Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$5,144.87

Service Code	APR-DRG 1102
Min. Negotiated Rate	$4,651.58
Max. Negotiated Rate	$5,144.87
Rate for Payer: BCBS Complete	$5,144.87
Rate for Payer: Mclaren Medicaid	$4,899.88
Rate for Payer: Meridian Medicaid	$5,144.87
Rate for Payer: PHP Medicaid	$4,651.58
Rate for Payer: Priority Health Choice Medicaid	$4,899.88
Rate for Payer: UHC Medicaid	$4,899.88
Rate for Payer: UHCCP Medicaid	$4,899.88

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$13,245.55

Service Code	APR-DRG 1104
Min. Negotiated Rate	$11,975.57
Max. Negotiated Rate	$13,245.55
Rate for Payer: BCBS Complete	$13,245.55
Rate for Payer: Mclaren Medicaid	$12,614.81
Rate for Payer: Meridian Medicaid	$13,245.55
Rate for Payer: PHP Medicaid	$11,975.57
Rate for Payer: Priority Health Choice Medicaid	$12,614.81
Rate for Payer: UHC Medicaid	$12,614.81
Rate for Payer: UHCCP Medicaid	$12,614.81

EATING DISORDERS

Facility

$5,434.79

Service Code	APR-DRG 7591
Min. Negotiated Rate	$4,913.70
Max. Negotiated Rate	$5,434.79
Rate for Payer: BCBS Complete	$5,434.79
Rate for Payer: Mclaren Medicaid	$5,175.99
Rate for Payer: Meridian Medicaid	$5,434.79
Rate for Payer: PHP Medicaid	$4,913.70
Rate for Payer: Priority Health Choice Medicaid	$5,175.99
Rate for Payer: UHC Medicaid	$5,175.99
Rate for Payer: UHCCP Medicaid	$5,175.99

EATING DISORDERS

Facility

$10,565.49

Service Code	APR-DRG 7593
Min. Negotiated Rate	$9,552.47
Max. Negotiated Rate	$10,565.49
Rate for Payer: BCBS Complete	$10,565.49
Rate for Payer: Mclaren Medicaid	$10,062.37
Rate for Payer: Meridian Medicaid	$10,565.49
Rate for Payer: PHP Medicaid	$9,552.47
Rate for Payer: Priority Health Choice Medicaid	$10,062.37
Rate for Payer: UHC Medicaid	$10,062.37
Rate for Payer: UHCCP Medicaid	$10,062.37

EATING DISORDERS

Facility

$21,352.23

Service Code	APR-DRG 7594
Min. Negotiated Rate	$19,304.97
Max. Negotiated Rate	$21,352.23
Rate for Payer: BCBS Complete	$21,352.23
Rate for Payer: Mclaren Medicaid	$20,335.46
Rate for Payer: Meridian Medicaid	$21,352.23
Rate for Payer: PHP Medicaid	$19,304.97
Rate for Payer: Priority Health Choice Medicaid	$20,335.46
Rate for Payer: UHC Medicaid	$20,335.46
Rate for Payer: UHCCP Medicaid	$20,335.46

EATING DISORDERS

Facility

$6,795.53

Service Code	APR-DRG 7592
Min. Negotiated Rate	$6,143.97
Max. Negotiated Rate	$6,795.53
Rate for Payer: BCBS Complete	$6,795.53
Rate for Payer: Mclaren Medicaid	$6,471.93
Rate for Payer: Meridian Medicaid	$6,795.53
Rate for Payer: PHP Medicaid	$6,143.97
Rate for Payer: Priority Health Choice Medicaid	$6,471.93
Rate for Payer: UHC Medicaid	$6,471.93
Rate for Payer: UHCCP Medicaid	$6,471.93

ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES

Facility

$291,608.78

Service Code	MSDRG 003
Min. Negotiated Rate	$146,872.18
Max. Negotiated Rate	$291,608.78
Rate for Payer: Aetna Medicare	$154,602.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$193,252.86
Rate for Payer: Amish Plain Church Group Commercial	$193,252.86
Rate for Payer: BCBS MAPPO	$154,602.29
Rate for Payer: BCN Medicare Advantage	$154,602.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$154,602.29
Rate for Payer: Humana Choice PPO Medicare	$154,602.29
Rate for Payer: Mclaren Medicare	$154,602.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$162,332.40
Rate for Payer: MI Amish Medical Board Commercial	$177,792.63
Rate for Payer: Molina Medicare/Medicaid	$170,062.52
Rate for Payer: PACE Medicare	$146,872.18
Rate for Payer: PACE SWMI	$154,602.29
Rate for Payer: PHP Commercial	$170,062.52
Rate for Payer: PHP Medicare Advantage	$154,602.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$291,608.78
Rate for Payer: Priority Health Medicare	$154,602.29
Rate for Payer: Priority Health Narrow Network	$233,287.02
Rate for Payer: Railroad Medicare Medicare	$154,602.29
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$154,602.29
Rate for Payer: UHC Exchange	$239,633.55
Rate for Payer: UHCCP DNSP	$154,602.29
Rate for Payer: VA VA	$154,602.29

ELECTIVE HIP JOINT REPLACEMENT

Facility

$10,052.69

Service Code	APR-DRG 3242
Min. Negotiated Rate	$9,088.84
Max. Negotiated Rate	$10,052.69
Rate for Payer: BCBS Complete	$10,052.69
Rate for Payer: Mclaren Medicaid	$9,573.99
Rate for Payer: Meridian Medicaid	$10,052.69
Rate for Payer: PHP Medicaid	$9,088.84
Rate for Payer: Priority Health Choice Medicaid	$9,573.99
Rate for Payer: UHC Medicaid	$9,573.99
Rate for Payer: UHCCP Medicaid	$9,573.99

ELECTIVE HIP JOINT REPLACEMENT

Facility

$8,167.71

Service Code	APR-DRG 3241
Min. Negotiated Rate	$7,384.59
Max. Negotiated Rate	$8,167.71
Rate for Payer: BCBS Complete	$8,167.71
Rate for Payer: Mclaren Medicaid	$7,778.77
Rate for Payer: Meridian Medicaid	$8,167.71
Rate for Payer: PHP Medicaid	$7,384.59
Rate for Payer: Priority Health Choice Medicaid	$7,778.77
Rate for Payer: UHC Medicaid	$7,778.77
Rate for Payer: UHCCP Medicaid	$7,778.77

ELECTIVE HIP JOINT REPLACEMENT

Facility

$14,350.71

Service Code	APR-DRG 3243
Min. Negotiated Rate	$12,974.76
Max. Negotiated Rate	$14,350.71
Rate for Payer: BCBS Complete	$14,350.71
Rate for Payer: Mclaren Medicaid	$13,667.35
Rate for Payer: Meridian Medicaid	$14,350.71
Rate for Payer: PHP Medicaid	$12,974.76
Rate for Payer: Priority Health Choice Medicaid	$13,667.35
Rate for Payer: UHC Medicaid	$13,667.35
Rate for Payer: UHCCP Medicaid	$13,667.35

ELECTIVE HIP JOINT REPLACEMENT

Facility

$21,947.32

Service Code	APR-DRG 3244
Min. Negotiated Rate	$19,843.00
Max. Negotiated Rate	$21,947.32
Rate for Payer: BCBS Complete	$21,947.32
Rate for Payer: Mclaren Medicaid	$20,902.21
Rate for Payer: Meridian Medicaid	$21,947.32
Rate for Payer: PHP Medicaid	$19,843.00
Rate for Payer: Priority Health Choice Medicaid	$20,902.21
Rate for Payer: UHC Medicaid	$20,902.21
Rate for Payer: UHCCP Medicaid	$20,902.21

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$9,205.84

Service Code	APR-DRG 3262
Min. Negotiated Rate	$8,323.18
Max. Negotiated Rate	$9,205.84
Rate for Payer: BCBS Complete	$9,205.84
Rate for Payer: Mclaren Medicaid	$8,767.47
Rate for Payer: Meridian Medicaid	$9,205.84
Rate for Payer: PHP Medicaid	$8,323.18
Rate for Payer: Priority Health Choice Medicaid	$8,767.47
Rate for Payer: UHC Medicaid	$8,767.47
Rate for Payer: UHCCP Medicaid	$8,767.47

