Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

OTHER COMPLICATIONS OF TREATMENT

Facility

$9,828.17

Service Code	APR-DRG 8134
Min. Negotiated Rate	$8,885.84
Max. Negotiated Rate	$9,828.17
Rate for Payer: BCBS Complete	$9,828.17
Rate for Payer: Mclaren Medicaid	$9,360.17
Rate for Payer: Meridian Medicaid	$9,828.17
Rate for Payer: PHP Medicaid	$8,885.84
Rate for Payer: Priority Health Choice Medicaid	$9,360.17
Rate for Payer: UHC Medicaid	$9,360.17
Rate for Payer: UHCCP Medicaid	$9,360.17

OTHER COMPLICATIONS OF TREATMENT

Facility

$4,986.84

Service Code	APR-DRG 8132
Min. Negotiated Rate	$4,508.70
Max. Negotiated Rate	$4,986.84
Rate for Payer: BCBS Complete	$4,986.84
Rate for Payer: Mclaren Medicaid	$4,749.37
Rate for Payer: Meridian Medicaid	$4,986.84
Rate for Payer: PHP Medicaid	$4,508.70
Rate for Payer: Priority Health Choice Medicaid	$4,749.37
Rate for Payer: UHC Medicaid	$4,749.37
Rate for Payer: UHCCP Medicaid	$4,749.37

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$7,665.81

Service Code	APR-DRG 2291
Min. Negotiated Rate	$6,930.81
Max. Negotiated Rate	$7,665.81
Rate for Payer: BCBS Complete	$7,665.81
Rate for Payer: Mclaren Medicaid	$7,300.77
Rate for Payer: Meridian Medicaid	$7,665.81
Rate for Payer: PHP Medicaid	$6,930.81
Rate for Payer: Priority Health Choice Medicaid	$7,300.77
Rate for Payer: UHC Medicaid	$7,300.77
Rate for Payer: UHCCP Medicaid	$7,300.77

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$14,224.28

Service Code	APR-DRG 2293
Min. Negotiated Rate	$12,860.46
Max. Negotiated Rate	$14,224.28
Rate for Payer: BCBS Complete	$14,224.28
Rate for Payer: Mclaren Medicaid	$13,546.94
Rate for Payer: Meridian Medicaid	$14,224.28
Rate for Payer: PHP Medicaid	$12,860.46
Rate for Payer: Priority Health Choice Medicaid	$13,546.94
Rate for Payer: UHC Medicaid	$13,546.94
Rate for Payer: UHCCP Medicaid	$13,546.94

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$9,569.32

Service Code	APR-DRG 2292
Min. Negotiated Rate	$8,651.81
Max. Negotiated Rate	$9,569.32
Rate for Payer: BCBS Complete	$9,569.32
Rate for Payer: Mclaren Medicaid	$9,113.64
Rate for Payer: Meridian Medicaid	$9,569.32
Rate for Payer: PHP Medicaid	$8,651.81
Rate for Payer: Priority Health Choice Medicaid	$9,113.64
Rate for Payer: UHC Medicaid	$9,113.64
Rate for Payer: UHCCP Medicaid	$9,113.64

OTHER DIGESTIVE SYSTEM AND ABDOMINAL PROCEDURES

Facility

$18,139.21

Service Code	APR-DRG 2294
Min. Negotiated Rate	$16,400.01
Max. Negotiated Rate	$18,139.21
Rate for Payer: BCBS Complete	$18,139.21
Rate for Payer: Mclaren Medicaid	$17,275.43
Rate for Payer: Meridian Medicaid	$18,139.21
Rate for Payer: PHP Medicaid	$16,400.01
Rate for Payer: Priority Health Choice Medicaid	$17,275.43
Rate for Payer: UHC Medicaid	$17,275.43
Rate for Payer: UHCCP Medicaid	$17,275.43

