Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$14,472.78

Service Code	APR-DRG 4614
Min. Negotiated Rate	$13,085.13
Max. Negotiated Rate	$14,472.78
Rate for Payer: BCBS Complete	$14,472.78
Rate for Payer: Mclaren Medicaid	$13,783.60
Rate for Payer: Meridian Medicaid	$14,472.78
Rate for Payer: PHP Medicaid	$13,085.13
Rate for Payer: Priority Health Choice Medicaid	$13,783.60
Rate for Payer: UHC Medicaid	$13,783.60
Rate for Payer: UHCCP Medicaid	$13,783.60

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$7,786.25

Service Code	APR-DRG 4613
Min. Negotiated Rate	$7,039.70
Max. Negotiated Rate	$7,786.25
Rate for Payer: BCBS Complete	$7,786.25
Rate for Payer: Mclaren Medicaid	$7,415.47
Rate for Payer: Meridian Medicaid	$7,786.25
Rate for Payer: PHP Medicaid	$7,039.70
Rate for Payer: Priority Health Choice Medicaid	$7,415.47
Rate for Payer: UHC Medicaid	$7,415.47
Rate for Payer: UHCCP Medicaid	$7,415.47

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$5,745.95

Service Code	APR-DRG 4612
Min. Negotiated Rate	$5,195.03
Max. Negotiated Rate	$5,745.95
Rate for Payer: BCBS Complete	$5,745.95
Rate for Payer: Mclaren Medicaid	$5,472.34
Rate for Payer: Meridian Medicaid	$5,745.95
Rate for Payer: PHP Medicaid	$5,195.03
Rate for Payer: Priority Health Choice Medicaid	$5,472.34
Rate for Payer: UHC Medicaid	$5,472.34
Rate for Payer: UHCCP Medicaid	$5,472.34

KIDNEY AND URINARY TRACT MALIGNANCY

Facility

$5,022.80

Service Code	APR-DRG 4611
Min. Negotiated Rate	$4,541.22
Max. Negotiated Rate	$5,022.80
Rate for Payer: BCBS Complete	$5,022.80
Rate for Payer: Mclaren Medicaid	$4,783.62
Rate for Payer: Meridian Medicaid	$5,022.80
Rate for Payer: PHP Medicaid	$4,541.22
Rate for Payer: Priority Health Choice Medicaid	$4,783.62
Rate for Payer: UHC Medicaid	$4,783.62
Rate for Payer: UHCCP Medicaid	$4,783.62

KIDNEY AND URINARY TRACT NEOPLASMS WITH CC

Facility

$14,414.88

Service Code	MSDRG 687
Min. Negotiated Rate	$8,834.92
Max. Negotiated Rate	$14,414.88
Rate for Payer: Aetna Medicare	$9,299.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,624.90
Rate for Payer: Amish Plain Church Group Commercial	$11,624.90
Rate for Payer: BCBS MAPPO	$9,299.92
Rate for Payer: BCN Medicare Advantage	$9,299.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,299.92
Rate for Payer: Humana Choice PPO Medicare	$9,299.92
Rate for Payer: Mclaren Medicare	$9,299.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,764.92
Rate for Payer: MI Amish Medical Board Commercial	$10,694.91
Rate for Payer: Molina Medicare/Medicaid	$10,229.91
Rate for Payer: PACE Medicare	$8,834.92
Rate for Payer: PACE SWMI	$9,299.92
Rate for Payer: PHP Commercial	$10,229.91
Rate for Payer: PHP Medicare Advantage	$9,299.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,395.51
Rate for Payer: Priority Health Medicare	$9,299.92
Rate for Payer: Priority Health Narrow Network	$11,516.41
Rate for Payer: Railroad Medicare Medicare	$9,299.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,299.92
Rate for Payer: UHC Exchange	$14,414.88
Rate for Payer: UHCCP DNSP	$9,299.92
Rate for Payer: VA VA	$9,299.92

KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC

Facility

$24,780.67

Service Code	MSDRG 686
Min. Negotiated Rate	$14,006.17
Max. Negotiated Rate	$24,780.67
Rate for Payer: Aetna Medicare	$14,743.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,429.17
Rate for Payer: Amish Plain Church Group Commercial	$18,429.17
Rate for Payer: BCBS MAPPO	$14,743.34
Rate for Payer: BCN Medicare Advantage	$14,743.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,743.34
Rate for Payer: Humana Choice PPO Medicare	$14,743.34
Rate for Payer: Mclaren Medicare	$14,743.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,480.51
Rate for Payer: MI Amish Medical Board Commercial	$16,954.84
Rate for Payer: Molina Medicare/Medicaid	$16,217.67
Rate for Payer: PACE Medicare	$14,006.17
Rate for Payer: PACE SWMI	$14,743.34
Rate for Payer: PHP Commercial	$16,217.67
Rate for Payer: PHP Medicare Advantage	$14,743.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,780.67
Rate for Payer: Priority Health Medicare	$14,743.34
Rate for Payer: Priority Health Narrow Network	$19,824.54
Rate for Payer: Railroad Medicare Medicare	$14,743.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,743.34
Rate for Payer: UHC Exchange	$22,852.18
Rate for Payer: UHCCP DNSP	$14,743.34
Rate for Payer: VA VA	$14,743.34

KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC

Facility

$11,540.68

Service Code	MSDRG 688
Min. Negotiated Rate	$7,073.32
Max. Negotiated Rate	$11,540.68
Rate for Payer: Aetna Medicare	$7,445.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,307.00
Rate for Payer: Amish Plain Church Group Commercial	$9,307.00
Rate for Payer: BCBS MAPPO	$7,445.60
Rate for Payer: BCN Medicare Advantage	$7,445.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,445.60
Rate for Payer: Humana Choice PPO Medicare	$7,445.60
Rate for Payer: Mclaren Medicare	$7,445.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,817.88
Rate for Payer: MI Amish Medical Board Commercial	$8,562.44
Rate for Payer: Molina Medicare/Medicaid	$8,190.16
Rate for Payer: PACE Medicare	$7,073.32
Rate for Payer: PACE SWMI	$7,445.60
Rate for Payer: PHP Commercial	$8,190.16
Rate for Payer: PHP Medicare Advantage	$7,445.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,857.77
Rate for Payer: Priority Health Medicare	$7,445.60
Rate for Payer: Priority Health Narrow Network	$8,686.22
Rate for Payer: Railroad Medicare Medicare	$7,445.60
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,445.60
Rate for Payer: UHC Exchange	$11,540.68
Rate for Payer: UHCCP DNSP	$7,445.60
Rate for Payer: VA VA	$7,445.60

KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$16,003.55

Service Code	APR-DRG 4423
Min. Negotiated Rate	$14,469.12
Max. Negotiated Rate	$16,003.55
Rate for Payer: BCBS Complete	$16,003.55
Rate for Payer: Mclaren Medicaid	$15,241.47
Rate for Payer: Meridian Medicaid	$16,003.55
Rate for Payer: PHP Medicaid	$14,469.12
Rate for Payer: Priority Health Choice Medicaid	$15,241.47
Rate for Payer: UHC Medicaid	$15,241.47
Rate for Payer: UHCCP Medicaid	$15,241.47

KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$27,078.02

Service Code	APR-DRG 4424
Min. Negotiated Rate	$24,481.77
Max. Negotiated Rate	$27,078.02
Rate for Payer: BCBS Complete	$27,078.02
Rate for Payer: Mclaren Medicaid	$25,788.59
Rate for Payer: Meridian Medicaid	$27,078.02
Rate for Payer: PHP Medicaid	$24,481.77
Rate for Payer: Priority Health Choice Medicaid	$25,788.59
Rate for Payer: UHC Medicaid	$25,788.59
Rate for Payer: UHCCP Medicaid	$25,788.59

KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$8,945.90

Service Code	APR-DRG 4421
Min. Negotiated Rate	$8,088.16
Max. Negotiated Rate	$8,945.90
Rate for Payer: BCBS Complete	$8,945.90
Rate for Payer: Mclaren Medicaid	$8,519.90
Rate for Payer: Meridian Medicaid	$8,945.90
Rate for Payer: PHP Medicaid	$8,088.16
Rate for Payer: Priority Health Choice Medicaid	$8,519.90
Rate for Payer: UHC Medicaid	$8,519.90
Rate for Payer: UHCCP Medicaid	$8,519.90

KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY

Facility

$10,447.78

Service Code	APR-DRG 4422
Min. Negotiated Rate	$9,446.04
Max. Negotiated Rate	$10,447.78
Rate for Payer: BCBS Complete	$10,447.78
Rate for Payer: Mclaren Medicaid	$9,950.27
Rate for Payer: Meridian Medicaid	$10,447.78
Rate for Payer: PHP Medicaid	$9,446.04
Rate for Payer: Priority Health Choice Medicaid	$9,950.27
Rate for Payer: UHC Medicaid	$9,950.27
Rate for Payer: UHCCP Medicaid	$9,950.27