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$20,120.64

Service Code	APR-DRG 3264
Min. Negotiated Rate	$18,191.47
Max. Negotiated Rate	$20,120.64
Rate for Payer: BCBS Complete	$20,120.64
Rate for Payer: Mclaren Medicaid	$19,162.52
Rate for Payer: Meridian Medicaid	$20,120.64
Rate for Payer: PHP Medicaid	$18,191.47
Rate for Payer: Priority Health Choice Medicaid	$19,162.52
Rate for Payer: UHC Medicaid	$19,162.52
Rate for Payer: UHCCP Medicaid	$19,162.52

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$8,015.12

Service Code	APR-DRG 3261
Min. Negotiated Rate	$7,246.63
Max. Negotiated Rate	$8,015.12
Rate for Payer: BCBS Complete	$8,015.12
Rate for Payer: Mclaren Medicaid	$7,633.45
Rate for Payer: Meridian Medicaid	$8,015.12
Rate for Payer: PHP Medicaid	$7,246.63
Rate for Payer: Priority Health Choice Medicaid	$7,633.45
Rate for Payer: UHC Medicaid	$7,633.45
Rate for Payer: UHCCP Medicaid	$7,633.45

ELECTIVE KNEE JOINT REPLACEMENT

Facility

$12,142.03

Service Code	APR-DRG 3263
Min. Negotiated Rate	$10,977.85
Max. Negotiated Rate	$12,142.03
Rate for Payer: BCBS Complete	$12,142.03
Rate for Payer: Mclaren Medicaid	$11,563.84
Rate for Payer: Meridian Medicaid	$12,142.03
Rate for Payer: PHP Medicaid	$10,977.85
Rate for Payer: Priority Health Choice Medicaid	$11,563.84
Rate for Payer: UHC Medicaid	$11,563.84
Rate for Payer: UHCCP Medicaid	$11,563.84

EMOLLIENT COMBINATION NO.117 TOPICAL CREAM

Facility

$18.95

Service Code	NDC 72140063382
Hospital Charge Code	203300
Hospital Revenue Code	637
Min. Negotiated Rate	$7.01
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna Commercial	$17.06
Rate for Payer: Aetna Medicare	$7.01
Rate for Payer: ASR ASR	$18.39
Rate for Payer: BCBS Complete	$7.58
Rate for Payer: BCBS Trust/PPO	$15.63
Rate for Payer: BCN Commercial	$15.63
Rate for Payer: Cash Price	$15.16
Rate for Payer: Cofinity Commercial	$17.82
Rate for Payer: Encore Health Key Benefits Commercial	$15.16
Rate for Payer: Healthscope Commercial	$18.39
Rate for Payer: Healthscope Whirlpool	$18.95
Rate for Payer: Mclaren Commercial	$17.06
Rate for Payer: MI Amish Medical Board Commercial	$15.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.11
Rate for Payer: Nomi Health Commercial	$15.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$16.61
Rate for Payer: Priority Health Narrow Network	$13.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.68

EMOLLIENT COMBINATION NO.117 TOPICAL CREAM

Facility

$18.95

Service Code	NDC 72140063382
Hospital Charge Code	203300
Hospital Revenue Code	637
Min. Negotiated Rate	$14.22
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna Commercial	$17.06
Rate for Payer: ASR ASR	$18.39
Rate for Payer: BCBS Trust/PPO	$15.57
Rate for Payer: BCN Commercial	$15.57
Rate for Payer: Cash Price	$15.16
Rate for Payer: Cofinity Commercial	$17.82
Rate for Payer: Encore Health Key Benefits Commercial	$15.16
Rate for Payer: Healthscope Commercial	$18.39
Rate for Payer: Healthscope Whirlpool	$18.95
Rate for Payer: Mclaren Commercial	$17.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.11
Rate for Payer: Nomi Health Commercial	$15.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$16.68