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$4,687.66

Service Code	APR-DRG 2542
Min. Negotiated Rate	$4,238.21
Max. Negotiated Rate	$4,687.66
Rate for Payer: BCBS Complete	$4,687.66
Rate for Payer: Mclaren Medicaid	$4,464.44
Rate for Payer: Meridian Medicaid	$4,687.66
Rate for Payer: PHP Medicaid	$4,238.21
Rate for Payer: Priority Health Choice Medicaid	$4,464.44
Rate for Payer: UHC Medicaid	$4,464.44
Rate for Payer: UHCCP Medicaid	$4,464.44

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$3,823.91

Service Code	APR-DRG 2541
Min. Negotiated Rate	$3,457.28
Max. Negotiated Rate	$3,823.91
Rate for Payer: BCBS Complete	$3,823.91
Rate for Payer: Mclaren Medicaid	$3,641.82
Rate for Payer: Meridian Medicaid	$3,823.91
Rate for Payer: PHP Medicaid	$3,457.28
Rate for Payer: Priority Health Choice Medicaid	$3,641.82
Rate for Payer: UHC Medicaid	$3,641.82
Rate for Payer: UHCCP Medicaid	$3,641.82

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$10,178.58

Service Code	APR-DRG 2544
Min. Negotiated Rate	$9,202.65
Max. Negotiated Rate	$10,178.58
Rate for Payer: BCBS Complete	$10,178.58
Rate for Payer: Mclaren Medicaid	$9,693.88
Rate for Payer: Meridian Medicaid	$10,178.58
Rate for Payer: PHP Medicaid	$9,202.65
Rate for Payer: Priority Health Choice Medicaid	$9,693.88
Rate for Payer: UHC Medicaid	$9,693.88
Rate for Payer: UHCCP Medicaid	$9,693.88

OTHER DIGESTIVE SYSTEM DIAGNOSES

Facility

$7,096.88

Service Code	APR-DRG 2543
Min. Negotiated Rate	$6,416.43
Max. Negotiated Rate	$7,096.88
Rate for Payer: BCBS Complete	$7,096.88
Rate for Payer: Mclaren Medicaid	$6,758.94
Rate for Payer: Meridian Medicaid	$7,096.88
Rate for Payer: PHP Medicaid	$6,416.43
Rate for Payer: Priority Health Choice Medicaid	$6,758.94
Rate for Payer: UHC Medicaid	$6,758.94
Rate for Payer: UHCCP Medicaid	$6,758.94

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC

Facility

$13,163.62

Service Code	MSDRG 394
Min. Negotiated Rate	$8,068.03
Max. Negotiated Rate	$13,163.62
Rate for Payer: Aetna Medicare	$8,492.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,615.83
Rate for Payer: Amish Plain Church Group Commercial	$10,615.83
Rate for Payer: BCBS MAPPO	$8,492.66
Rate for Payer: BCN Medicare Advantage	$8,492.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,492.66
Rate for Payer: Humana Choice PPO Medicare	$8,492.66
Rate for Payer: Mclaren Medicare	$8,492.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,917.29
Rate for Payer: MI Amish Medical Board Commercial	$9,766.56
Rate for Payer: Molina Medicare/Medicaid	$9,341.93
Rate for Payer: PACE Medicare	$8,068.03
Rate for Payer: PACE SWMI	$8,492.66
Rate for Payer: PHP Commercial	$9,341.93
Rate for Payer: PHP Medicare Advantage	$8,492.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$12,855.40
Rate for Payer: Priority Health Medicare	$8,492.66
Rate for Payer: Priority Health Narrow Network	$10,284.32
Rate for Payer: Railroad Medicare Medicare	$8,492.66
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,492.66
Rate for Payer: UHC Exchange	$13,163.62
Rate for Payer: UHCCP DNSP	$8,492.66
Rate for Payer: VA VA	$8,492.66

OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC

Facility

$21,972.46

Service Code	MSDRG 393
Min. Negotiated Rate	$12,607.84
Max. Negotiated Rate	$21,972.46
Rate for Payer: Aetna Medicare	$13,271.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,589.26
Rate for Payer: Amish Plain Church Group Commercial	$16,589.26
Rate for Payer: BCBS MAPPO	$13,271.41
Rate for Payer: BCN Medicare Advantage	$13,271.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,271.41
Rate for Payer: Humana Choice PPO Medicare	$13,271.41
Rate for Payer: Mclaren Medicare	$13,271.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,934.98
Rate for Payer: MI Amish Medical Board Commercial	$15,262.12
Rate for Payer: Molina Medicare/Medicaid	$14,598.55
Rate for Payer: PACE Medicare	$12,607.84
Rate for Payer: PACE SWMI	$13,271.41
Rate for Payer: PHP Commercial	$14,598.55
Rate for Payer: PHP Medicare Advantage	$13,271.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,972.46
Rate for Payer: Priority Health Medicare	$13,271.41
Rate for Payer: Priority Health Narrow Network	$17,577.97
Rate for Payer: Railroad Medicare Medicare	$13,271.41
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,271.41
Rate for Payer: UHC Exchange	$20,570.69
Rate for Payer: UHCCP DNSP	$13,271.41
Rate for Payer: VA VA	$13,271.41

OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC

Facility

$9,963.51

Service Code	MSDRG 395
Min. Negotiated Rate	$6,106.67
Max. Negotiated Rate	$9,963.51
Rate for Payer: Aetna Medicare	$6,428.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,035.09
Rate for Payer: Amish Plain Church Group Commercial	$8,035.09
Rate for Payer: BCBS MAPPO	$6,428.07
Rate for Payer: BCN Medicare Advantage	$6,428.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,428.07
Rate for Payer: Humana Choice PPO Medicare	$6,428.07
Rate for Payer: Mclaren Medicare	$6,428.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,749.47
Rate for Payer: MI Amish Medical Board Commercial	$7,392.28
Rate for Payer: Molina Medicare/Medicaid	$7,070.88
Rate for Payer: PACE Medicare	$6,106.67
Rate for Payer: PACE SWMI	$6,428.07
Rate for Payer: PHP Commercial	$7,070.88
Rate for Payer: PHP Medicare Advantage	$6,428.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$8,916.48
Rate for Payer: Priority Health Medicare	$6,428.07
Rate for Payer: Priority Health Narrow Network	$7,133.18
Rate for Payer: Railroad Medicare Medicare	$6,428.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,428.07
Rate for Payer: UHC Exchange	$9,963.51
Rate for Payer: UHCCP DNSP	$6,428.07
Rate for Payer: VA VA	$6,428.07

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC

Facility

$31,949.58

Service Code	MSDRG 357
Min. Negotiated Rate	$17,575.90
Max. Negotiated Rate	$31,949.58
Rate for Payer: Aetna Medicare	$18,500.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$23,126.19
Rate for Payer: Amish Plain Church Group Commercial	$23,126.19
Rate for Payer: BCBS MAPPO	$18,500.95
Rate for Payer: BCN Medicare Advantage	$18,500.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,500.95
Rate for Payer: Humana Choice PPO Medicare	$18,500.95
Rate for Payer: Mclaren Medicare	$18,500.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,426.00
Rate for Payer: MI Amish Medical Board Commercial	$21,276.09
Rate for Payer: Molina Medicare/Medicaid	$20,351.04
Rate for Payer: PACE Medicare	$17,575.90
Rate for Payer: PACE SWMI	$18,500.95
Rate for Payer: PHP Commercial	$20,351.04
Rate for Payer: PHP Medicare Advantage	$18,500.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$31,949.58
Rate for Payer: Priority Health Medicare	$18,500.95
Rate for Payer: Priority Health Narrow Network	$25,559.66
Rate for Payer: Railroad Medicare Medicare	$18,500.95
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,500.95
Rate for Payer: UHC Exchange	$28,676.47
Rate for Payer: UHCCP DNSP	$18,500.95
Rate for Payer: VA VA	$18,500.95

