Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$17,102.71

Service Code	APR-DRG 1831
Min. Negotiated Rate	$15,462.90
Max. Negotiated Rate	$17,102.71
Rate for Payer: BCBS Complete	$17,102.71
Rate for Payer: Mclaren Medicaid	$16,288.30
Rate for Payer: Meridian Medicaid	$17,102.71
Rate for Payer: PHP Medicaid	$15,462.90
Rate for Payer: Priority Health Choice Medicaid	$16,288.30
Rate for Payer: UHC Medicaid	$16,288.30
Rate for Payer: UHCCP Medicaid	$16,288.30

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$23,588.71

Service Code	APR-DRG 1833
Min. Negotiated Rate	$21,327.01
Max. Negotiated Rate	$23,588.71
Rate for Payer: BCBS Complete	$23,588.71
Rate for Payer: Mclaren Medicaid	$22,465.43
Rate for Payer: Meridian Medicaid	$23,588.71
Rate for Payer: PHP Medicaid	$21,327.01
Rate for Payer: Priority Health Choice Medicaid	$22,465.43
Rate for Payer: UHC Medicaid	$22,465.43
Rate for Payer: UHCCP Medicaid	$22,465.43

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$18,690.70

Service Code	APR-DRG 1832
Min. Negotiated Rate	$16,898.62
Max. Negotiated Rate	$18,690.70
Rate for Payer: BCBS Complete	$18,690.70
Rate for Payer: Mclaren Medicaid	$17,800.66
Rate for Payer: Meridian Medicaid	$18,690.70
Rate for Payer: PHP Medicaid	$16,898.62
Rate for Payer: Priority Health Choice Medicaid	$17,800.66
Rate for Payer: UHC Medicaid	$17,800.66
Rate for Payer: UHCCP Medicaid	$17,800.66

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$33,182.55

Service Code	APR-DRG 1834
Min. Negotiated Rate	$30,001.00
Max. Negotiated Rate	$33,182.55
Rate for Payer: BCBS Complete	$33,182.55
Rate for Payer: Mclaren Medicaid	$31,602.43
Rate for Payer: Meridian Medicaid	$33,182.55
Rate for Payer: PHP Medicaid	$30,001.00
Rate for Payer: Priority Health Choice Medicaid	$31,602.43
Rate for Payer: UHC Medicaid	$31,602.43
Rate for Payer: UHCCP Medicaid	$31,602.43

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$4,745.97

Service Code	APR-DRG 1972
Min. Negotiated Rate	$4,290.92
Max. Negotiated Rate	$4,745.97
Rate for Payer: BCBS Complete	$4,745.97
Rate for Payer: Mclaren Medicaid	$4,519.97
Rate for Payer: Meridian Medicaid	$4,745.97
Rate for Payer: PHP Medicaid	$4,290.92
Rate for Payer: Priority Health Choice Medicaid	$4,519.97
Rate for Payer: UHC Medicaid	$4,519.97
Rate for Payer: UHCCP Medicaid	$4,519.97

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$7,461.46

Service Code	APR-DRG 1973
Min. Negotiated Rate	$6,746.05
Max. Negotiated Rate	$7,461.46
Rate for Payer: BCBS Complete	$7,461.46
Rate for Payer: Mclaren Medicaid	$7,106.15
Rate for Payer: Meridian Medicaid	$7,461.46
Rate for Payer: PHP Medicaid	$6,746.05
Rate for Payer: Priority Health Choice Medicaid	$7,106.15
Rate for Payer: UHC Medicaid	$7,106.15
Rate for Payer: UHCCP Medicaid	$7,106.15

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$3,606.48

Service Code	APR-DRG 1971
Min. Negotiated Rate	$3,260.69
Max. Negotiated Rate	$3,606.48
Rate for Payer: BCBS Complete	$3,606.48
Rate for Payer: Mclaren Medicaid	$3,434.74
Rate for Payer: Meridian Medicaid	$3,606.48
Rate for Payer: PHP Medicaid	$3,260.69
Rate for Payer: Priority Health Choice Medicaid	$3,434.74
Rate for Payer: UHC Medicaid	$3,434.74
Rate for Payer: UHCCP Medicaid	$3,434.74

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$10,882.11

Service Code	APR-DRG 1974
Min. Negotiated Rate	$9,838.73
Max. Negotiated Rate	$10,882.11
Rate for Payer: BCBS Complete	$10,882.11
Rate for Payer: Mclaren Medicaid	$10,363.91
Rate for Payer: Meridian Medicaid	$10,882.11
Rate for Payer: PHP Medicaid	$9,838.73
Rate for Payer: Priority Health Choice Medicaid	$10,363.91
Rate for Payer: UHC Medicaid	$10,363.91
Rate for Payer: UHCCP Medicaid	$10,363.91

