Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

RENAL FAILURE WITHOUT CC/MCC

Facility

$9,419.92

Service Code	MSDRG 684
Min. Negotiated Rate	$5,773.50
Max. Negotiated Rate	$9,419.92
Rate for Payer: Aetna Medicare	$6,077.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,596.71
Rate for Payer: Amish Plain Church Group Commercial	$7,596.71
Rate for Payer: BCBS MAPPO	$6,077.37
Rate for Payer: BCN Medicare Advantage	$6,077.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,077.37
Rate for Payer: Humana Choice PPO Medicare	$6,077.37
Rate for Payer: Mclaren Medicare	$6,077.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,381.24
Rate for Payer: MI Amish Medical Board Commercial	$6,988.98
Rate for Payer: Molina Medicare/Medicaid	$6,685.11
Rate for Payer: PACE Medicare	$5,773.50
Rate for Payer: PACE SWMI	$6,077.37
Rate for Payer: PHP Commercial	$6,685.11
Rate for Payer: PHP Medicare Advantage	$6,077.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$8,247.40
Rate for Payer: Priority Health Medicare	$6,077.37
Rate for Payer: Priority Health Narrow Network	$6,597.92
Rate for Payer: Railroad Medicare Medicare	$6,077.37
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,077.37
Rate for Payer: UHC Exchange	$9,419.92
Rate for Payer: UHCCP DNSP	$6,077.37
Rate for Payer: VA VA	$6,077.37

RESOURCE ARGINAID ORAL PACKET CUSTOM

Facility

$3.97

Service Code	NDC 43900035984
Hospital Charge Code	150858
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: ASR ASR	$3.85
Rate for Payer: BCBS Complete	$1.59
Rate for Payer: BCBS Trust/PPO	$3.27
Rate for Payer: BCN Commercial	$3.27
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Commercial	$3.73
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Healthscope Whirlpool	$3.96
Rate for Payer: Mclaren Commercial	$3.57
Rate for Payer: MI Amish Medical Board Commercial	$3.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Nomi Health Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.47
Rate for Payer: Priority Health Narrow Network	$2.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.49

RESOURCE ARGINAID ORAL PACKET CUSTOM

Facility

$3.97

Service Code	NDC 43900035984
Hospital Charge Code	150858
Hospital Revenue Code	637
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: ASR ASR	$3.85
Rate for Payer: BCBS Trust/PPO	$3.26
Rate for Payer: BCN Commercial	$3.26
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Commercial	$3.73
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Healthscope Whirlpool	$3.96
Rate for Payer: Mclaren Commercial	$3.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Nomi Health Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.49

RESOURCE ARGINAID ORAL PACKET CUSTOM

Facility

$3.97

Service Code	NDC 43900035988
Hospital Charge Code	150858
Hospital Revenue Code	637
Min. Negotiated Rate	$2.97
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: ASR ASR	$3.85
Rate for Payer: BCBS Trust/PPO	$3.26
Rate for Payer: BCN Commercial	$3.26
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Commercial	$3.73
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Healthscope Whirlpool	$3.96
Rate for Payer: Mclaren Commercial	$3.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Nomi Health Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.49

RESOURCE ARGINAID ORAL PACKET CUSTOM

Facility

$3.97

Service Code	NDC 43900035988
Hospital Charge Code	150858
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.96
Rate for Payer: Aetna Commercial	$3.57
Rate for Payer: Aetna Medicare	$1.47
Rate for Payer: ASR ASR	$3.85
Rate for Payer: BCBS Complete	$1.59
Rate for Payer: BCBS Trust/PPO	$3.27
Rate for Payer: BCN Commercial	$3.27
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Commercial	$3.73
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.85
Rate for Payer: Healthscope Whirlpool	$3.96
Rate for Payer: Mclaren Commercial	$3.57
Rate for Payer: MI Amish Medical Board Commercial	$3.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Nomi Health Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.47
Rate for Payer: Priority Health Narrow Network	$2.78
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.49