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC

Facility

$60,351.80

Service Code	MSDRG 356
Min. Negotiated Rate	$31,718.69
Max. Negotiated Rate	$60,351.80
Rate for Payer: Aetna Medicare	$33,388.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$41,735.11
Rate for Payer: Amish Plain Church Group Commercial	$41,735.11
Rate for Payer: BCBS MAPPO	$33,388.09
Rate for Payer: BCN Medicare Advantage	$33,388.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$33,388.09
Rate for Payer: Humana Choice PPO Medicare	$33,388.09
Rate for Payer: Mclaren Medicare	$33,388.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35,057.49
Rate for Payer: MI Amish Medical Board Commercial	$38,396.30
Rate for Payer: Molina Medicare/Medicaid	$36,726.90
Rate for Payer: PACE Medicare	$31,718.69
Rate for Payer: PACE SWMI	$33,388.09
Rate for Payer: PHP Commercial	$36,726.90
Rate for Payer: PHP Medicare Advantage	$33,388.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$60,351.80
Rate for Payer: Priority Health Medicare	$33,388.09
Rate for Payer: Priority Health Narrow Network	$48,281.44
Rate for Payer: Railroad Medicare Medicare	$33,388.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$33,388.09
Rate for Payer: UHC Exchange	$51,751.54
Rate for Payer: UHCCP DNSP	$33,388.09
Rate for Payer: VA VA	$33,388.09

OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC

Facility

$19,205.47

Service Code	MSDRG 358
Min. Negotiated Rate	$11,230.02
Max. Negotiated Rate	$19,205.47
Rate for Payer: Aetna Medicare	$11,821.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,776.34
Rate for Payer: Amish Plain Church Group Commercial	$14,776.34
Rate for Payer: BCBS MAPPO	$11,821.07
Rate for Payer: BCN Medicare Advantage	$11,821.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,821.07
Rate for Payer: Humana Choice PPO Medicare	$11,821.07
Rate for Payer: Mclaren Medicare	$11,821.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,412.12
Rate for Payer: MI Amish Medical Board Commercial	$13,594.23
Rate for Payer: Molina Medicare/Medicaid	$13,003.18
Rate for Payer: PACE Medicare	$11,230.02
Rate for Payer: PACE SWMI	$11,821.07
Rate for Payer: PHP Commercial	$13,003.18
Rate for Payer: PHP Medicare Advantage	$11,821.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19,205.47
Rate for Payer: Priority Health Medicare	$11,821.07
Rate for Payer: Priority Health Narrow Network	$15,364.37
Rate for Payer: Railroad Medicare Medicare	$11,821.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,821.07
Rate for Payer: UHC Exchange	$18,322.66
Rate for Payer: UHCCP DNSP	$11,821.07
Rate for Payer: VA VA	$11,821.07

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$8,042.92

Service Code	APR-DRG 0583
Min. Negotiated Rate	$7,271.76
Max. Negotiated Rate	$8,042.92
Rate for Payer: BCBS Complete	$8,042.92
Rate for Payer: Mclaren Medicaid	$7,659.92
Rate for Payer: Meridian Medicaid	$8,042.92
Rate for Payer: PHP Medicaid	$7,271.76
Rate for Payer: Priority Health Choice Medicaid	$7,659.92
Rate for Payer: UHC Medicaid	$7,659.92
Rate for Payer: UHCCP Medicaid	$7,659.92

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$10,918.62

Service Code	APR-DRG 0584
Min. Negotiated Rate	$9,871.74
Max. Negotiated Rate	$10,918.62
Rate for Payer: BCBS Complete	$10,918.62
Rate for Payer: Mclaren Medicaid	$10,398.68
Rate for Payer: Meridian Medicaid	$10,918.62
Rate for Payer: PHP Medicaid	$9,871.74
Rate for Payer: Priority Health Choice Medicaid	$10,398.68
Rate for Payer: UHC Medicaid	$10,398.68
Rate for Payer: UHCCP Medicaid	$10,398.68