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$12,394.34

Service Code	APR-DRG 0484
Min. Negotiated Rate	$11,205.97
Max. Negotiated Rate	$12,394.34
Rate for Payer: BCBS Complete	$12,394.34
Rate for Payer: Mclaren Medicaid	$11,804.14
Rate for Payer: Meridian Medicaid	$12,394.34
Rate for Payer: PHP Medicaid	$11,205.97
Rate for Payer: Priority Health Choice Medicaid	$11,804.14
Rate for Payer: UHC Medicaid	$11,804.14
Rate for Payer: UHCCP Medicaid	$11,804.14

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$5,116.54

Service Code	APR-DRG 0482
Min. Negotiated Rate	$4,625.96
Max. Negotiated Rate	$5,116.54
Rate for Payer: BCBS Complete	$5,116.54
Rate for Payer: Mclaren Medicaid	$4,872.89
Rate for Payer: Meridian Medicaid	$5,116.54
Rate for Payer: PHP Medicaid	$4,625.96
Rate for Payer: Priority Health Choice Medicaid	$4,872.89
Rate for Payer: UHC Medicaid	$4,872.89
Rate for Payer: UHCCP Medicaid	$4,872.89

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$7,792.78

Service Code	APR-DRG 0483
Min. Negotiated Rate	$7,045.61
Max. Negotiated Rate	$7,792.78
Rate for Payer: BCBS Complete	$7,792.78
Rate for Payer: Mclaren Medicaid	$7,421.70
Rate for Payer: Meridian Medicaid	$7,792.78
Rate for Payer: PHP Medicaid	$7,045.61
Rate for Payer: Priority Health Choice Medicaid	$7,421.70
Rate for Payer: UHC Medicaid	$7,421.70
Rate for Payer: UHCCP Medicaid	$7,421.70

PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS

Facility

$3,976.50

Service Code	APR-DRG 0481
Min. Negotiated Rate	$3,595.23
Max. Negotiated Rate	$3,976.50
Rate for Payer: BCBS Complete	$3,976.50
Rate for Payer: Mclaren Medicaid	$3,787.14
Rate for Payer: Meridian Medicaid	$3,976.50
Rate for Payer: PHP Medicaid	$3,595.23
Rate for Payer: Priority Health Choice Medicaid	$3,787.14
Rate for Payer: UHC Medicaid	$3,787.14
Rate for Payer: UHCCP Medicaid	$3,787.14

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR

Facility

$30,207.50

Service Code	MSDRG 041
Min. Negotiated Rate	$16,708.44
Max. Negotiated Rate	$30,207.50
Rate for Payer: Aetna Medicare	$17,587.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,984.79
Rate for Payer: Amish Plain Church Group Commercial	$21,984.79
Rate for Payer: BCBS MAPPO	$17,587.83
Rate for Payer: BCN Medicare Advantage	$17,587.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,587.83
Rate for Payer: Humana Choice PPO Medicare	$17,587.83
Rate for Payer: Mclaren Medicare	$17,587.83
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,467.22
Rate for Payer: MI Amish Medical Board Commercial	$20,226.00
Rate for Payer: Molina Medicare/Medicaid	$19,346.61
Rate for Payer: PACE Medicare	$16,708.44
Rate for Payer: PACE SWMI	$17,587.83
Rate for Payer: PHP Commercial	$19,346.61
Rate for Payer: PHP Medicare Advantage	$17,587.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$30,207.50
Rate for Payer: Priority Health Medicare	$17,587.83
Rate for Payer: Priority Health Narrow Network	$24,166.00
Rate for Payer: Railroad Medicare Medicare	$17,587.83
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$17,587.83
Rate for Payer: UHC Exchange	$27,261.14
Rate for Payer: UHCCP DNSP	$17,587.83
Rate for Payer: VA VA	$17,587.83

