Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS

Facility

$36.51

Service Code	NDC 61314063006
Hospital Charge Code	10708
Hospital Revenue Code	637
Min. Negotiated Rate	$13.51
Max. Negotiated Rate	$36.51
Rate for Payer: Aetna Commercial	$32.85
Rate for Payer: Aetna Medicare	$13.51
Rate for Payer: ASR ASR	$35.41
Rate for Payer: BCBS Complete	$14.60
Rate for Payer: BCBS Trust/PPO	$30.10
Rate for Payer: BCN Commercial	$30.10
Rate for Payer: Cash Price	$29.20
Rate for Payer: Cofinity Commercial	$34.31
Rate for Payer: Encore Health Key Benefits Commercial	$29.20
Rate for Payer: Healthscope Commercial	$35.41
Rate for Payer: Healthscope Whirlpool	$36.51
Rate for Payer: Mclaren Commercial	$32.85
Rate for Payer: MI Amish Medical Board Commercial	$29.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.03
Rate for Payer: Nomi Health Commercial	$29.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$31.99
Rate for Payer: Priority Health Narrow Network	$25.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$32.12

NEOMYCIN-POLYMYXIN-DEXAMETH 3.5 MG/ML-10,000 UNIT/ML-0.1% EYE DROPS

Facility

$51.73

Service Code	NDC 24208083060
Hospital Charge Code	10708
Hospital Revenue Code	637
Min. Negotiated Rate	$19.14
Max. Negotiated Rate	$51.73
Rate for Payer: Aetna Commercial	$46.56
Rate for Payer: Aetna Medicare	$19.14
Rate for Payer: ASR ASR	$50.18
Rate for Payer: BCBS Complete	$20.69
Rate for Payer: BCBS Trust/PPO	$42.65
Rate for Payer: BCN Commercial	$42.65
Rate for Payer: Cash Price	$41.38
Rate for Payer: Cofinity Commercial	$48.63
Rate for Payer: Encore Health Key Benefits Commercial	$41.38
Rate for Payer: Healthscope Commercial	$50.18
Rate for Payer: Healthscope Whirlpool	$51.73
Rate for Payer: Mclaren Commercial	$46.56
Rate for Payer: MI Amish Medical Board Commercial	$41.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.97
Rate for Payer: Nomi Health Commercial	$42.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$45.33
Rate for Payer: Priority Health Narrow Network	$36.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$45.52

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP

Facility

$157.82

Service Code	NDC 24208063562
Hospital Charge Code	28810
Hospital Revenue Code	637
Min. Negotiated Rate	$118.36
Max. Negotiated Rate	$157.81
Rate for Payer: Aetna Commercial	$142.03
Rate for Payer: ASR ASR	$153.08
Rate for Payer: BCBS Trust/PPO	$129.60
Rate for Payer: BCN Commercial	$129.60
Rate for Payer: Cash Price	$126.25
Rate for Payer: Cofinity Commercial	$148.35
Rate for Payer: Encore Health Key Benefits Commercial	$126.25
Rate for Payer: Healthscope Commercial	$153.08
Rate for Payer: Healthscope Whirlpool	$157.81
Rate for Payer: Mclaren Commercial	$142.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.14
Rate for Payer: Nomi Health Commercial	$129.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$138.88

NEOMYCIN-POLYMYXIN-HYDROCORT 3.5 MG-10,000 UNIT/ML-1 % EAR DROPS,SUSP

Facility

$157.82

Service Code	NDC 24208063562
Hospital Charge Code	28810
Hospital Revenue Code	637
Min. Negotiated Rate	$58.39
Max. Negotiated Rate	$157.81
Rate for Payer: Aetna Commercial	$142.03
Rate for Payer: Aetna Medicare	$58.39
Rate for Payer: ASR ASR	$153.08
Rate for Payer: BCBS Complete	$63.13
Rate for Payer: BCBS Trust/PPO	$130.12
Rate for Payer: BCN Commercial	$130.12
Rate for Payer: Cash Price	$126.25
Rate for Payer: Cofinity Commercial	$148.35
Rate for Payer: Encore Health Key Benefits Commercial	$126.25
Rate for Payer: Healthscope Commercial	$153.08
Rate for Payer: Healthscope Whirlpool	$157.81
Rate for Payer: Mclaren Commercial	$142.03
Rate for Payer: MI Amish Medical Board Commercial	$126.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.14
Rate for Payer: Nomi Health Commercial	$129.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$138.28
Rate for Payer: Priority Health Narrow Network	$110.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$138.88