EMPAGLIFLOZIN 10 MG TABLET

Facility

$1,204.35

Service Code	NDC 597015237
Hospital Charge Code	171967
Hospital Revenue Code	637
Min. Negotiated Rate	$445.61
Max. Negotiated Rate	$1,204.35
Rate for Payer: Aetna Commercial	$1,083.91
Rate for Payer: Aetna Medicare	$445.61
Rate for Payer: ASR ASR	$1,168.22
Rate for Payer: BCBS Complete	$481.74
Rate for Payer: BCBS Trust/PPO	$992.99
Rate for Payer: BCN Commercial	$992.99
Rate for Payer: Cash Price	$963.48
Rate for Payer: Cofinity Commercial	$1,132.09
Rate for Payer: Encore Health Key Benefits Commercial	$963.48
Rate for Payer: Healthscope Commercial	$1,168.22
Rate for Payer: Healthscope Whirlpool	$1,204.35
Rate for Payer: Mclaren Commercial	$1,083.91
Rate for Payer: MI Amish Medical Board Commercial	$963.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,023.70
Rate for Payer: Nomi Health Commercial	$987.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1,055.25
Rate for Payer: Priority Health Narrow Network	$844.25
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,059.83

EMPAGLIFLOZIN 10 MG TABLET

Facility

$1,204.35

Service Code	NDC 597015237
Hospital Charge Code	171967
Hospital Revenue Code	637
Min. Negotiated Rate	$903.26
Max. Negotiated Rate	$1,204.35
Rate for Payer: Aetna Commercial	$1,083.91
Rate for Payer: ASR ASR	$1,168.22
Rate for Payer: BCBS Trust/PPO	$989.01
Rate for Payer: BCN Commercial	$989.01
Rate for Payer: Cash Price	$963.48
Rate for Payer: Cofinity Commercial	$1,132.09
Rate for Payer: Encore Health Key Benefits Commercial	$963.48
Rate for Payer: Healthscope Commercial	$1,168.22
Rate for Payer: Healthscope Whirlpool	$1,204.35
Rate for Payer: Mclaren Commercial	$1,083.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,023.70
Rate for Payer: Nomi Health Commercial	$987.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,059.83

EMPTY CONTAINER BOTTLE

Facility

$50.98

Service Code	NDC 264975706
Hospital Charge Code	113131
Hospital Revenue Code	250
Min. Negotiated Rate	$38.24
Max. Negotiated Rate	$50.98
Rate for Payer: Aetna Commercial	$45.88
Rate for Payer: ASR ASR	$49.45
Rate for Payer: BCBS Trust/PPO	$41.87
Rate for Payer: BCN Commercial	$41.87
Rate for Payer: Cash Price	$40.79
Rate for Payer: Cofinity Commercial	$47.92
Rate for Payer: Encore Health Key Benefits Commercial	$40.79
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Healthscope Whirlpool	$50.98
Rate for Payer: Mclaren Commercial	$45.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.34
Rate for Payer: Nomi Health Commercial	$41.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.87

EMPTY CONTAINER BOTTLE

Facility

$50.98

Service Code	NDC 264975706
Hospital Charge Code	113131
Hospital Revenue Code	250
Min. Negotiated Rate	$18.86
Max. Negotiated Rate	$50.98
Rate for Payer: Aetna Commercial	$45.88
Rate for Payer: Aetna Medicare	$18.86
Rate for Payer: ASR ASR	$49.45
Rate for Payer: BCBS Complete	$20.39
Rate for Payer: BCBS Trust/PPO	$42.04
Rate for Payer: BCN Commercial	$42.04
Rate for Payer: Cash Price	$40.79
Rate for Payer: Cofinity Commercial	$47.92
Rate for Payer: Encore Health Key Benefits Commercial	$40.79
Rate for Payer: Healthscope Commercial	$49.45
Rate for Payer: Healthscope Whirlpool	$50.98
Rate for Payer: Mclaren Commercial	$45.88
Rate for Payer: MI Amish Medical Board Commercial	$40.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.34
Rate for Payer: Nomi Health Commercial	$41.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$38.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$44.67
Rate for Payer: Priority Health Narrow Network	$35.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$44.87

