Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$6,372.10

Service Code	APR-DRG 8173
Min. Negotiated Rate	$5,761.14
Max. Negotiated Rate	$6,372.10
Rate for Payer: BCBS Complete	$6,372.10
Rate for Payer: Mclaren Medicaid	$6,068.67
Rate for Payer: Meridian Medicaid	$6,372.10
Rate for Payer: PHP Medicaid	$5,761.14
Rate for Payer: Priority Health Choice Medicaid	$6,068.67
Rate for Payer: UHC Medicaid	$6,068.67
Rate for Payer: UHCCP Medicaid	$6,068.67

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$10,884.29

Service Code	APR-DRG 8174
Min. Negotiated Rate	$9,840.70
Max. Negotiated Rate	$10,884.29
Rate for Payer: BCBS Complete	$10,884.29
Rate for Payer: Mclaren Medicaid	$10,365.99
Rate for Payer: Meridian Medicaid	$10,884.29
Rate for Payer: PHP Medicaid	$9,840.70
Rate for Payer: Priority Health Choice Medicaid	$10,365.99
Rate for Payer: UHC Medicaid	$10,365.99
Rate for Payer: UHCCP Medicaid	$10,365.99

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$2,453.36

Service Code	APR-DRG 8171
Min. Negotiated Rate	$2,218.14
Max. Negotiated Rate	$2,453.36
Rate for Payer: BCBS Complete	$2,453.36
Rate for Payer: Mclaren Medicaid	$2,336.54
Rate for Payer: Meridian Medicaid	$2,453.36
Rate for Payer: PHP Medicaid	$2,218.14
Rate for Payer: Priority Health Choice Medicaid	$2,336.54
Rate for Payer: UHC Medicaid	$2,336.54
Rate for Payer: UHCCP Medicaid	$2,336.54

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$3,544.90

Service Code	APR-DRG 8172
Min. Negotiated Rate	$3,205.01
Max. Negotiated Rate	$3,544.90
Rate for Payer: BCBS Complete	$3,544.90
Rate for Payer: Mclaren Medicaid	$3,376.09
Rate for Payer: Meridian Medicaid	$3,544.90
Rate for Payer: PHP Medicaid	$3,205.01
Rate for Payer: Priority Health Choice Medicaid	$3,376.09
Rate for Payer: UHC Medicaid	$3,376.09
Rate for Payer: UHCCP Medicaid	$3,376.09

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR PEN INJECTOR

Facility

$3,496.74

Service Code	HCPCS Q3027
Hospital Charge Code	159694
Hospital Revenue Code	636
Min. Negotiated Rate	$2,622.56
Max. Negotiated Rate	$3,496.74
Rate for Payer: Aetna Commercial	$3,147.07
Rate for Payer: ASR ASR	$3,391.84
Rate for Payer: BCBS Trust/PPO	$2,871.53
Rate for Payer: BCN Commercial	$2,871.53
Rate for Payer: Cash Price	$2,797.40
Rate for Payer: Cofinity Commercial	$3,286.94
Rate for Payer: Encore Health Key Benefits Commercial	$2,797.40
Rate for Payer: Healthscope Commercial	$3,391.84
Rate for Payer: Healthscope Whirlpool	$3,496.74
Rate for Payer: Mclaren Commercial	$3,147.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,972.23
Rate for Payer: Nomi Health Commercial	$2,867.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,622.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,077.13

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR PEN INJECTOR

Facility

$3,496.74

Service Code	HCPCS Q3027
Hospital Charge Code	159694
Hospital Revenue Code	636
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$3,496.74
Rate for Payer: Aetna Commercial	$3,147.07
Rate for Payer: Aetna Medicare	$1,293.80
Rate for Payer: ASR ASR	$3,391.84
Rate for Payer: BCBS Complete	$1,398.70
Rate for Payer: BCBS Trust/PPO	$2,883.07
Rate for Payer: BCN Commercial	$2,883.07
Rate for Payer: Cash Price	$2,797.40
Rate for Payer: Cash Price	$2,797.40
Rate for Payer: Cofinity Commercial	$3,286.94
Rate for Payer: Encore Health Key Benefits Commercial	$2,797.40
Rate for Payer: Healthscope Commercial	$3,391.84
Rate for Payer: Healthscope Whirlpool	$3,496.74
Rate for Payer: Mclaren Commercial	$3,147.07
Rate for Payer: MI Amish Medical Board Commercial	$2,797.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,972.23
Rate for Payer: Nomi Health Commercial	$2,867.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,622.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$73.42
Rate for Payer: Priority Health Narrow Network	$58.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,077.13