NEONATAL AFTERCARE

Facility

$12,892.43

Service Code	APR-DRG 8632
Min. Negotiated Rate	$11,656.30
Max. Negotiated Rate	$12,892.43
Rate for Payer: BCBS Complete	$12,892.43
Rate for Payer: Mclaren Medicaid	$12,278.50
Rate for Payer: Meridian Medicaid	$12,892.43
Rate for Payer: PHP Medicaid	$11,656.30
Rate for Payer: Priority Health Choice Medicaid	$12,278.50
Rate for Payer: UHC Medicaid	$12,278.50
Rate for Payer: UHCCP Medicaid	$12,278.50

NEONATAL AFTERCARE

Facility

$52,268.88

Service Code	APR-DRG 8634
Min. Negotiated Rate	$47,257.32
Max. Negotiated Rate	$52,268.88
Rate for Payer: BCBS Complete	$52,268.88
Rate for Payer: Mclaren Medicaid	$49,779.89
Rate for Payer: Meridian Medicaid	$52,268.88
Rate for Payer: PHP Medicaid	$47,257.32
Rate for Payer: Priority Health Choice Medicaid	$49,779.89
Rate for Payer: UHC Medicaid	$49,779.89
Rate for Payer: UHCCP Medicaid	$49,779.89

NEONATAL AFTERCARE

Facility

$6,621.14

Service Code	APR-DRG 8631
Min. Negotiated Rate	$5,986.31
Max. Negotiated Rate	$6,621.14
Rate for Payer: BCBS Complete	$6,621.14
Rate for Payer: Mclaren Medicaid	$6,305.85
Rate for Payer: Meridian Medicaid	$6,621.14
Rate for Payer: PHP Medicaid	$5,986.31
Rate for Payer: Priority Health Choice Medicaid	$6,305.85
Rate for Payer: UHC Medicaid	$6,305.85
Rate for Payer: UHCCP Medicaid	$6,305.85

NEONATAL AFTERCARE

Facility

$22,077.01

Service Code	APR-DRG 8633
Min. Negotiated Rate	$19,960.26
Max. Negotiated Rate	$22,077.01
Rate for Payer: BCBS Complete	$22,077.01
Rate for Payer: Mclaren Medicaid	$21,025.73
Rate for Payer: Meridian Medicaid	$22,077.01
Rate for Payer: PHP Medicaid	$19,960.26
Rate for Payer: Priority Health Choice Medicaid	$21,025.73
Rate for Payer: UHC Medicaid	$21,025.73
Rate for Payer: UHCCP Medicaid	$21,025.73

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$64,828.34

Service Code	APR-DRG 6034
Min. Negotiated Rate	$58,612.58
Max. Negotiated Rate	$64,828.34
Rate for Payer: BCBS Complete	$64,828.34
Rate for Payer: Mclaren Medicaid	$61,741.28
Rate for Payer: Meridian Medicaid	$64,828.34
Rate for Payer: PHP Medicaid	$58,612.58
Rate for Payer: Priority Health Choice Medicaid	$61,741.28
Rate for Payer: UHC Medicaid	$61,741.28
Rate for Payer: UHCCP Medicaid	$61,741.28

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$8,591.68

Service Code	APR-DRG 6031
Min. Negotiated Rate	$7,767.91
Max. Negotiated Rate	$8,591.68
Rate for Payer: BCBS Complete	$8,591.68
Rate for Payer: Mclaren Medicaid	$8,182.55
Rate for Payer: Meridian Medicaid	$8,591.68
Rate for Payer: PHP Medicaid	$7,767.91
Rate for Payer: Priority Health Choice Medicaid	$8,182.55
Rate for Payer: UHC Medicaid	$8,182.55
Rate for Payer: UHCCP Medicaid	$8,182.55

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$40,187.88

Service Code	APR-DRG 6033
Min. Negotiated Rate	$36,334.65
Max. Negotiated Rate	$40,187.88
Rate for Payer: BCBS Complete	$40,187.88
Rate for Payer: Mclaren Medicaid	$38,274.17
Rate for Payer: Meridian Medicaid	$40,187.88
Rate for Payer: PHP Medicaid	$36,334.65
Rate for Payer: Priority Health Choice Medicaid	$38,274.17
Rate for Payer: UHC Medicaid	$38,274.17
Rate for Payer: UHCCP Medicaid	$38,274.17