EMPTY CONTAINER BOTTLE

Facility

$45.41

Service Code	NDC 85412046162
Hospital Charge Code	113131
Hospital Revenue Code	250
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$45.41
Rate for Payer: Aetna Commercial	$40.87
Rate for Payer: Aetna Medicare	$16.80
Rate for Payer: ASR ASR	$44.04
Rate for Payer: BCBS Complete	$18.16
Rate for Payer: BCBS Trust/PPO	$37.44
Rate for Payer: BCN Commercial	$37.44
Rate for Payer: Cash Price	$36.33
Rate for Payer: Cofinity Commercial	$42.68
Rate for Payer: Encore Health Key Benefits Commercial	$36.33
Rate for Payer: Healthscope Commercial	$44.04
Rate for Payer: Healthscope Whirlpool	$45.41
Rate for Payer: Mclaren Commercial	$40.87
Rate for Payer: MI Amish Medical Board Commercial	$36.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.60
Rate for Payer: Nomi Health Commercial	$37.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$39.79
Rate for Payer: Priority Health Narrow Network	$31.83
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$39.96

EMPTY CONTAINER BOTTLE

Facility

$45.41

Service Code	NDC 85412046162
Hospital Charge Code	113131
Hospital Revenue Code	250
Min. Negotiated Rate	$34.06
Max. Negotiated Rate	$45.41
Rate for Payer: Aetna Commercial	$40.87
Rate for Payer: ASR ASR	$44.04
Rate for Payer: BCBS Trust/PPO	$37.29
Rate for Payer: BCN Commercial	$37.29
Rate for Payer: Cash Price	$36.33
Rate for Payer: Cofinity Commercial	$42.68
Rate for Payer: Encore Health Key Benefits Commercial	$36.33
Rate for Payer: Healthscope Commercial	$44.04
Rate for Payer: Healthscope Whirlpool	$45.41
Rate for Payer: Mclaren Commercial	$40.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$38.60
Rate for Payer: Nomi Health Commercial	$37.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.06
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$39.96

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET

Facility

$89.28

Service Code	NDC 42385095330
Hospital Charge Code	39255
Hospital Revenue Code	637
Min. Negotiated Rate	$33.03
Max. Negotiated Rate	$89.28
Rate for Payer: Aetna Commercial	$80.35
Rate for Payer: Aetna Medicare	$33.03
Rate for Payer: ASR ASR	$86.60
Rate for Payer: BCBS Complete	$35.71
Rate for Payer: BCBS Trust/PPO	$73.61
Rate for Payer: BCN Commercial	$73.61
Rate for Payer: Cash Price	$71.42
Rate for Payer: Cofinity Commercial	$83.92
Rate for Payer: Encore Health Key Benefits Commercial	$71.42
Rate for Payer: Healthscope Commercial	$86.60
Rate for Payer: Healthscope Whirlpool	$89.28
Rate for Payer: Mclaren Commercial	$80.35
Rate for Payer: MI Amish Medical Board Commercial	$71.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.89
Rate for Payer: Nomi Health Commercial	$73.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$78.23
Rate for Payer: Priority Health Narrow Network	$62.59
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$78.57

EMTRICITABINE 200 MG-TENOFOVIR DISOPROXIL FUMARATE 300 MG TABLET

Facility

$89.28

Service Code	NDC 42385095330
Hospital Charge Code	39255
Hospital Revenue Code	637
Min. Negotiated Rate	$66.96
Max. Negotiated Rate	$89.28
Rate for Payer: Aetna Commercial	$80.35
Rate for Payer: ASR ASR	$86.60
Rate for Payer: BCBS Trust/PPO	$73.32
Rate for Payer: BCN Commercial	$73.32
Rate for Payer: Cash Price	$71.42
Rate for Payer: Cofinity Commercial	$83.92
Rate for Payer: Encore Health Key Benefits Commercial	$71.42
Rate for Payer: Healthscope Commercial	$86.60
Rate for Payer: Healthscope Whirlpool	$89.28
Rate for Payer: Mclaren Commercial	$80.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.89
Rate for Payer: Nomi Health Commercial	$73.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.96
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$78.57

Know your out-of-pocket cost for care.

All Charges