RESPIRATORY FAILURE

Facility

$4,791.20

Service Code	APR-DRG 1332
Min. Negotiated Rate	$4,331.82
Max. Negotiated Rate	$4,791.20
Rate for Payer: BCBS Complete	$4,791.20
Rate for Payer: Mclaren Medicaid	$4,563.05
Rate for Payer: Meridian Medicaid	$4,791.20
Rate for Payer: PHP Medicaid	$4,331.82
Rate for Payer: Priority Health Choice Medicaid	$4,563.05
Rate for Payer: UHC Medicaid	$4,563.05
Rate for Payer: UHCCP Medicaid	$4,563.05

RESPIRATORY FAILURE

Facility

$3,492.58

Service Code	APR-DRG 1331
Min. Negotiated Rate	$3,157.71
Max. Negotiated Rate	$3,492.58
Rate for Payer: BCBS Complete	$3,492.58
Rate for Payer: Mclaren Medicaid	$3,326.27
Rate for Payer: Meridian Medicaid	$3,492.58
Rate for Payer: PHP Medicaid	$3,157.71
Rate for Payer: Priority Health Choice Medicaid	$3,326.27
Rate for Payer: UHC Medicaid	$3,326.27
Rate for Payer: UHCCP Medicaid	$3,326.27

RESPIRATORY FAILURE

Facility

$7,376.44

Service Code	APR-DRG 1333
Min. Negotiated Rate	$6,669.19
Max. Negotiated Rate	$7,376.44
Rate for Payer: BCBS Complete	$7,376.44
Rate for Payer: Mclaren Medicaid	$7,025.18
Rate for Payer: Meridian Medicaid	$7,376.44
Rate for Payer: PHP Medicaid	$6,669.19
Rate for Payer: Priority Health Choice Medicaid	$7,025.18
Rate for Payer: UHC Medicaid	$7,025.18
Rate for Payer: UHCCP Medicaid	$7,025.18

RESPIRATORY FAILURE

Facility

$11,818.88

Service Code	APR-DRG 1334
Min. Negotiated Rate	$10,685.68
Max. Negotiated Rate	$11,818.88
Rate for Payer: BCBS Complete	$11,818.88
Rate for Payer: Mclaren Medicaid	$11,256.07
Rate for Payer: Meridian Medicaid	$11,818.88
Rate for Payer: PHP Medicaid	$10,685.68
Rate for Payer: Priority Health Choice Medicaid	$11,256.07
Rate for Payer: UHC Medicaid	$11,256.07
Rate for Payer: UHCCP Medicaid	$11,256.07

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$13,613.46

Service Code	MSDRG 178
Min. Negotiated Rate	$8,343.74
Max. Negotiated Rate	$13,613.46
Rate for Payer: Aetna Medicare	$8,782.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,978.60
Rate for Payer: Amish Plain Church Group Commercial	$10,978.60
Rate for Payer: BCBS MAPPO	$8,782.88
Rate for Payer: BCN Medicare Advantage	$8,782.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,782.88
Rate for Payer: Humana Choice PPO Medicare	$8,782.88
Rate for Payer: Mclaren Medicare	$8,782.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,222.02
Rate for Payer: MI Amish Medical Board Commercial	$10,100.31
Rate for Payer: Molina Medicare/Medicaid	$9,661.17
Rate for Payer: PACE Medicare	$8,343.74
Rate for Payer: PACE SWMI	$8,782.88
Rate for Payer: PHP Commercial	$9,661.17
Rate for Payer: PHP Medicare Advantage	$8,782.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,409.07
Rate for Payer: Priority Health Medicare	$8,782.88
Rate for Payer: Priority Health Narrow Network	$10,727.26
Rate for Payer: Railroad Medicare Medicare	$8,782.88
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,782.88
Rate for Payer: UHC Exchange	$13,613.46
Rate for Payer: UHCCP DNSP	$8,782.88
Rate for Payer: VA VA	$8,782.88