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$5,993.30

Service Code	HCPCS Q3027
Hospital Charge Code	161584
Hospital Revenue Code	636
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$5,993.30
Rate for Payer: Aetna Commercial	$5,393.97
Rate for Payer: Aetna Medicare	$2,217.52
Rate for Payer: ASR ASR	$5,813.50
Rate for Payer: BCBS Complete	$2,397.32
Rate for Payer: BCBS Trust/PPO	$4,941.48
Rate for Payer: BCN Commercial	$4,941.48
Rate for Payer: Cash Price	$4,794.64
Rate for Payer: Cash Price	$4,794.64
Rate for Payer: Cofinity Commercial	$5,633.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,794.64
Rate for Payer: Healthscope Commercial	$5,813.50
Rate for Payer: Healthscope Whirlpool	$5,993.30
Rate for Payer: Mclaren Commercial	$5,393.97
Rate for Payer: MI Amish Medical Board Commercial	$4,794.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,094.30
Rate for Payer: Nomi Health Commercial	$4,914.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,494.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$73.42
Rate for Payer: Priority Health Narrow Network	$58.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,274.10

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$5,993.30

Service Code	HCPCS Q3027
Hospital Charge Code	161584
Hospital Revenue Code	636
Min. Negotiated Rate	$4,494.97
Max. Negotiated Rate	$5,993.30
Rate for Payer: Aetna Commercial	$5,393.97
Rate for Payer: ASR ASR	$5,813.50
Rate for Payer: BCBS Trust/PPO	$4,921.70
Rate for Payer: BCN Commercial	$4,921.70
Rate for Payer: Cash Price	$4,794.64
Rate for Payer: Cofinity Commercial	$5,633.70
Rate for Payer: Encore Health Key Benefits Commercial	$4,794.64
Rate for Payer: Healthscope Commercial	$5,813.50
Rate for Payer: Healthscope Whirlpool	$5,993.30
Rate for Payer: Mclaren Commercial	$5,393.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,094.30
Rate for Payer: Nomi Health Commercial	$4,914.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,494.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,274.10

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR SYRINGE KIT

Facility

$5,747.92

Service Code	HCPCS Q3027
Hospital Charge Code	36417
Hospital Revenue Code	636
Min. Negotiated Rate	$58.74
Max. Negotiated Rate	$5,747.92
Rate for Payer: Aetna Commercial	$5,173.13
Rate for Payer: Aetna Medicare	$2,126.73
Rate for Payer: ASR ASR	$5,575.48
Rate for Payer: BCBS Complete	$2,299.17
Rate for Payer: BCBS Trust/PPO	$4,739.16
Rate for Payer: BCN Commercial	$4,739.16
Rate for Payer: Cash Price	$4,598.34
Rate for Payer: Cash Price	$4,598.34
Rate for Payer: Cofinity Commercial	$5,403.04
Rate for Payer: Encore Health Key Benefits Commercial	$4,598.34
Rate for Payer: Healthscope Commercial	$5,575.48
Rate for Payer: Healthscope Whirlpool	$5,747.92
Rate for Payer: Mclaren Commercial	$5,173.13
Rate for Payer: MI Amish Medical Board Commercial	$4,598.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,885.73
Rate for Payer: Nomi Health Commercial	$4,713.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,310.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$73.42
Rate for Payer: Priority Health Narrow Network	$58.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,058.17