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$27,470.38

Service Code	APR-DRG 6032
Min. Negotiated Rate	$24,836.51
Max. Negotiated Rate	$27,470.38
Rate for Payer: BCBS Complete	$27,470.38
Rate for Payer: Mclaren Medicaid	$26,162.27
Rate for Payer: Meridian Medicaid	$27,470.38
Rate for Payer: PHP Medicaid	$24,836.51
Rate for Payer: Priority Health Choice Medicaid	$26,162.27
Rate for Payer: UHC Medicaid	$26,162.27
Rate for Payer: UHCCP Medicaid	$26,162.27

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$26,800.10

Service Code	APR-DRG 6021
Min. Negotiated Rate	$24,230.49
Max. Negotiated Rate	$26,800.10
Rate for Payer: BCBS Complete	$26,800.10
Rate for Payer: Mclaren Medicaid	$25,523.90
Rate for Payer: Meridian Medicaid	$26,800.10
Rate for Payer: PHP Medicaid	$24,230.49
Rate for Payer: Priority Health Choice Medicaid	$25,523.90
Rate for Payer: UHC Medicaid	$25,523.90
Rate for Payer: UHCCP Medicaid	$25,523.90

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$33,125.33

Service Code	APR-DRG 6022
Min. Negotiated Rate	$29,949.26
Max. Negotiated Rate	$33,125.33
Rate for Payer: BCBS Complete	$33,125.33
Rate for Payer: Mclaren Medicaid	$31,547.93
Rate for Payer: Meridian Medicaid	$33,125.33
Rate for Payer: PHP Medicaid	$29,949.26
Rate for Payer: Priority Health Choice Medicaid	$31,547.93
Rate for Payer: UHC Medicaid	$31,547.93
Rate for Payer: UHCCP Medicaid	$31,547.93

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$57,158.17

Service Code	APR-DRG 6024
Min. Negotiated Rate	$51,677.82
Max. Negotiated Rate	$57,158.17
Rate for Payer: BCBS Complete	$57,158.17
Rate for Payer: Mclaren Medicaid	$54,436.35
Rate for Payer: Meridian Medicaid	$57,158.17
Rate for Payer: PHP Medicaid	$51,677.82
Rate for Payer: Priority Health Choice Medicaid	$54,436.35
Rate for Payer: UHC Medicaid	$54,436.35
Rate for Payer: UHCCP Medicaid	$54,436.35

NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$42,702.83

Service Code	APR-DRG 6023
Min. Negotiated Rate	$38,608.46
Max. Negotiated Rate	$42,702.83
Rate for Payer: BCBS Complete	$42,702.83
Rate for Payer: Mclaren Medicaid	$40,669.36
Rate for Payer: Meridian Medicaid	$42,702.83
Rate for Payer: PHP Medicaid	$38,608.46
Rate for Payer: Priority Health Choice Medicaid	$40,669.36
Rate for Payer: UHC Medicaid	$40,669.36
Rate for Payer: UHCCP Medicaid	$40,669.36

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$26,424.63

Service Code	APR-DRG 6084
Min. Negotiated Rate	$23,891.02
Max. Negotiated Rate	$26,424.63
Rate for Payer: BCBS Complete	$26,424.63
Rate for Payer: Mclaren Medicaid	$25,166.31
Rate for Payer: Meridian Medicaid	$26,424.63
Rate for Payer: PHP Medicaid	$23,891.02
Rate for Payer: Priority Health Choice Medicaid	$25,166.31
Rate for Payer: UHC Medicaid	$25,166.31
Rate for Payer: UHCCP Medicaid	$25,166.31

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$24,520.57

Service Code	APR-DRG 6083
Min. Negotiated Rate	$22,169.53
Max. Negotiated Rate	$24,520.57
Rate for Payer: BCBS Complete	$24,520.57
Rate for Payer: Mclaren Medicaid	$23,352.92
Rate for Payer: Meridian Medicaid	$24,520.57
Rate for Payer: PHP Medicaid	$22,169.53
Rate for Payer: Priority Health Choice Medicaid	$23,352.92
Rate for Payer: UHC Medicaid	$23,352.92
Rate for Payer: UHCCP Medicaid	$23,352.92