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$21,469.62

Service Code	MSDRG 177
Min. Negotiated Rate	$12,357.46
Max. Negotiated Rate	$21,469.62
Rate for Payer: Aetna Medicare	$13,007.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,259.81
Rate for Payer: Amish Plain Church Group Commercial	$16,259.81
Rate for Payer: BCBS MAPPO	$13,007.85
Rate for Payer: BCN Medicare Advantage	$13,007.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,007.85
Rate for Payer: Humana Choice PPO Medicare	$13,007.85
Rate for Payer: Mclaren Medicare	$13,007.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,658.24
Rate for Payer: MI Amish Medical Board Commercial	$14,959.03
Rate for Payer: Molina Medicare/Medicaid	$14,308.64
Rate for Payer: PACE Medicare	$12,357.46
Rate for Payer: PACE SWMI	$13,007.85
Rate for Payer: PHP Commercial	$14,308.64
Rate for Payer: PHP Medicare Advantage	$13,007.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$21,469.62
Rate for Payer: Priority Health Medicare	$13,007.85
Rate for Payer: Priority Health Narrow Network	$17,175.70
Rate for Payer: Railroad Medicare Medicare	$13,007.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,007.85
Rate for Payer: UHC Exchange	$20,162.17
Rate for Payer: UHCCP DNSP	$13,007.85
Rate for Payer: VA VA	$13,007.85

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$11,146.67

Service Code	MSDRG 179
Min. Negotiated Rate	$6,831.83
Max. Negotiated Rate	$11,146.67
Rate for Payer: Aetna Medicare	$7,191.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,989.25
Rate for Payer: Amish Plain Church Group Commercial	$8,989.25
Rate for Payer: BCBS MAPPO	$7,191.40
Rate for Payer: BCN Medicare Advantage	$7,191.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,191.40
Rate for Payer: Humana Choice PPO Medicare	$7,191.40
Rate for Payer: Mclaren Medicare	$7,191.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,550.97
Rate for Payer: MI Amish Medical Board Commercial	$8,270.11
Rate for Payer: Molina Medicare/Medicaid	$7,910.54
Rate for Payer: PACE Medicare	$6,831.83
Rate for Payer: PACE SWMI	$7,191.40
Rate for Payer: PHP Commercial	$7,910.54
Rate for Payer: PHP Medicare Advantage	$7,191.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,372.79
Rate for Payer: Priority Health Medicare	$7,191.40
Rate for Payer: Priority Health Narrow Network	$8,298.24
Rate for Payer: Railroad Medicare Medicare	$7,191.40
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,191.40
Rate for Payer: UHC Exchange	$11,146.67
Rate for Payer: UHCCP DNSP	$7,191.40
Rate for Payer: VA VA	$7,191.40

RESPIRATORY MALIGNANCY

Facility

$11,949.12

Service Code	APR-DRG 1364
Min. Negotiated Rate	$10,803.43
Max. Negotiated Rate	$11,949.12
Rate for Payer: BCBS Complete	$11,949.12
Rate for Payer: Mclaren Medicaid	$11,380.11
Rate for Payer: Meridian Medicaid	$11,949.12
Rate for Payer: PHP Medicaid	$10,803.43
Rate for Payer: Priority Health Choice Medicaid	$11,380.11
Rate for Payer: UHC Medicaid	$11,380.11
Rate for Payer: UHCCP Medicaid	$11,380.11

RESPIRATORY MALIGNANCY

Facility

$5,810.80

Service Code	APR-DRG 1361
Min. Negotiated Rate	$5,253.66
Max. Negotiated Rate	$5,810.80
Rate for Payer: BCBS Complete	$5,810.80
Rate for Payer: Mclaren Medicaid	$5,534.10
Rate for Payer: Meridian Medicaid	$5,810.80
Rate for Payer: PHP Medicaid	$5,253.66
Rate for Payer: Priority Health Choice Medicaid	$5,534.10
Rate for Payer: UHC Medicaid	$5,534.10
Rate for Payer: UHCCP Medicaid	$5,534.10

