Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS

Facility

$91.80

Service Code	HCPCS J2305
Hospital Charge Code	15859
Hospital Revenue Code	636
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: Aetna Medicare	$33.97
Rate for Payer: ASR ASR	$89.05
Rate for Payer: BCBS Complete	$36.72
Rate for Payer: BCBS Trust/PPO	$75.69
Rate for Payer: BCN Commercial	$75.69
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$89.05
Rate for Payer: Healthscope Whirlpool	$91.80
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: MI Amish Medical Board Commercial	$73.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.58
Rate for Payer: Priority Health Narrow Network	$1.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS

Facility

$91.80

Service Code	HCPCS J2305
Hospital Charge Code	15859
Hospital Revenue Code	636
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$91.80
Rate for Payer: Aetna Commercial	$82.62
Rate for Payer: ASR ASR	$89.05
Rate for Payer: BCBS Trust/PPO	$75.39
Rate for Payer: BCN Commercial	$75.39
Rate for Payer: Cash Price	$73.44
Rate for Payer: Cofinity Commercial	$86.29
Rate for Payer: Encore Health Key Benefits Commercial	$73.44
Rate for Payer: Healthscope Commercial	$89.05
Rate for Payer: Healthscope Whirlpool	$91.80
Rate for Payer: Mclaren Commercial	$82.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$78.03
Rate for Payer: Nomi Health Commercial	$75.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$80.78

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC

Facility

$31,529.17

Service Code	MSDRG 098
Min. Negotiated Rate	$17,366.56
Max. Negotiated Rate	$31,529.17
Rate for Payer: Aetna Medicare	$18,280.59
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,850.74
Rate for Payer: Amish Plain Church Group Commercial	$22,850.74
Rate for Payer: BCBS MAPPO	$18,280.59
Rate for Payer: BCN Medicare Advantage	$18,280.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,280.59
Rate for Payer: Humana Choice PPO Medicare	$18,280.59
Rate for Payer: Mclaren Medicare	$18,280.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,194.62
Rate for Payer: MI Amish Medical Board Commercial	$21,022.68
Rate for Payer: Molina Medicare/Medicaid	$20,108.65
Rate for Payer: PACE Medicare	$17,366.56
Rate for Payer: PACE SWMI	$18,280.59
Rate for Payer: PHP Commercial	$20,108.65
Rate for Payer: PHP Medicare Advantage	$18,280.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$31,529.17
Rate for Payer: Priority Health Medicare	$18,280.59
Rate for Payer: Priority Health Narrow Network	$25,223.34
Rate for Payer: Railroad Medicare Medicare	$18,280.59
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,280.59
Rate for Payer: UHC Exchange	$28,334.91
Rate for Payer: UHCCP DNSP	$18,280.59
Rate for Payer: VA VA	$18,280.59

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC

Facility

$49,621.80

Service Code	MSDRG 097
Min. Negotiated Rate	$26,375.71
Max. Negotiated Rate	$49,621.80
Rate for Payer: Aetna Medicare	$27,763.91
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,704.89
Rate for Payer: Amish Plain Church Group Commercial	$34,704.89
Rate for Payer: BCBS MAPPO	$27,763.91
Rate for Payer: BCN Medicare Advantage	$27,763.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,763.91
Rate for Payer: Humana Choice PPO Medicare	$27,763.91
Rate for Payer: Mclaren Medicare	$27,763.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29,152.11
Rate for Payer: MI Amish Medical Board Commercial	$31,928.50
Rate for Payer: Molina Medicare/Medicaid	$30,540.30
Rate for Payer: PACE Medicare	$26,375.71
Rate for Payer: PACE SWMI	$27,763.91
Rate for Payer: PHP Commercial	$30,540.30
Rate for Payer: PHP Medicare Advantage	$27,763.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$49,621.80
Rate for Payer: Priority Health Medicare	$27,763.91
Rate for Payer: Priority Health Narrow Network	$39,697.44
Rate for Payer: Railroad Medicare Medicare	$27,763.91
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,763.91
Rate for Payer: UHC Exchange	$43,034.06
Rate for Payer: UHCCP DNSP	$27,763.91
Rate for Payer: VA VA	$27,763.91

NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC

Facility

$18,717.74

Service Code	MSDRG 099
Min. Negotiated Rate	$10,987.17
Max. Negotiated Rate	$18,717.74
Rate for Payer: Aetna Medicare	$11,565.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,456.80
Rate for Payer: Amish Plain Church Group Commercial	$14,456.80
Rate for Payer: BCBS MAPPO	$11,565.44
Rate for Payer: BCN Medicare Advantage	$11,565.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,565.44
Rate for Payer: Humana Choice PPO Medicare	$11,565.44
Rate for Payer: Mclaren Medicare	$11,565.44
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,143.71
Rate for Payer: MI Amish Medical Board Commercial	$13,300.26
Rate for Payer: Molina Medicare/Medicaid	$12,721.98
Rate for Payer: PACE Medicare	$10,987.17
Rate for Payer: PACE SWMI	$11,565.44
Rate for Payer: PHP Commercial	$12,721.98
Rate for Payer: PHP Medicare Advantage	$11,565.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$18,717.74
Rate for Payer: Priority Health Medicare	$11,565.44
Rate for Payer: Priority Health Narrow Network	$14,974.19
Rate for Payer: Railroad Medicare Medicare	$11,565.44
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,565.44
Rate for Payer: UHC Exchange	$17,926.43
Rate for Payer: UHCCP DNSP	$11,565.44
Rate for Payer: VA VA	$11,565.44

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$30,449.08

Service Code	APR-DRG 0504
Min. Negotiated Rate	$27,529.61
Max. Negotiated Rate	$30,449.08
Rate for Payer: BCBS Complete	$30,449.08
Rate for Payer: Mclaren Medicaid	$28,999.12
Rate for Payer: Meridian Medicaid	$30,449.08
Rate for Payer: PHP Medicaid	$27,529.61
Rate for Payer: Priority Health Choice Medicaid	$28,999.12
Rate for Payer: UHC Medicaid	$28,999.12
Rate for Payer: UHCCP Medicaid	$28,999.12

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$11,546.40

Service Code	APR-DRG 0503
Min. Negotiated Rate	$10,439.33
Max. Negotiated Rate	$11,546.40
Rate for Payer: BCBS Complete	$11,546.40
Rate for Payer: Mclaren Medicaid	$10,996.57
Rate for Payer: Meridian Medicaid	$11,546.40
Rate for Payer: PHP Medicaid	$10,439.33
Rate for Payer: Priority Health Choice Medicaid	$10,996.57
Rate for Payer: UHC Medicaid	$10,996.57
Rate for Payer: UHCCP Medicaid	$10,996.57

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$8,200.41

Service Code	APR-DRG 0502
Min. Negotiated Rate	$7,414.15
Max. Negotiated Rate	$8,200.41
Rate for Payer: BCBS Complete	$8,200.41
Rate for Payer: Mclaren Medicaid	$7,809.91
Rate for Payer: Meridian Medicaid	$8,200.41
Rate for Payer: PHP Medicaid	$7,414.15
Rate for Payer: Priority Health Choice Medicaid	$7,809.91
Rate for Payer: UHC Medicaid	$7,809.91
Rate for Payer: UHCCP Medicaid	$7,809.91

NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS

Facility

$3,817.37

Service Code	APR-DRG 0501
Min. Negotiated Rate	$3,451.36
Max. Negotiated Rate	$3,817.37
Rate for Payer: BCBS Complete	$3,817.37
Rate for Payer: Mclaren Medicaid	$3,635.59
Rate for Payer: Meridian Medicaid	$3,817.37
Rate for Payer: PHP Medicaid	$3,451.36
Rate for Payer: Priority Health Choice Medicaid	$3,635.59
Rate for Payer: UHC Medicaid	$3,635.59
Rate for Payer: UHCCP Medicaid	$3,635.59

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$9,217.28

Service Code	APR-DRG 3231
Min. Negotiated Rate	$8,333.53
Max. Negotiated Rate	$9,217.28
Rate for Payer: BCBS Complete	$9,217.28
Rate for Payer: Mclaren Medicaid	$8,778.37
Rate for Payer: Meridian Medicaid	$9,217.28
Rate for Payer: PHP Medicaid	$8,333.53
Rate for Payer: Priority Health Choice Medicaid	$8,778.37
Rate for Payer: UHC Medicaid	$8,778.37
Rate for Payer: UHCCP Medicaid	$8,778.37