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$15,758.32

Service Code	APR-DRG 6082
Min. Negotiated Rate	$14,247.41
Max. Negotiated Rate	$15,758.32
Rate for Payer: BCBS Complete	$15,758.32
Rate for Payer: Mclaren Medicaid	$15,007.92
Rate for Payer: Meridian Medicaid	$15,758.32
Rate for Payer: PHP Medicaid	$14,247.41
Rate for Payer: Priority Health Choice Medicaid	$15,007.92
Rate for Payer: UHC Medicaid	$15,007.92
Rate for Payer: UHCCP Medicaid	$15,007.92

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION

Facility

$9,262.52

Service Code	APR-DRG 6081
Min. Negotiated Rate	$8,374.42
Max. Negotiated Rate	$9,262.52
Rate for Payer: BCBS Complete	$9,262.52
Rate for Payer: Mclaren Medicaid	$8,821.44
Rate for Payer: Meridian Medicaid	$9,262.52
Rate for Payer: PHP Medicaid	$8,374.42
Rate for Payer: Priority Health Choice Medicaid	$8,821.44
Rate for Payer: UHC Medicaid	$8,821.44
Rate for Payer: UHCCP Medicaid	$8,821.44

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$39,026.59

Service Code	APR-DRG 6074
Min. Negotiated Rate	$35,284.71
Max. Negotiated Rate	$39,026.59
Rate for Payer: BCBS Complete	$39,026.59
Rate for Payer: Mclaren Medicaid	$37,168.18
Rate for Payer: Meridian Medicaid	$39,026.59
Rate for Payer: PHP Medicaid	$35,284.71
Rate for Payer: Priority Health Choice Medicaid	$37,168.18
Rate for Payer: UHC Medicaid	$37,168.18
Rate for Payer: UHCCP Medicaid	$37,168.18

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$30,214.75

Service Code	APR-DRG 6073
Min. Negotiated Rate	$27,317.75
Max. Negotiated Rate	$30,214.75
Rate for Payer: BCBS Complete	$30,214.75
Rate for Payer: Mclaren Medicaid	$28,775.96
Rate for Payer: Meridian Medicaid	$30,214.75
Rate for Payer: PHP Medicaid	$27,317.75
Rate for Payer: Priority Health Choice Medicaid	$28,775.96
Rate for Payer: UHC Medicaid	$28,775.96
Rate for Payer: UHCCP Medicaid	$28,775.96

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$22,184.91

Service Code	APR-DRG 6072
Min. Negotiated Rate	$20,057.82
Max. Negotiated Rate	$22,184.91
Rate for Payer: BCBS Complete	$22,184.91
Rate for Payer: Mclaren Medicaid	$21,128.49
Rate for Payer: Meridian Medicaid	$22,184.91
Rate for Payer: PHP Medicaid	$20,057.82
Rate for Payer: Priority Health Choice Medicaid	$21,128.49
Rate for Payer: UHC Medicaid	$21,128.49
Rate for Payer: UHCCP Medicaid	$21,128.49

NEONATE BIRTH WEIGHT 1250-1499 GRAMS WITH RESPIRATORY DISTRESS SYNDROME OR OTHER MAJ

Facility

$14,178.51

Service Code	APR-DRG 6071
Min. Negotiated Rate	$12,819.07
Max. Negotiated Rate	$14,178.51
Rate for Payer: BCBS Complete	$14,178.51
Rate for Payer: Mclaren Medicaid	$13,503.34
Rate for Payer: Meridian Medicaid	$14,178.51
Rate for Payer: PHP Medicaid	$12,819.07
Rate for Payer: Priority Health Choice Medicaid	$13,503.34
Rate for Payer: UHC Medicaid	$13,503.34
Rate for Payer: UHCCP Medicaid	$13,503.34

NEONATE BIRTH WEIGHT 1500-1999 GRAMS WITH CONGENITAL OR PERINATAL INFECTION

Facility

$27,783.19

Service Code	APR-DRG 6133
Min. Negotiated Rate	$25,119.32
Max. Negotiated Rate	$27,783.19
Rate for Payer: BCBS Complete	$27,783.19
Rate for Payer: Mclaren Medicaid	$26,460.18
Rate for Payer: Meridian Medicaid	$27,783.19
Rate for Payer: PHP Medicaid	$25,119.32
Rate for Payer: Priority Health Choice Medicaid	$26,460.18
Rate for Payer: UHC Medicaid	$26,460.18
Rate for Payer: UHCCP Medicaid	$26,460.18

Know your out-of-pocket cost for care.

All Charges