INTERFERON BETA-1A 30 MCG/0.5 ML INTRAMUSCULAR SYRINGE KIT

Facility

$5,747.92

Service Code	HCPCS Q3027
Hospital Charge Code	36417
Hospital Revenue Code	636
Min. Negotiated Rate	$4,310.94
Max. Negotiated Rate	$5,747.92
Rate for Payer: Aetna Commercial	$5,173.13
Rate for Payer: ASR ASR	$5,575.48
Rate for Payer: BCBS Trust/PPO	$4,720.19
Rate for Payer: BCN Commercial	$4,720.19
Rate for Payer: Cash Price	$4,598.34
Rate for Payer: Cofinity Commercial	$5,403.04
Rate for Payer: Encore Health Key Benefits Commercial	$4,598.34
Rate for Payer: Healthscope Commercial	$5,575.48
Rate for Payer: Healthscope Whirlpool	$5,747.92
Rate for Payer: Mclaren Commercial	$5,173.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,885.73
Rate for Payer: Nomi Health Commercial	$4,713.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,310.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5,058.17

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$3,335.64

Service Code	APR-DRG 1421
Min. Negotiated Rate	$3,015.82
Max. Negotiated Rate	$3,335.64
Rate for Payer: BCBS Complete	$3,335.64
Rate for Payer: Mclaren Medicaid	$3,176.80
Rate for Payer: Meridian Medicaid	$3,335.64
Rate for Payer: PHP Medicaid	$3,015.82
Rate for Payer: Priority Health Choice Medicaid	$3,176.80
Rate for Payer: UHC Medicaid	$3,176.80
Rate for Payer: UHCCP Medicaid	$3,176.80

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$10,222.17

Service Code	APR-DRG 1424
Min. Negotiated Rate	$9,242.07
Max. Negotiated Rate	$10,222.17
Rate for Payer: BCBS Complete	$10,222.17
Rate for Payer: Mclaren Medicaid	$9,735.40
Rate for Payer: Meridian Medicaid	$10,222.17
Rate for Payer: PHP Medicaid	$9,242.07
Rate for Payer: Priority Health Choice Medicaid	$9,735.40
Rate for Payer: UHC Medicaid	$9,735.40
Rate for Payer: UHCCP Medicaid	$9,735.40

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$5,093.10

Service Code	APR-DRG 1422
Min. Negotiated Rate	$4,604.77
Max. Negotiated Rate	$5,093.10
Rate for Payer: BCBS Complete	$5,093.10
Rate for Payer: Mclaren Medicaid	$4,850.57
Rate for Payer: Meridian Medicaid	$5,093.10
Rate for Payer: PHP Medicaid	$4,604.77
Rate for Payer: Priority Health Choice Medicaid	$4,850.57
Rate for Payer: UHC Medicaid	$4,850.57
Rate for Payer: UHCCP Medicaid	$4,850.57

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$7,212.41

Service Code	APR-DRG 1423
Min. Negotiated Rate	$6,520.88
Max. Negotiated Rate	$7,212.41
Rate for Payer: BCBS Complete	$7,212.41
Rate for Payer: Mclaren Medicaid	$6,868.97
Rate for Payer: Meridian Medicaid	$7,212.41
Rate for Payer: PHP Medicaid	$6,520.88
Rate for Payer: Priority Health Choice Medicaid	$6,868.97
Rate for Payer: UHC Medicaid	$6,868.97
Rate for Payer: UHCCP Medicaid	$6,868.97

INTERSTITIAL LUNG DISEASE WITH CC

Facility

$13,313.20

Service Code	MSDRG 197
Min. Negotiated Rate	$8,159.70
Max. Negotiated Rate	$13,313.20
Rate for Payer: Aetna Medicare	$8,589.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,736.45
Rate for Payer: Amish Plain Church Group Commercial	$10,736.45
Rate for Payer: BCBS MAPPO	$8,589.16
Rate for Payer: BCN Medicare Advantage	$8,589.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,589.16
Rate for Payer: Humana Choice PPO Medicare	$8,589.16
Rate for Payer: Mclaren Medicare	$8,589.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,018.62
Rate for Payer: MI Amish Medical Board Commercial	$9,877.53
Rate for Payer: Molina Medicare/Medicaid	$9,448.08
Rate for Payer: PACE Medicare	$8,159.70
Rate for Payer: PACE SWMI	$8,589.16
Rate for Payer: PHP Commercial	$9,448.08
Rate for Payer: PHP Medicare Advantage	$8,589.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,039.50
Rate for Payer: Priority Health Medicare	$8,589.16
Rate for Payer: Priority Health Narrow Network	$10,431.60
Rate for Payer: Railroad Medicare Medicare	$8,589.16
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,589.16
Rate for Payer: UHC Exchange	$13,313.20
Rate for Payer: UHCCP DNSP	$8,589.16
Rate for Payer: VA VA	$8,589.16