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$19,964.79

Service Code	APR-DRG 4434
Min. Negotiated Rate	$18,050.56
Max. Negotiated Rate	$19,964.79
Rate for Payer: BCBS Complete	$19,964.79
Rate for Payer: Mclaren Medicaid	$19,014.08
Rate for Payer: Meridian Medicaid	$19,964.79
Rate for Payer: PHP Medicaid	$18,050.56
Rate for Payer: Priority Health Choice Medicaid	$19,014.08
Rate for Payer: UHC Medicaid	$19,014.08
Rate for Payer: UHCCP Medicaid	$19,014.08

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$10,015.09

Service Code	APR-DRG 4432
Min. Negotiated Rate	$9,054.84
Max. Negotiated Rate	$10,015.09
Rate for Payer: BCBS Complete	$10,015.09
Rate for Payer: Mclaren Medicaid	$9,538.18
Rate for Payer: Meridian Medicaid	$10,015.09
Rate for Payer: PHP Medicaid	$9,054.84
Rate for Payer: Priority Health Choice Medicaid	$9,538.18
Rate for Payer: UHC Medicaid	$9,538.18
Rate for Payer: UHCCP Medicaid	$9,538.18

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$8,698.49

Service Code	APR-DRG 4431
Min. Negotiated Rate	$7,864.48
Max. Negotiated Rate	$8,698.49
Rate for Payer: BCBS Complete	$8,698.49
Rate for Payer: Mclaren Medicaid	$8,284.28
Rate for Payer: Meridian Medicaid	$8,698.49
Rate for Payer: PHP Medicaid	$7,864.48
Rate for Payer: Priority Health Choice Medicaid	$8,284.28
Rate for Payer: UHC Medicaid	$8,284.28
Rate for Payer: UHCCP Medicaid	$8,284.28

KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY

Facility

$11,460.84

Service Code	APR-DRG 4433
Min. Negotiated Rate	$10,361.97
Max. Negotiated Rate	$11,460.84
Rate for Payer: BCBS Complete	$11,460.84
Rate for Payer: Mclaren Medicaid	$10,915.09
Rate for Payer: Meridian Medicaid	$11,460.84
Rate for Payer: PHP Medicaid	$10,361.97
Rate for Payer: Priority Health Choice Medicaid	$10,915.09
Rate for Payer: UHC Medicaid	$10,915.09
Rate for Payer: UHCCP Medicaid	$10,915.09

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC

Facility

$15,714.44

Service Code	MSDRG 695
Min. Negotiated Rate	$9,491.68
Max. Negotiated Rate	$15,714.44
Rate for Payer: Aetna Medicare	$9,991.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,489.05
Rate for Payer: Amish Plain Church Group Commercial	$12,489.05
Rate for Payer: BCBS MAPPO	$9,991.24
Rate for Payer: BCN Medicare Advantage	$9,991.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,991.24
Rate for Payer: Humana Choice PPO Medicare	$9,991.24
Rate for Payer: Mclaren Medicare	$9,991.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,490.80
Rate for Payer: MI Amish Medical Board Commercial	$11,489.93
Rate for Payer: Molina Medicare/Medicaid	$10,990.36
Rate for Payer: PACE Medicare	$9,491.68
Rate for Payer: PACE SWMI	$9,991.24
Rate for Payer: PHP Commercial	$10,990.36
Rate for Payer: PHP Medicare Advantage	$9,991.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$15,714.44
Rate for Payer: Priority Health Medicare	$9,991.24
Rate for Payer: Priority Health Narrow Network	$12,571.55
Rate for Payer: Railroad Medicare Medicare	$9,991.24
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,991.24
Rate for Payer: UHC Exchange	$15,486.42
Rate for Payer: UHCCP DNSP	$9,991.24
Rate for Payer: VA VA	$9,991.24

KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC

Facility

$10,409.97

Service Code	MSDRG 696
Min. Negotiated Rate	$6,380.30
Max. Negotiated Rate	$10,409.97
Rate for Payer: Aetna Medicare	$6,716.11
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,395.14
Rate for Payer: Amish Plain Church Group Commercial	$8,395.14
Rate for Payer: BCBS MAPPO	$6,716.11
Rate for Payer: BCN Medicare Advantage	$6,716.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,716.11
Rate for Payer: Humana Choice PPO Medicare	$6,716.11
Rate for Payer: Mclaren Medicare	$6,716.11
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,051.92
Rate for Payer: MI Amish Medical Board Commercial	$7,723.53
Rate for Payer: Molina Medicare/Medicaid	$7,387.72
Rate for Payer: PACE Medicare	$6,380.30
Rate for Payer: PACE SWMI	$6,716.11
Rate for Payer: PHP Commercial	$7,387.72
Rate for Payer: PHP Medicare Advantage	$6,716.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,466.03
Rate for Payer: Priority Health Medicare	$6,716.11
Rate for Payer: Priority Health Narrow Network	$7,572.83
Rate for Payer: Railroad Medicare Medicare	$6,716.11
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,716.11
Rate for Payer: UHC Exchange	$10,409.97
Rate for Payer: UHCCP DNSP	$6,716.11
Rate for Payer: VA VA	$6,716.11

KIDNEY TRANSPLANT

Facility

$44,369.45

Service Code	MSDRG 652
Min. Negotiated Rate	$23,760.34
Max. Negotiated Rate	$44,369.45
Rate for Payer: Aetna Medicare	$25,010.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,263.60
Rate for Payer: Amish Plain Church Group Commercial	$31,263.60
Rate for Payer: BCBS MAPPO	$25,010.88
Rate for Payer: BCN Medicare Advantage	$25,010.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,010.88
Rate for Payer: Humana Choice PPO Medicare	$25,010.88
Rate for Payer: Mclaren Medicare	$25,010.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26,261.42
Rate for Payer: MI Amish Medical Board Commercial	$28,762.51
Rate for Payer: Molina Medicare/Medicaid	$27,511.97
Rate for Payer: PACE Medicare	$23,760.34
Rate for Payer: PACE SWMI	$25,010.88
Rate for Payer: PHP Commercial	$27,511.97
Rate for Payer: PHP Medicare Advantage	$25,010.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$44,369.45
Rate for Payer: Priority Health Medicare	$25,010.88
Rate for Payer: Priority Health Narrow Network	$35,495.56
Rate for Payer: Railroad Medicare Medicare	$25,010.88
Rate for Payer: UHCCP DNSP	$25,010.88
Rate for Payer: VA VA	$25,010.88

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

Facility

$64,591.59

Service Code	MSDRG 650
Min. Negotiated Rate	$33,829.86
Max. Negotiated Rate	$64,591.59
Rate for Payer: Aetna Medicare	$35,610.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$44,512.97
Rate for Payer: Amish Plain Church Group Commercial	$44,512.97
Rate for Payer: BCBS MAPPO	$35,610.38
Rate for Payer: BCN Medicare Advantage	$35,610.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$35,610.38
Rate for Payer: Humana Choice PPO Medicare	$35,610.38
Rate for Payer: Mclaren Medicare	$35,610.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37,390.90
Rate for Payer: MI Amish Medical Board Commercial	$40,951.94
Rate for Payer: Molina Medicare/Medicaid	$39,171.42
Rate for Payer: PACE Medicare	$33,829.86
Rate for Payer: PACE SWMI	$35,610.38
Rate for Payer: PHP Commercial	$39,171.42
Rate for Payer: PHP Medicare Advantage	$35,610.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$64,591.59
Rate for Payer: Priority Health Medicare	$35,610.38
Rate for Payer: Priority Health Narrow Network	$51,673.28
Rate for Payer: Railroad Medicare Medicare	$35,610.38
Rate for Payer: UHCCP DNSP	$35,610.38
Rate for Payer: VA VA	$35,610.38

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Facility

$50,913.25

Service Code	MSDRG 651
Min. Negotiated Rate	$27,018.79
Max. Negotiated Rate	$50,913.25
Rate for Payer: Aetna Medicare	$28,440.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$35,551.04
Rate for Payer: Amish Plain Church Group Commercial	$35,551.04
Rate for Payer: BCBS MAPPO	$28,440.83
Rate for Payer: BCN Medicare Advantage	$28,440.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$28,440.83
Rate for Payer: Humana Choice PPO Medicare	$28,440.83
Rate for Payer: Mclaren Medicare	$28,440.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29,862.87
Rate for Payer: MI Amish Medical Board Commercial	$32,706.95
Rate for Payer: Molina Medicare/Medicaid	$31,284.91
Rate for Payer: PACE Medicare	$27,018.79
Rate for Payer: PACE SWMI	$28,440.83
Rate for Payer: PHP Commercial	$31,284.91
Rate for Payer: PHP Medicare Advantage	$28,440.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$50,913.25
Rate for Payer: Priority Health Medicare	$28,440.83
Rate for Payer: Priority Health Narrow Network	$40,730.60
Rate for Payer: Railroad Medicare Medicare	$28,440.83
Rate for Payer: UHCCP DNSP	$28,440.83
Rate for Payer: VA VA	$28,440.83