RESPIRATORY MALIGNANCY

Facility

$7,811.86

Service Code	APR-DRG 1363
Min. Negotiated Rate	$7,062.85
Max. Negotiated Rate	$7,811.86
Rate for Payer: BCBS Complete	$7,811.86
Rate for Payer: Mclaren Medicaid	$7,439.86
Rate for Payer: Meridian Medicaid	$7,811.86
Rate for Payer: PHP Medicaid	$7,062.85
Rate for Payer: Priority Health Choice Medicaid	$7,439.86
Rate for Payer: UHC Medicaid	$7,439.86
Rate for Payer: UHCCP Medicaid	$7,439.86

RESPIRATORY MALIGNANCY

Facility

$6,324.69

Service Code	APR-DRG 1362
Min. Negotiated Rate	$5,718.28
Max. Negotiated Rate	$6,324.69
Rate for Payer: BCBS Complete	$6,324.69
Rate for Payer: Mclaren Medicaid	$6,023.51
Rate for Payer: Meridian Medicaid	$6,324.69
Rate for Payer: PHP Medicaid	$5,718.28
Rate for Payer: Priority Health Choice Medicaid	$6,023.51
Rate for Payer: UHC Medicaid	$6,023.51
Rate for Payer: UHCCP Medicaid	$6,023.51

RESPIRATORY NEOPLASMS WITH CC

Facility

$14,714.25

Service Code	MSDRG 181
Min. Negotiated Rate	$8,993.64
Max. Negotiated Rate	$14,714.25
Rate for Payer: Aetna Medicare	$9,466.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,833.74
Rate for Payer: Amish Plain Church Group Commercial	$11,833.74
Rate for Payer: BCBS MAPPO	$9,466.99
Rate for Payer: BCN Medicare Advantage	$9,466.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,466.99
Rate for Payer: Humana Choice PPO Medicare	$9,466.99
Rate for Payer: Mclaren Medicare	$9,466.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,940.34
Rate for Payer: MI Amish Medical Board Commercial	$10,887.04
Rate for Payer: Molina Medicare/Medicaid	$10,413.69
Rate for Payer: PACE Medicare	$8,993.64
Rate for Payer: PACE SWMI	$9,466.99
Rate for Payer: PHP Commercial	$10,413.69
Rate for Payer: PHP Medicare Advantage	$9,466.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,714.25
Rate for Payer: Priority Health Medicare	$9,466.99
Rate for Payer: Priority Health Narrow Network	$11,771.40
Rate for Payer: Railroad Medicare Medicare	$9,466.99
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,466.99
Rate for Payer: UHC Exchange	$14,673.83
Rate for Payer: UHCCP DNSP	$9,466.99
Rate for Payer: VA VA	$9,466.99

RESPIRATORY NEOPLASMS WITH MCC

Facility

$24,262.72

Service Code	MSDRG 180
Min. Negotiated Rate	$13,748.26
Max. Negotiated Rate	$24,262.72
Rate for Payer: Aetna Medicare	$14,471.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,089.81
Rate for Payer: Amish Plain Church Group Commercial	$18,089.81
Rate for Payer: BCBS MAPPO	$14,471.85
Rate for Payer: BCN Medicare Advantage	$14,471.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,471.85
Rate for Payer: Humana Choice PPO Medicare	$14,471.85
Rate for Payer: Mclaren Medicare	$14,471.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,195.44
Rate for Payer: MI Amish Medical Board Commercial	$16,642.63
Rate for Payer: Molina Medicare/Medicaid	$15,919.03
Rate for Payer: PACE Medicare	$13,748.26
Rate for Payer: PACE SWMI	$14,471.85
Rate for Payer: PHP Commercial	$15,919.03
Rate for Payer: PHP Medicare Advantage	$14,471.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,262.72
Rate for Payer: Priority Health Medicare	$14,471.85
Rate for Payer: Priority Health Narrow Network	$19,410.18
Rate for Payer: Railroad Medicare Medicare	$14,471.85
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,471.85
Rate for Payer: UHC Exchange	$22,431.37
Rate for Payer: UHCCP DNSP	$14,471.85
Rate for Payer: VA VA	$14,471.85