INTERSTITIAL LUNG DISEASE WITH MCC

Facility

$25,927.86

Service Code	MSDRG 196
Min. Negotiated Rate	$14,577.42
Max. Negotiated Rate	$25,927.86
Rate for Payer: Aetna Medicare	$15,344.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,180.81
Rate for Payer: Amish Plain Church Group Commercial	$19,180.81
Rate for Payer: BCBS MAPPO	$15,344.65
Rate for Payer: BCN Medicare Advantage	$15,344.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,344.65
Rate for Payer: Humana Choice PPO Medicare	$15,344.65
Rate for Payer: Mclaren Medicare	$15,344.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,111.88
Rate for Payer: MI Amish Medical Board Commercial	$17,646.35
Rate for Payer: Molina Medicare/Medicaid	$16,879.12
Rate for Payer: PACE Medicare	$14,577.42
Rate for Payer: PACE SWMI	$15,344.65
Rate for Payer: PHP Commercial	$16,879.12
Rate for Payer: PHP Medicare Advantage	$15,344.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25,927.86
Rate for Payer: Priority Health Medicare	$15,344.65
Rate for Payer: Priority Health Narrow Network	$20,742.29
Rate for Payer: Railroad Medicare Medicare	$15,344.65
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,344.65
Rate for Payer: UHC Exchange	$23,784.21
Rate for Payer: UHCCP DNSP	$15,344.65
Rate for Payer: VA VA	$15,344.65

INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC

Facility

$10,713.58

Service Code	MSDRG 198
Min. Negotiated Rate	$6,566.39
Max. Negotiated Rate	$10,713.58
Rate for Payer: Aetna Medicare	$6,911.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,639.99
Rate for Payer: Amish Plain Church Group Commercial	$8,639.99
Rate for Payer: BCBS MAPPO	$6,911.99
Rate for Payer: BCN Medicare Advantage	$6,911.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,911.99
Rate for Payer: Humana Choice PPO Medicare	$6,911.99
Rate for Payer: Mclaren Medicare	$6,911.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,257.59
Rate for Payer: MI Amish Medical Board Commercial	$7,948.79
Rate for Payer: Molina Medicare/Medicaid	$7,603.19
Rate for Payer: PACE Medicare	$6,566.39
Rate for Payer: PACE SWMI	$6,911.99
Rate for Payer: PHP Commercial	$7,603.19
Rate for Payer: PHP Medicare Advantage	$6,911.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,839.73
Rate for Payer: Priority Health Medicare	$6,911.99
Rate for Payer: Priority Health Narrow Network	$7,871.78
Rate for Payer: Railroad Medicare Medicare	$6,911.99
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,911.99
Rate for Payer: UHC Exchange	$10,713.58
Rate for Payer: UHCCP DNSP	$6,911.99
Rate for Payer: VA VA	$6,911.99

INTESTINAL OBSTRUCTION

Facility

$5,516.53

Service Code	APR-DRG 2473
Min. Negotiated Rate	$4,987.60
Max. Negotiated Rate	$5,516.53
Rate for Payer: BCBS Complete	$5,516.53
Rate for Payer: Mclaren Medicaid	$5,253.84
Rate for Payer: Meridian Medicaid	$5,516.53
Rate for Payer: PHP Medicaid	$4,987.60
Rate for Payer: Priority Health Choice Medicaid	$5,253.84
Rate for Payer: UHC Medicaid	$5,253.84
Rate for Payer: UHCCP Medicaid	$5,253.84

INTESTINAL OBSTRUCTION

Facility

$10,560.04

Service Code	APR-DRG 2474
Min. Negotiated Rate	$9,547.54
Max. Negotiated Rate	$10,560.04
Rate for Payer: BCBS Complete	$10,560.04
Rate for Payer: Mclaren Medicaid	$10,057.18
Rate for Payer: Meridian Medicaid	$10,560.04
Rate for Payer: PHP Medicaid	$9,547.54
Rate for Payer: Priority Health Choice Medicaid	$10,057.18
Rate for Payer: UHC Medicaid	$10,057.18
Rate for Payer: UHCCP Medicaid	$10,057.18

