MI Amish Medical Board Commercial	$18,564.75
Rate for Payer: Molina Medicare/Medicaid	$17,757.59
Rate for Payer: PACE Medicare	$15,336.10
Rate for Payer: PACE SWMI	$16,143.26
Rate for Payer: PHP Commercial	$17,757.59
Rate for Payer: PHP Medicare Advantage	$16,143.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$27,451.50
Rate for Payer: Priority Health Medicare	$16,143.26
Rate for Payer: Priority Health Narrow Network	$21,961.20
Rate for Payer: Railroad Medicare Medicare	$16,143.26
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,143.26
Rate for Payer: UHC Exchange	$25,022.05
Rate for Payer: UHCCP DNSP	$16,143.26
Rate for Payer: VA VA	$16,143.26

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC

Facility

$67,850.44

Service Code	MSDRG 853
Min. Negotiated Rate	$35,452.59
Max. Negotiated Rate	$67,850.44
Rate for Payer: Aetna Medicare	$37,318.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$46,648.15
Rate for Payer: Amish Plain Church Group Commercial	$46,648.15
Rate for Payer: BCBS MAPPO	$37,318.52
Rate for Payer: BCN Medicare Advantage	$37,318.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$37,318.52
Rate for Payer: Humana Choice PPO Medicare	$37,318.52
Rate for Payer: Mclaren Medicare	$37,318.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$39,184.45
Rate for Payer: MI Amish Medical Board Commercial	$42,916.30
Rate for Payer: Molina Medicare/Medicaid	$41,050.37
Rate for Payer: PACE Medicare	$35,452.59
Rate for Payer: PACE SWMI	$37,318.52
Rate for Payer: PHP Commercial	$41,050.37
Rate for Payer: PHP Medicare Advantage	$37,318.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$67,850.44
Rate for Payer: Priority Health Medicare	$37,318.52
Rate for Payer: Priority Health Narrow Network	$54,280.35
Rate for Payer: Railroad Medicare Medicare	$37,318.52
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$37,318.52
Rate for Payer: UHC Exchange	$57,843.71
Rate for Payer: UHCCP DNSP	$37,318.52
Rate for Payer: VA VA	$37,318.52

INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$20,569.73

Service Code	MSDRG 855
Min. Negotiated Rate	$11,909.35
Max. Negotiated Rate	$20,569.73
Rate for Payer: Aetna Medicare	$12,536.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,670.20
Rate for Payer: Amish Plain Church Group Commercial	$15,670.20
Rate for Payer: BCBS MAPPO	$12,536.16
Rate for Payer: BCN Medicare Advantage	$12,536.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,536.16
Rate for Payer: Humana Choice PPO Medicare	$12,536.16
Rate for Payer: Mclaren Medicare	$12,536.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,162.97
Rate for Payer: MI Amish Medical Board Commercial	$14,416.58
Rate for Payer: Molina Medicare/Medicaid	$13,789.78
Rate for Payer: PACE Medicare	$11,909.35
Rate for Payer: PACE SWMI	$12,536.16
Rate for Payer: PHP Commercial	$13,789.78
Rate for Payer: PHP Medicare Advantage	$12,536.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$20,569.73
Rate for Payer: Priority Health Medicare	$12,536.16
Rate for Payer: Priority Health Narrow Network	$16,455.79
Rate for Payer: Railroad Medicare Medicare	$12,536.16
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,536.16
Rate for Payer: UHC Exchange	$19,431.05
Rate for Payer: UHCCP DNSP	$12,536.16
Rate for Payer: VA VA	$12,536.16

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC

Facility

$20,373.27

Service Code	MSDRG 727
Min. Negotiated Rate	$11,811.52
Max. Negotiated Rate	$20,373.27
Rate for Payer: Aetna Medicare	$12,433.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,541.48
Rate for Payer: Amish Plain Church Group Commercial	$15,541.48
Rate for Payer: BCBS MAPPO	$12,433.18
Rate for Payer: BCN Medicare Advantage	$12,433.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,433.18
Rate for Payer: Humana Choice PPO Medicare	$12,433.18
Rate for Payer: Mclaren Medicare	$12,433.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,054.84
Rate for Payer: MI Amish Medical Board Commercial	$14,298.16
Rate for Payer: Molina Medicare/Medicaid	$13,676.50
Rate for Payer: PACE Medicare	$11,811.52
Rate for Payer: PACE SWMI	$12,433.18
Rate for Payer: PHP Commercial	$13,676.50
Rate for Payer: PHP Medicare Advantage	$12,433.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$20,373.27
Rate for Payer: Priority Health Medicare	$12,433.18
Rate for Payer: Priority Health Narrow Network	$16,298.61
Rate for Payer: Railroad Medicare Medicare	$12,433.18
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,433.18
Rate for Payer: UHC Exchange	$19,271.43
Rate for Payer: UHCCP DNSP	$12,433.18
Rate for Payer: VA VA	$12,433.18

INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC

Facility

$11,773.95

Service Code	MSDRG 728
Min. Negotiated Rate	$7,216.30
Max. Negotiated Rate	$11,773.95
Rate for Payer: Aetna Medicare	$7,596.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,495.12
Rate for Payer: Amish Plain Church Group Commercial	$9,495.12
Rate for Payer: BCBS MAPPO	$7,596.10
Rate for Payer: BCN Medicare Advantage	$7,596.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,596.10
Rate for Payer: Humana Choice PPO Medicare	$7,596.10
Rate for Payer: Mclaren Medicare	$7,596.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,975.90
Rate for Payer: MI Amish Medical Board Commercial	$8,735.51
Rate for Payer: Molina Medicare/Medicaid	$8,355.71
Rate for Payer: PACE Medicare	$7,216.30
Rate for Payer: PACE SWMI	$7,596.10
Rate for Payer: PHP Commercial	$8,355.71
Rate for Payer: PHP Medicare Advantage	$7,596.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,144.91
Rate for Payer: Priority Health Medicare	$7,596.10
Rate for Payer: Priority Health Narrow Network	$8,915.93
Rate for Payer: Railroad Medicare Medicare	$7,596.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,596.10
Rate for Payer: UHC Exchange	$11,773.95
Rate for Payer: UHCCP DNSP	$7,596.10
Rate for Payer: VA VA	$7,596.10

INFLAMMATORY BOWEL DISEASE

Facility

$3,307.30

Service Code	APR-DRG 2451
Min. Negotiated Rate	$2,990.20
Max. Negotiated Rate	$3,307.30
Rate for Payer: BCBS Complete	$3,307.30
Rate for Payer: Mclaren Medicaid	$3,149.81
Rate for Payer: Meridian Medicaid	$3,307.30
Rate for Payer: PHP Medicaid	$2,990.20
Rate for Payer: Priority Health Choice Medicaid	$3,149.81
Rate for Payer: UHC Medicaid	$3,149.81
Rate for Payer: UHCCP Medicaid	$3,149.81

INFLAMMATORY BOWEL DISEASE

Facility

$10,343.15

Service Code	APR-DRG 2454
Min. Negotiated Rate	$9,351.45
Max. Negotiated Rate	$10,343.15
Rate for Payer: BCBS Complete	$10,343.15
Rate for Payer: Mclaren Medicaid	$9,850.62
Rate for Payer: Meridian Medicaid	$10,343.15
Rate for Payer: PHP Medicaid	$9,351.45
Rate for Payer: Priority Health Choice Medicaid	$9,850.62
Rate for Payer: UHC Medicaid	$9,850.62
Rate for Payer: UHCCP Medicaid	$9,850.62

INFLAMMATORY BOWEL DISEASE

Facility

$4,688.20

Service Code	APR-DRG 2452
Min. Negotiated Rate	$4,238.70
Max. Negotiated Rate	$4,688.20
Rate for Payer: BCBS Complete	$4,688.20
Rate for Payer: Mclaren Medicaid	$4,464.96
Rate for Payer: Meridian Medicaid	$4,688.20
Rate for Payer: PHP Medicaid	$4,238.70
Rate for Payer: Priority Health Choice Medicaid	$4,464.96
Rate for Payer: UHC Medicaid	$4,464.96
Rate for Payer: UHCCP Medicaid	$4,464.96

INFLAMMATORY BOWEL DISEASE

Facility

$7,275.63

Service Code	APR-DRG 2453
Min. Negotiated Rate	$6,578.04
Max. Negotiated Rate	$7,275.63
Rate for Payer: BCBS Complete	$7,275.63
Rate for Payer: Mclaren Medicaid	$6,929.17
Rate for Payer: Meridian Medicaid	$7,275.63
Rate for Payer: PHP Medicaid	$6,578.04
Rate for Payer: Priority Health Choice Medicaid	$6,929.17
Rate for Payer: UHC Medicaid	$6,929.17
Rate for Payer: UHCCP Medicaid	$6,929.17

INFLAMMATORY BOWEL DISEASE WITH CC

Facility

$13,616.80

Service Code	MSDRG 386
Min. Negotiated Rate	$8,345.78
Max. Negotiated Rate	$13,616.80
Rate for Payer: Aetna Medicare	$8,785.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,981.29
Rate for Payer: Amish Plain Church Group Commercial	$10,981.29
Rate for Payer: BCBS MAPPO	$8,785.03
Rate for Payer: BCN Medicare Advantage	$8,785.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,785.03
Rate for Payer: Humana Choice PPO Medicare	$8,785.03
Rate for Payer: Mclaren Medicare	$8,785.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,224.28
Rate for Payer: MI Amish Medical Board Commercial	$10,102.78
Rate for Payer: Molina Medicare/Medicaid	$9,663.53
Rate for Payer: PACE Medicare	$8,345.78
Rate for Payer: PACE SWMI	$8,785.03
Rate for Payer: PHP Commercial	$9,663.53
Rate for Payer: PHP Medicare Advantage	$8,785.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,413.19
Rate for Payer: Priority Health Medicare	$8,785.03
Rate for Payer: Priority Health Narrow Network	$10,730.55
Rate for Payer: Railroad Medicare Medicare	$8,785.03
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,785.03
Rate for Payer: UHC Exchange	$13,616.80
Rate for Payer: UHCCP DNSP	$8,785.03
Rate for Payer: VA VA	$8,785.03

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