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$21,316.26

Service Code	APR-DRG 3234
Min. Negotiated Rate	$19,272.45
Max. Negotiated Rate	$21,316.26
Rate for Payer: BCBS Complete	$21,316.26
Rate for Payer: Mclaren Medicaid	$20,301.20
Rate for Payer: Meridian Medicaid	$21,316.26
Rate for Payer: PHP Medicaid	$19,272.45
Rate for Payer: Priority Health Choice Medicaid	$20,301.20
Rate for Payer: UHC Medicaid	$20,301.20
Rate for Payer: UHCCP Medicaid	$20,301.20

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$14,728.36

Service Code	APR-DRG 3233
Min. Negotiated Rate	$13,316.20
Max. Negotiated Rate	$14,728.36
Rate for Payer: BCBS Complete	$14,728.36
Rate for Payer: Mclaren Medicaid	$14,027.01
Rate for Payer: Meridian Medicaid	$14,728.36
Rate for Payer: PHP Medicaid	$13,316.20
Rate for Payer: Priority Health Choice Medicaid	$14,027.01
Rate for Payer: UHC Medicaid	$14,027.01
Rate for Payer: UHCCP Medicaid	$14,027.01

NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT

Facility

$11,144.23

Service Code	APR-DRG 3232
Min. Negotiated Rate	$10,075.72
Max. Negotiated Rate	$11,144.23
Rate for Payer: BCBS Complete	$11,144.23
Rate for Payer: Mclaren Medicaid	$10,613.55
Rate for Payer: Meridian Medicaid	$11,144.23
Rate for Payer: PHP Medicaid	$10,075.72
Rate for Payer: Priority Health Choice Medicaid	$10,613.55
Rate for Payer: UHC Medicaid	$10,613.55
Rate for Payer: UHCCP Medicaid	$10,613.55

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$22,733.68

Service Code	APR-DRG 3254
Min. Negotiated Rate	$20,553.97
Max. Negotiated Rate	$22,733.68
Rate for Payer: BCBS Complete	$22,733.68
Rate for Payer: Mclaren Medicaid	$21,651.12
Rate for Payer: Meridian Medicaid	$22,733.68
Rate for Payer: PHP Medicaid	$20,553.97
Rate for Payer: Priority Health Choice Medicaid	$21,651.12
Rate for Payer: UHC Medicaid	$21,651.12
Rate for Payer: UHCCP Medicaid	$21,651.12

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$12,040.67

Service Code	APR-DRG 3251
Min. Negotiated Rate	$10,886.21
Max. Negotiated Rate	$12,040.67
Rate for Payer: BCBS Complete	$12,040.67
Rate for Payer: Mclaren Medicaid	$11,467.31
Rate for Payer: Meridian Medicaid	$12,040.67
Rate for Payer: PHP Medicaid	$10,886.21
Rate for Payer: Priority Health Choice Medicaid	$11,467.31
Rate for Payer: UHC Medicaid	$11,467.31
Rate for Payer: UHCCP Medicaid	$11,467.31

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$14,688.58

Service Code	APR-DRG 3252
Min. Negotiated Rate	$13,280.24
Max. Negotiated Rate	$14,688.58
Rate for Payer: BCBS Complete	$14,688.58
Rate for Payer: Mclaren Medicaid	$13,989.13
Rate for Payer: Meridian Medicaid	$14,688.58
Rate for Payer: PHP Medicaid	$13,280.24
Rate for Payer: Priority Health Choice Medicaid	$13,989.13
Rate for Payer: UHC Medicaid	$13,989.13
Rate for Payer: UHCCP Medicaid	$13,989.13

NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT

Facility

$18,265.09

Service Code	APR-DRG 3253
Min. Negotiated Rate	$16,513.83
Max. Negotiated Rate	$18,265.09
Rate for Payer: BCBS Complete	$18,265.09
Rate for Payer: Mclaren Medicaid	$17,395.32
Rate for Payer: Meridian Medicaid	$18,265.09
Rate for Payer: PHP Medicaid	$16,513.83
Rate for Payer: Priority Health Choice Medicaid	$17,395.32
Rate for Payer: UHC Medicaid	$17,395.32
Rate for Payer: UHCCP Medicaid	$17,395.32

NON-EXTENSIVE BURNS

Facility

$28,301.93

Service Code	MSDRG 935
Min. Negotiated Rate	$15,759.58
Max. Negotiated Rate	$28,301.93
Rate for Payer: Aetna Medicare	$16,589.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,736.29
Rate for Payer: Amish Plain Church Group Commercial	$20,736.29
Rate for Payer: BCBS MAPPO	$16,589.03
Rate for Payer: BCN Medicare Advantage	$16,589.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,589.03
Rate for Payer: Humana Choice PPO Medicare	$16,589.03
Rate for Payer: Mclaren Medicare	$16,589.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17,418.48
Rate for Payer: MI Amish Medical Board Commercial	$19,077.38
Rate for Payer: Molina Medicare/Medicaid	$18,247.93
Rate for Payer: PACE Medicare	$15,759.58
Rate for Payer: PACE SWMI	$16,589.03
Rate for Payer: PHP Commercial	$18,247.93
Rate for Payer: PHP Medicare Advantage	$16,589.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$28,301.93
Rate for Payer: Priority Health Medicare	$16,589.03
Rate for Payer: Priority Health Narrow Network	$22,641.54
Rate for Payer: Railroad Medicare Medicare	$16,589.03
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,589.03
Rate for Payer: UHC Exchange	$25,713.00
Rate for Payer: UHCCP DNSP	$16,589.03
Rate for Payer: VA VA	$16,589.03

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$20,867.77

Service Code	APR-DRG 7944
Min. Negotiated Rate	$18,866.96
Max. Negotiated Rate	$20,867.77
Rate for Payer: BCBS Complete	$20,867.77
Rate for Payer: Mclaren Medicaid	$19,874.07
Rate for Payer: Meridian Medicaid	$20,867.77
Rate for Payer: PHP Medicaid	$18,866.96
Rate for Payer: Priority Health Choice Medicaid	$19,874.07
Rate for Payer: UHC Medicaid	$19,874.07
Rate for Payer: UHCCP Medicaid	$19,874.07

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$10,396.56

Service Code	APR-DRG 7943
Min. Negotiated Rate	$9,399.73
Max. Negotiated Rate	$10,396.56
Rate for Payer: BCBS Complete	$10,396.56
Rate for Payer: Mclaren Medicaid	$9,901.48
Rate for Payer: Meridian Medicaid	$10,396.56
Rate for Payer: PHP Medicaid	$9,399.73
Rate for Payer: Priority Health Choice Medicaid	$9,901.48
Rate for Payer: UHC Medicaid	$9,901.48
Rate for Payer: UHCCP Medicaid	$9,901.48

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$5,414.62

Service Code	APR-DRG 7941
Min. Negotiated Rate	$4,895.47
Max. Negotiated Rate	$5,414.62
Rate for Payer: BCBS Complete	$5,414.62
Rate for Payer: Mclaren Medicaid	$5,156.78
Rate for Payer: Meridian Medicaid	$5,414.62
Rate for Payer: PHP Medicaid	$4,895.47
Rate for Payer: Priority Health Choice Medicaid	$5,156.78
Rate for Payer: UHC Medicaid	$5,156.78
Rate for Payer: UHCCP Medicaid	$5,156.78

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$7,308.32

Service Code	APR-DRG 7942
Min. Negotiated Rate	$6,607.60
Max. Negotiated Rate	$7,308.32
Rate for Payer: BCBS Complete	$7,308.32
Rate for Payer: Mclaren Medicaid	$6,960.31
Rate for Payer: Meridian Medicaid	$7,308.32
Rate for Payer: PHP Medicaid	$6,607.60
Rate for Payer: Priority Health Choice Medicaid	$6,960.31
Rate for Payer: UHC Medicaid	$6,960.31
Rate for Payer: UHCCP Medicaid	$6,960.31