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$11,682.09

Service Code	APR-DRG 3132
Min. Negotiated Rate	$10,562.01
Max. Negotiated Rate	$11,682.09
Rate for Payer: BCBS Complete	$11,682.09
Rate for Payer: Mclaren Medicaid	$11,125.80
Rate for Payer: Meridian Medicaid	$11,682.09
Rate for Payer: PHP Medicaid	$10,562.01
Rate for Payer: Priority Health Choice Medicaid	$11,125.80
Rate for Payer: UHC Medicaid	$11,125.80
Rate for Payer: UHCCP Medicaid	$11,125.80

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$23,506.42

Service Code	APR-DRG 3134
Min. Negotiated Rate	$21,252.61
Max. Negotiated Rate	$23,506.42
Rate for Payer: BCBS Complete	$23,506.42
Rate for Payer: Mclaren Medicaid	$22,387.06
Rate for Payer: Meridian Medicaid	$23,506.42
Rate for Payer: PHP Medicaid	$21,252.61
Rate for Payer: Priority Health Choice Medicaid	$22,387.06
Rate for Payer: UHC Medicaid	$22,387.06
Rate for Payer: UHCCP Medicaid	$22,387.06

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$14,077.15

Service Code	APR-DRG 3133
Min. Negotiated Rate	$12,727.43
Max. Negotiated Rate	$14,077.15
Rate for Payer: BCBS Complete	$14,077.15
Rate for Payer: Mclaren Medicaid	$13,406.81
Rate for Payer: Meridian Medicaid	$14,077.15
Rate for Payer: PHP Medicaid	$12,727.43
Rate for Payer: Priority Health Choice Medicaid	$13,406.81
Rate for Payer: UHC Medicaid	$13,406.81
Rate for Payer: UHCCP Medicaid	$13,406.81

KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT

Facility

$9,229.82

Service Code	APR-DRG 3131
Min. Negotiated Rate	$8,344.86
Max. Negotiated Rate	$9,229.82
Rate for Payer: BCBS Complete	$9,229.82
Rate for Payer: Mclaren Medicaid	$8,790.30
Rate for Payer: Meridian Medicaid	$9,229.82
Rate for Payer: PHP Medicaid	$8,344.86
Rate for Payer: Priority Health Choice Medicaid	$8,790.30
Rate for Payer: UHC Medicaid	$8,790.30
Rate for Payer: UHCCP Medicaid	$8,790.30

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$24,302.56

Service Code	MSDRG 488
Min. Negotiated Rate	$13,768.10
Max. Negotiated Rate	$24,302.56
Rate for Payer: Aetna Medicare	$14,492.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,115.92
Rate for Payer: Amish Plain Church Group Commercial	$18,115.92
Rate for Payer: BCBS MAPPO	$14,492.74
Rate for Payer: BCN Medicare Advantage	$14,492.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,492.74
Rate for Payer: Humana Choice PPO Medicare	$14,492.74
Rate for Payer: Mclaren Medicare	$14,492.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,217.38
Rate for Payer: MI Amish Medical Board Commercial	$16,666.65
Rate for Payer: Molina Medicare/Medicaid	$15,942.01
Rate for Payer: PACE Medicare	$13,768.10
Rate for Payer: PACE SWMI	$14,492.74
Rate for Payer: PHP Commercial	$15,942.01
Rate for Payer: PHP Medicare Advantage	$14,492.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,302.56
Rate for Payer: Priority Health Medicare	$14,492.74
Rate for Payer: Priority Health Narrow Network	$19,442.05
Rate for Payer: Railroad Medicare Medicare	$14,492.74
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,492.74
Rate for Payer: UHC Exchange	$22,463.75
Rate for Payer: UHCCP DNSP	$14,492.74
Rate for Payer: VA VA	$14,492.74

Know your out-of-pocket cost for care.

All Charges