INTESTINAL OBSTRUCTION

Facility

$3,784.13

Service Code	APR-DRG 2472
Min. Negotiated Rate	$3,421.31
Max. Negotiated Rate	$3,784.13
Rate for Payer: BCBS Complete	$3,784.13
Rate for Payer: Mclaren Medicaid	$3,603.94
Rate for Payer: Meridian Medicaid	$3,784.13
Rate for Payer: PHP Medicaid	$3,421.31
Rate for Payer: Priority Health Choice Medicaid	$3,603.94
Rate for Payer: UHC Medicaid	$3,603.94
Rate for Payer: UHCCP Medicaid	$3,603.94

INTESTINAL OBSTRUCTION

Facility

$2,896.41

Service Code	APR-DRG 2471
Min. Negotiated Rate	$2,618.70
Max. Negotiated Rate	$2,896.41
Rate for Payer: BCBS Complete	$2,896.41
Rate for Payer: Mclaren Medicaid	$2,758.49
Rate for Payer: Meridian Medicaid	$2,896.41
Rate for Payer: PHP Medicaid	$2,618.70
Rate for Payer: Priority Health Choice Medicaid	$2,758.49
Rate for Payer: UHC Medicaid	$2,758.49
Rate for Payer: UHCCP Medicaid	$2,758.49

INTRACRANIAL HEMORRHAGE

Facility

$4,976.48

Service Code	APR-DRG 0441
Min. Negotiated Rate	$4,499.34
Max. Negotiated Rate	$4,976.48
Rate for Payer: BCBS Complete	$4,976.48
Rate for Payer: Mclaren Medicaid	$4,739.51
Rate for Payer: Meridian Medicaid	$4,976.48
Rate for Payer: PHP Medicaid	$4,499.34
Rate for Payer: Priority Health Choice Medicaid	$4,739.51
Rate for Payer: UHC Medicaid	$4,739.51
Rate for Payer: UHCCP Medicaid	$4,739.51

INTRACRANIAL HEMORRHAGE

Facility

$11,728.41

Service Code	APR-DRG 0443
Min. Negotiated Rate	$10,603.89
Max. Negotiated Rate	$11,728.41
Rate for Payer: BCBS Complete	$11,728.41
Rate for Payer: Mclaren Medicaid	$11,169.92
Rate for Payer: Meridian Medicaid	$11,728.41
Rate for Payer: PHP Medicaid	$10,603.89
Rate for Payer: Priority Health Choice Medicaid	$11,169.92
Rate for Payer: UHC Medicaid	$11,169.92
Rate for Payer: UHCCP Medicaid	$11,169.92

INTRACRANIAL HEMORRHAGE

Facility

$7,665.27

Service Code	APR-DRG 0442
Min. Negotiated Rate	$6,930.32
Max. Negotiated Rate	$7,665.27
Rate for Payer: BCBS Complete	$7,665.27
Rate for Payer: Mclaren Medicaid	$7,300.25
Rate for Payer: Meridian Medicaid	$7,665.27
Rate for Payer: PHP Medicaid	$6,930.32
Rate for Payer: Priority Health Choice Medicaid	$7,300.25
Rate for Payer: UHC Medicaid	$7,300.25
Rate for Payer: UHCCP Medicaid	$7,300.25

INTRACRANIAL HEMORRHAGE

Facility

$14,834.63

Service Code	APR-DRG 0444
Min. Negotiated Rate	$13,412.28
Max. Negotiated Rate	$14,834.63
Rate for Payer: BCBS Complete	$14,834.63
Rate for Payer: Mclaren Medicaid	$14,128.22
Rate for Payer: Meridian Medicaid	$14,834.63
Rate for Payer: PHP Medicaid	$13,412.28
Rate for Payer: Priority Health Choice Medicaid	$14,128.22
Rate for Payer: UHC Medicaid	$14,128.22
Rate for Payer: UHCCP Medicaid	$14,128.22

Know your out-of-pocket cost for care.

All Charges