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$22,581.09

Service Code	MSDRG 988
Min. Negotiated Rate	$12,910.91
Max. Negotiated Rate	$22,581.09
Rate for Payer: Aetna Medicare	$13,590.43
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,988.04
Rate for Payer: Amish Plain Church Group Commercial	$16,988.04
Rate for Payer: BCBS MAPPO	$13,590.43
Rate for Payer: BCN Medicare Advantage	$13,590.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,590.43
Rate for Payer: Humana Choice PPO Medicare	$13,590.43
Rate for Payer: Mclaren Medicare	$13,590.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,269.95
Rate for Payer: MI Amish Medical Board Commercial	$15,628.99
Rate for Payer: Molina Medicare/Medicaid	$14,949.47
Rate for Payer: PACE Medicare	$12,910.91
Rate for Payer: PACE SWMI	$13,590.43
Rate for Payer: PHP Commercial	$14,949.47
Rate for Payer: PHP Medicare Advantage	$13,590.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22,581.09
Rate for Payer: Priority Health Medicare	$13,590.43
Rate for Payer: Priority Health Narrow Network	$18,064.87
Rate for Payer: Railroad Medicare Medicare	$13,590.43
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,590.43
Rate for Payer: UHC Exchange	$21,065.17
Rate for Payer: UHCCP DNSP	$13,590.43
Rate for Payer: VA VA	$13,590.43

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$47,102.10

Service Code	MSDRG 987
Min. Negotiated Rate	$25,121.05
Max. Negotiated Rate	$47,102.10
Rate for Payer: Aetna Medicare	$26,443.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,054.01
Rate for Payer: Amish Plain Church Group Commercial	$33,054.01
Rate for Payer: BCBS MAPPO	$26,443.21
Rate for Payer: BCN Medicare Advantage	$26,443.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,443.21
Rate for Payer: Humana Choice PPO Medicare	$26,443.21
Rate for Payer: Mclaren Medicare	$26,443.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27,765.37
Rate for Payer: MI Amish Medical Board Commercial	$30,409.69
Rate for Payer: Molina Medicare/Medicaid	$29,087.53
Rate for Payer: PACE Medicare	$25,121.05
Rate for Payer: PACE SWMI	$26,443.21
Rate for Payer: PHP Commercial	$29,087.53
Rate for Payer: PHP Medicare Advantage	$26,443.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$47,102.10
Rate for Payer: Priority Health Medicare	$26,443.21
Rate for Payer: Priority Health Narrow Network	$37,681.68
Rate for Payer: Railroad Medicare Medicare	$26,443.21
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,443.21
Rate for Payer: UHC Exchange	$40,986.98
Rate for Payer: UHCCP DNSP	$26,443.21
Rate for Payer: VA VA	$26,443.21

NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$16,475.57

Service Code	MSDRG 989
Min. Negotiated Rate	$9,870.67
Max. Negotiated Rate	$16,475.57
Rate for Payer: Aetna Medicare	$10,390.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,987.73
Rate for Payer: Amish Plain Church Group Commercial	$12,987.73
Rate for Payer: BCBS MAPPO	$10,390.18
Rate for Payer: BCN Medicare Advantage	$10,390.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,390.18
Rate for Payer: Humana Choice PPO Medicare	$10,390.18
Rate for Payer: Mclaren Medicare	$10,390.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,909.69
Rate for Payer: MI Amish Medical Board Commercial	$11,948.71
Rate for Payer: Molina Medicare/Medicaid	$11,429.20
Rate for Payer: PACE Medicare	$9,870.67
Rate for Payer: PACE SWMI	$10,390.18
Rate for Payer: PHP Commercial	$11,429.20
Rate for Payer: PHP Medicare Advantage	$10,390.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16,475.57
Rate for Payer: Priority Health Medicare	$10,390.18
Rate for Payer: Priority Health Narrow Network	$13,180.46
Rate for Payer: Railroad Medicare Medicare	$10,390.18
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,390.18
Rate for Payer: UHC Exchange	$16,104.78
Rate for Payer: UHCCP DNSP	$10,390.18
Rate for Payer: VA VA	$10,390.18

Know your out-of-pocket cost for care.

All Charges