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$3,947.62

Service Code	APR-DRG 0581
Min. Negotiated Rate	$3,569.12
Max. Negotiated Rate	$3,947.62
Rate for Payer: BCBS Complete	$3,947.62
Rate for Payer: Mclaren Medicaid	$3,759.64
Rate for Payer: Meridian Medicaid	$3,947.62
Rate for Payer: PHP Medicaid	$3,569.12
Rate for Payer: Priority Health Choice Medicaid	$3,759.64
Rate for Payer: UHC Medicaid	$3,759.64
Rate for Payer: UHCCP Medicaid	$3,759.64

OTHER DISORDERS OF NERVOUS SYSTEM

Facility

$5,812.98

Service Code	APR-DRG 0582
Min. Negotiated Rate	$5,255.63
Max. Negotiated Rate	$5,812.98
Rate for Payer: BCBS Complete	$5,812.98
Rate for Payer: Mclaren Medicaid	$5,536.17
Rate for Payer: Meridian Medicaid	$5,812.98
Rate for Payer: PHP Medicaid	$5,255.63
Rate for Payer: Priority Health Choice Medicaid	$5,536.17
Rate for Payer: UHC Medicaid	$5,536.17
Rate for Payer: UHCCP Medicaid	$5,536.17

OTHER DISORDERS OF NERVOUS SYSTEM WITH CC

Facility

$14,138.05

Service Code	MSDRG 092
Min. Negotiated Rate	$8,665.25
Max. Negotiated Rate	$14,138.05
Rate for Payer: Aetna Medicare	$9,121.32
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,401.65
Rate for Payer: Amish Plain Church Group Commercial	$11,401.65
Rate for Payer: BCBS MAPPO	$9,121.32
Rate for Payer: BCN Medicare Advantage	$9,121.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,121.32
Rate for Payer: Humana Choice PPO Medicare	$9,121.32
Rate for Payer: Mclaren Medicare	$9,121.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,577.39
Rate for Payer: MI Amish Medical Board Commercial	$10,489.52
Rate for Payer: Molina Medicare/Medicaid	$10,033.45
Rate for Payer: PACE Medicare	$8,665.25
Rate for Payer: PACE SWMI	$9,121.32
Rate for Payer: PHP Commercial	$10,033.45
Rate for Payer: PHP Medicare Advantage	$9,121.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,054.79
Rate for Payer: Priority Health Medicare	$9,121.32
Rate for Payer: Priority Health Narrow Network	$11,243.83
Rate for Payer: Railroad Medicare Medicare	$9,121.32
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,121.32
Rate for Payer: UHC Exchange	$14,138.05
Rate for Payer: UHCCP DNSP	$9,121.32
Rate for Payer: VA VA	$9,121.32

OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC

Facility

$24,128.08

Service Code	MSDRG 091
Min. Negotiated Rate	$13,681.22
Max. Negotiated Rate	$24,128.08
Rate for Payer: Aetna Medicare	$14,401.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,001.60
Rate for Payer: Amish Plain Church Group Commercial	$18,001.60
Rate for Payer: BCBS MAPPO	$14,401.28
Rate for Payer: BCN Medicare Advantage	$14,401.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,401.28
Rate for Payer: Humana Choice PPO Medicare	$14,401.28
Rate for Payer: Mclaren Medicare	$14,401.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,121.34
Rate for Payer: MI Amish Medical Board Commercial	$16,561.47
Rate for Payer: Molina Medicare/Medicaid	$15,841.41
Rate for Payer: PACE Medicare	$13,681.22
Rate for Payer: PACE SWMI	$14,401.28
Rate for Payer: PHP Commercial	$15,841.41
Rate for Payer: PHP Medicare Advantage	$14,401.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,128.08
Rate for Payer: Priority Health Medicare	$14,401.28
Rate for Payer: Priority Health Narrow Network	$19,302.46
Rate for Payer: Railroad Medicare Medicare	$14,401.28
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,401.28
Rate for Payer: UHC Exchange	$22,321.98
Rate for Payer: UHCCP DNSP	$14,401.28
Rate for Payer: VA VA	$14,401.28

OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$11,607.66

Service Code	MSDRG 093
Min. Negotiated Rate	$7,114.37
Max. Negotiated Rate	$11,607.66
Rate for Payer: Aetna Medicare	$7,488.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,361.01
Rate for Payer: Amish Plain Church Group Commercial	$9,361.01
Rate for Payer: BCBS MAPPO	$7,488.81
Rate for Payer: BCN Medicare Advantage	$7,488.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,488.81
Rate for Payer: Humana Choice PPO Medicare	$7,488.81
Rate for Payer: Mclaren Medicare	$7,488.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,863.25
Rate for Payer: MI Amish Medical Board Commercial	$8,612.13
Rate for Payer: Molina Medicare/Medicaid	$8,237.69
Rate for Payer: PACE Medicare	$7,114.37
Rate for Payer: PACE SWMI	$7,488.81
Rate for Payer: PHP Commercial	$8,237.69
Rate for Payer: PHP Medicare Advantage	$7,488.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,940.21
Rate for Payer: Priority Health Medicare	$7,488.81
Rate for Payer: Priority Health Narrow Network	$8,752.17
Rate for Payer: Railroad Medicare Medicare	$7,488.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,488.81
Rate for Payer: UHC Exchange	$11,607.66
Rate for Payer: UHCCP DNSP	$7,488.81
Rate for Payer: VA VA	$7,488.81

OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT

Facility

$18,177.81

Service Code	MSDRG 124
Min. Negotiated Rate	$10,718.30
Max. Negotiated Rate	$18,177.81
Rate for Payer: Aetna Medicare	$11,282.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,103.02
Rate for Payer: Amish Plain Church Group Commercial	$14,103.02
Rate for Payer: BCBS MAPPO	$11,282.42
Rate for Payer: BCN Medicare Advantage	$11,282.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,282.42
Rate for Payer: Humana Choice PPO Medicare	$11,282.42
Rate for Payer: Mclaren Medicare	$11,282.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,846.54
Rate for Payer: MI Amish Medical Board Commercial	$12,974.78
Rate for Payer: Molina Medicare/Medicaid	$12,410.66
Rate for Payer: PACE Medicare	$10,718.30
Rate for Payer: PACE SWMI	$11,282.42
Rate for Payer: PHP Commercial	$12,410.66
Rate for Payer: PHP Medicare Advantage	$11,282.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$18,177.81
Rate for Payer: Priority Health Medicare	$11,282.42
Rate for Payer: Priority Health Narrow Network	$14,542.25
Rate for Payer: Railroad Medicare Medicare	$11,282.42
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11,282.42
Rate for Payer: UHC Exchange	$17,487.75
Rate for Payer: UHCCP DNSP	$11,282.42
Rate for Payer: VA VA	$11,282.42

OTHER DISORDERS OF THE EYE WITHOUT MCC

Facility

$11,289.55

Service Code	MSDRG 125
Min. Negotiated Rate	$6,919.40
Max. Negotiated Rate	$11,289.55
Rate for Payer: Aetna Medicare	$7,283.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,104.48
Rate for Payer: Amish Plain Church Group Commercial	$9,104.48
Rate for Payer: BCBS MAPPO	$7,283.58
Rate for Payer: BCN Medicare Advantage	$7,283.58
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,283.58
Rate for Payer: Humana Choice PPO Medicare	$7,283.58
Rate for Payer: Mclaren Medicare	$7,283.58
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,647.76
Rate for Payer: MI Amish Medical Board Commercial	$8,376.12
Rate for Payer: Molina Medicare/Medicaid	$8,011.94
Rate for Payer: PACE Medicare	$6,919.40
Rate for Payer: PACE SWMI	$7,283.58
Rate for Payer: PHP Commercial	$8,011.94
Rate for Payer: PHP Medicare Advantage	$7,283.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,548.65
Rate for Payer: Priority Health Medicare	$7,283.58
Rate for Payer: Priority Health Narrow Network	$8,438.92
Rate for Payer: Railroad Medicare Medicare	$7,283.58
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,283.58
Rate for Payer: UHC Exchange	$11,289.55
Rate for Payer: UHCCP DNSP	$7,283.58
Rate for Payer: VA VA	$7,283.58

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