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC

Facility

$53,048.25

Service Code	MSDRG 040
Min. Negotiated Rate	$28,081.90
Max. Negotiated Rate	$53,048.25
Rate for Payer: Aetna Medicare	$29,559.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$36,949.86
Rate for Payer: Amish Plain Church Group Commercial	$36,949.86
Rate for Payer: BCBS MAPPO	$29,559.89
Rate for Payer: BCN Medicare Advantage	$29,559.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$29,559.89
Rate for Payer: Humana Choice PPO Medicare	$29,559.89
Rate for Payer: Mclaren Medicare	$29,559.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$31,037.88
Rate for Payer: MI Amish Medical Board Commercial	$33,993.87
Rate for Payer: Molina Medicare/Medicaid	$32,515.88
Rate for Payer: PACE Medicare	$28,081.90
Rate for Payer: PACE SWMI	$29,559.89
Rate for Payer: PHP Commercial	$32,515.88
Rate for Payer: PHP Medicare Advantage	$29,559.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$53,048.25
Rate for Payer: Priority Health Medicare	$29,559.89
Rate for Payer: Priority Health Narrow Network	$42,438.60
Rate for Payer: Railroad Medicare Medicare	$29,559.89
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$29,559.89
Rate for Payer: UHC Exchange	$45,817.83
Rate for Payer: UHCCP DNSP	$29,559.89
Rate for Payer: VA VA	$29,559.89

PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC

Facility

$23,736.52

Service Code	MSDRG 042
Min. Negotiated Rate	$13,486.25
Max. Negotiated Rate	$23,736.52
Rate for Payer: Aetna Medicare	$14,196.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,745.06
Rate for Payer: Amish Plain Church Group Commercial	$17,745.06
Rate for Payer: BCBS MAPPO	$14,196.05
Rate for Payer: BCN Medicare Advantage	$14,196.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,196.05
Rate for Payer: Humana Choice PPO Medicare	$14,196.05
Rate for Payer: Mclaren Medicare	$14,196.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,905.85
Rate for Payer: MI Amish Medical Board Commercial	$16,325.46
Rate for Payer: Molina Medicare/Medicaid	$15,615.66
Rate for Payer: PACE Medicare	$13,486.25
Rate for Payer: PACE SWMI	$14,196.05
Rate for Payer: PHP Commercial	$15,615.66
Rate for Payer: PHP Medicare Advantage	$14,196.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$23,736.52
Rate for Payer: Priority Health Medicare	$14,196.05
Rate for Payer: Priority Health Narrow Network	$18,989.22
Rate for Payer: Railroad Medicare Medicare	$14,196.05
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,196.05
Rate for Payer: UHC Exchange	$22,003.88
Rate for Payer: UHCCP DNSP	$14,196.05
Rate for Payer: VA VA	$14,196.05

PERIPHERAL VASCULAR DISORDERS WITH CC

Facility

$14,666.17

Service Code	MSDRG 300
Min. Negotiated Rate	$8,969.70
Max. Negotiated Rate	$14,666.17
Rate for Payer: Aetna Medicare	$9,441.79
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,802.24
Rate for Payer: Amish Plain Church Group Commercial	$11,802.24
Rate for Payer: BCBS MAPPO	$9,441.79
Rate for Payer: BCN Medicare Advantage	$9,441.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,441.79
Rate for Payer: Humana Choice PPO Medicare	$9,441.79
Rate for Payer: Mclaren Medicare	$9,441.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,913.88
Rate for Payer: MI Amish Medical Board Commercial	$10,858.06
Rate for Payer: Molina Medicare/Medicaid	$10,385.97
Rate for Payer: PACE Medicare	$8,969.70
Rate for Payer: PACE SWMI	$9,441.79
Rate for Payer: PHP Commercial	$10,385.97
Rate for Payer: PHP Medicare Advantage	$9,441.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,666.17
Rate for Payer: Priority Health Medicare	$9,441.79
Rate for Payer: Priority Health Narrow Network	$11,732.94
Rate for Payer: Railroad Medicare Medicare	$9,441.79
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,441.79
Rate for Payer: UHC Exchange	$14,634.77
Rate for Payer: UHCCP DNSP	$9,441.79
Rate for Payer: VA VA	$9,441.79

PERIPHERAL VASCULAR DISORDERS WITH MCC

Facility

$22,431.34

Service Code	MSDRG 299
Min. Negotiated Rate	$12,836.33
Max. Negotiated Rate	$22,431.34
Rate for Payer: Aetna Medicare	$13,511.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,889.91
Rate for Payer: Amish Plain Church Group Commercial	$16,889.91
Rate for Payer: BCBS MAPPO	$13,511.93
Rate for Payer: BCN Medicare Advantage	$13,511.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,511.93
Rate for Payer: Humana Choice PPO Medicare	$13,511.93
Rate for Payer: Mclaren Medicare	$13,511.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,187.53
Rate for Payer: MI Amish Medical Board Commercial	$15,538.72
Rate for Payer: Molina Medicare/Medicaid	$14,863.12
Rate for Payer: PACE Medicare	$12,836.33
Rate for Payer: PACE SWMI	$13,511.93
Rate for Payer: PHP Commercial	$14,863.12
Rate for Payer: PHP Medicare Advantage	$13,511.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22,431.34
Rate for Payer: Priority Health Medicare	$13,511.93
Rate for Payer: Priority Health Narrow Network	$17,945.07
Rate for Payer: Railroad Medicare Medicare	$13,511.93
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,511.93
Rate for Payer: UHC Exchange	$20,943.49
Rate for Payer: UHCCP DNSP	$13,511.93
Rate for Payer: VA VA	$13,511.93

PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC

Facility

$10,752.64

Service Code	MSDRG 301
Min. Negotiated Rate	$6,590.33
Max. Negotiated Rate	$10,752.64
Rate for Payer: Aetna Medicare	$6,937.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,671.49
Rate for Payer: Amish Plain Church Group Commercial	$8,671.49
Rate for Payer: BCBS MAPPO	$6,937.19
Rate for Payer: BCN Medicare Advantage	$6,937.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,937.19
Rate for Payer: Humana Choice PPO Medicare	$6,937.19
Rate for Payer: Mclaren Medicare	$6,937.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,284.05
Rate for Payer: MI Amish Medical Board Commercial	$7,977.77
Rate for Payer: Molina Medicare/Medicaid	$7,630.91
Rate for Payer: PACE Medicare	$6,590.33
Rate for Payer: PACE SWMI	$6,937.19
Rate for Payer: PHP Commercial	$7,630.91
Rate for Payer: PHP Medicare Advantage	$6,937.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,887.81
Rate for Payer: Priority Health Medicare	$6,937.19
Rate for Payer: Priority Health Narrow Network	$7,910.25
Rate for Payer: Railroad Medicare Medicare	$6,937.19
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,937.19
Rate for Payer: UHC Exchange	$10,752.64
Rate for Payer: UHCCP DNSP	$6,937.19
Rate for Payer: VA VA	$6,937.19

PERITONEAL ADHESIOLYSIS

Facility

$14,304.39

Service Code	APR-DRG 2243
Min. Negotiated Rate	$12,932.88
Max. Negotiated Rate	$14,304.39
Rate for Payer: BCBS Complete	$14,304.39
Rate for Payer: Mclaren Medicaid	$13,623.23
Rate for Payer: Meridian Medicaid	$14,304.39
Rate for Payer: PHP Medicaid	$12,932.88
Rate for Payer: Priority Health Choice Medicaid	$13,623.23
Rate for Payer: UHC Medicaid	$13,623.23
Rate for Payer: UHCCP Medicaid	$13,623.23

PERITONEAL ADHESIOLYSIS

Facility

$26,721.62

Service Code	APR-DRG 2244
Min. Negotiated Rate	$24,159.54
Max. Negotiated Rate	$26,721.62
Rate for Payer: BCBS Complete	$26,721.62
Rate for Payer: Mclaren Medicaid	$25,449.17
Rate for Payer: Meridian Medicaid	$26,721.62
Rate for Payer: PHP Medicaid	$24,159.54
Rate for Payer: Priority Health Choice Medicaid	$25,449.17
Rate for Payer: UHC Medicaid	$25,449.17
Rate for Payer: UHCCP Medicaid	$25,449.17

PERITONEAL ADHESIOLYSIS

Facility

$8,420.57

Service Code	APR-DRG 2241
Min. Negotiated Rate	$7,613.20
Max. Negotiated Rate	$8,420.57
Rate for Payer: BCBS Complete	$8,420.57
Rate for Payer: Mclaren Medicaid	$8,019.59
Rate for Payer: Meridian Medicaid	$8,420.57
Rate for Payer: PHP Medicaid	$7,613.20
Rate for Payer: Priority Health Choice Medicaid	$8,019.59
Rate for Payer: UHC Medicaid	$8,019.59
Rate for Payer: UHCCP Medicaid	$8,019.59

PERITONEAL ADHESIOLYSIS

Facility

$11,035.78

Service Code	APR-DRG 2242
Min. Negotiated Rate	$9,977.67
Max. Negotiated Rate	$11,035.78
Rate for Payer: BCBS Complete	$11,035.78
Rate for Payer: Mclaren Medicaid	$10,510.27
Rate for Payer: Meridian Medicaid	$11,035.78
Rate for Payer: PHP Medicaid	$9,977.67
Rate for Payer: Priority Health Choice Medicaid	$10,510.27
Rate for Payer: UHC Medicaid	$10,510.27
Rate for Payer: UHCCP Medicaid	$10,510.27

PERITONEAL ADHESIOLYSIS WITH CC

Facility

$28,971.01

Service Code	MSDRG 336
Min. Negotiated Rate	$16,092.73
Max. Negotiated Rate	$28,971.01
Rate for Payer: Aetna Medicare	$16,939.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,174.65
Rate for Payer: Amish Plain Church Group Commercial	$21,174.65
Rate for Payer: BCBS MAPPO	$16,939.72
Rate for Payer: BCN Medicare Advantage	$16,939.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,939.72
Rate for Payer: Humana Choice PPO Medicare	$16,939.72
Rate for Payer: Mclaren Medicare	$16,939.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17,786.71
Rate for Payer: MI Amish Medical Board Commercial	$19,480.68
Rate for Payer: Molina Medicare/Medicaid	$18,633.69
Rate for Payer: PACE Medicare	$16,092.73
Rate for Payer: PACE SWMI	$16,939.72
Rate for Payer: PHP Commercial	$18,633.69
Rate for Payer: PHP Medicare Advantage	$16,939.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$28,971.01
Rate for Payer: Priority Health Medicare	$16,939.72
Rate for Payer: Priority Health Narrow Network	$23,176.81
Rate for Payer: Railroad Medicare Medicare	$16,939.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,939.72
Rate for Payer: UHC Exchange	$26,256.57
Rate for Payer: UHCCP DNSP	$16,939.72
Rate for Payer: VA VA	$16,939.72

PERITONEAL ADHESIOLYSIS WITH MCC

Facility

$49,059.88

Service Code	MSDRG 335
Min. Negotiated Rate	$26,095.91
Max. Negotiated Rate	$49,059.88
Rate for Payer: Aetna Medicare	$27,469.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,336.72
Rate for Payer: Amish Plain Church Group Commercial	$34,336.72
Rate for Payer: BCBS MAPPO	$27,469.38
Rate for Payer: BCN Medicare Advantage	$27,469.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,469.38
Rate for Payer: Humana Choice PPO Medicare	$27,469.38
Rate for Payer: Mclaren Medicare	$27,469.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,842.85
Rate for Payer: MI Amish Medical Board Commercial	$31,589.79
Rate for Payer: Molina Medicare/Medicaid	$30,216.32
Rate for Payer: PACE Medicare	$26,095.91
Rate for Payer: PACE SWMI	$27,469.38
Rate for Payer: PHP Commercial	$30,216.32
Rate for Payer: PHP Medicare Advantage	$27,469.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$49,059.88
Rate for Payer: Priority Health Medicare	$27,469.38
Rate for Payer: Priority Health Narrow Network	$39,247.90
Rate for Payer: Railroad Medicare Medicare	$27,469.38
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,469.38
Rate for Payer: UHC Exchange	$42,577.54
Rate for Payer: UHCCP DNSP	$27,469.38
Rate for Payer: VA VA	$27,469.38

PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC

Facility

$21,089.06

Service Code	MSDRG 337
Min. Negotiated Rate	$12,167.95
Max. Negotiated Rate	$21,089.06
Rate for Payer: Aetna Medicare	$12,808.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,010.46
Rate for Payer: Amish Plain Church Group Commercial	$16,010.46
Rate for Payer: BCBS MAPPO	$12,808.37
Rate for Payer: BCN Medicare Advantage	$12,808.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,808.37
Rate for Payer: Humana Choice PPO Medicare	$12,808.37
Rate for Payer: Mclaren Medicare	$12,808.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,448.79
Rate for Payer: MI Amish Medical Board Commercial	$14,729.63
Rate for Payer: Molina Medicare/Medicaid	$14,089.21
Rate for Payer: PACE Medicare	$12,167.95
Rate for Payer: PACE SWMI	$12,808.37
Rate for Payer: PHP Commercial	$14,089.21
Rate for Payer: PHP Medicare Advantage	$12,808.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,089.06
Rate for Payer: Priority Health Medicare	$12,808.37
Rate for Payer: Priority Health Narrow Network	$16,871.25
Rate for Payer: Railroad Medicare Medicare	$12,808.37
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,808.37
Rate for Payer: UHC Exchange	$19,852.97
Rate for Payer: UHCCP DNSP	$12,808.37
Rate for Payer: VA VA	$12,808.37

Know your out-of-pocket cost for care.

All Charges