RESPIRATORY NEOPLASMS WITHOUT CC/MCC

Facility

$11,133.28

Service Code	MSDRG 182
Min. Negotiated Rate	$6,823.62
Max. Negotiated Rate	$11,133.28
Rate for Payer: Aetna Medicare	$7,182.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,978.45
Rate for Payer: Amish Plain Church Group Commercial	$8,978.45
Rate for Payer: BCBS MAPPO	$7,182.76
Rate for Payer: BCN Medicare Advantage	$7,182.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,182.76
Rate for Payer: Humana Choice PPO Medicare	$7,182.76
Rate for Payer: Mclaren Medicare	$7,182.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,541.90
Rate for Payer: MI Amish Medical Board Commercial	$8,260.17
Rate for Payer: Molina Medicare/Medicaid	$7,901.04
Rate for Payer: PACE Medicare	$6,823.62
Rate for Payer: PACE SWMI	$7,182.76
Rate for Payer: PHP Commercial	$7,901.04
Rate for Payer: PHP Medicare Advantage	$7,182.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,356.31
Rate for Payer: Priority Health Medicare	$7,182.76
Rate for Payer: Priority Health Narrow Network	$8,285.05
Rate for Payer: Railroad Medicare Medicare	$7,182.76
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,182.76
Rate for Payer: UHC Exchange	$11,133.28
Rate for Payer: UHCCP DNSP	$7,182.76
Rate for Payer: VA VA	$7,182.76

RESPIRATORY SIGNS AND SYMPTOMS

Facility

$11,731.56

Service Code	MSDRG 204
Min. Negotiated Rate	$7,190.31
Max. Negotiated Rate	$11,731.56
Rate for Payer: Aetna Medicare	$7,568.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,460.94
Rate for Payer: Amish Plain Church Group Commercial	$9,460.94
Rate for Payer: BCBS MAPPO	$7,568.75
Rate for Payer: BCN Medicare Advantage	$7,568.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,568.75
Rate for Payer: Humana Choice PPO Medicare	$7,568.75
Rate for Payer: Mclaren Medicare	$7,568.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,947.19
Rate for Payer: MI Amish Medical Board Commercial	$8,704.06
Rate for Payer: Molina Medicare/Medicaid	$8,325.62
Rate for Payer: PACE Medicare	$7,190.31
Rate for Payer: PACE SWMI	$7,568.75
Rate for Payer: PHP Commercial	$8,325.62
Rate for Payer: PHP Medicare Advantage	$7,568.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,092.71
Rate for Payer: Priority Health Medicare	$7,568.75
Rate for Payer: Priority Health Narrow Network	$8,874.17
Rate for Payer: Railroad Medicare Medicare	$7,568.75
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,568.75
Rate for Payer: UHC Exchange	$11,731.56
Rate for Payer: UHCCP DNSP	$7,568.75
Rate for Payer: VA VA	$7,568.75

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$5,118.17

Service Code	APR-DRG 1442
Min. Negotiated Rate	$4,627.44
Max. Negotiated Rate	$5,118.17
Rate for Payer: BCBS Complete	$5,118.17
Rate for Payer: Mclaren Medicaid	$4,874.45
Rate for Payer: Meridian Medicaid	$5,118.17
Rate for Payer: PHP Medicaid	$4,627.44
Rate for Payer: Priority Health Choice Medicaid	$4,874.45
Rate for Payer: UHC Medicaid	$4,874.45
Rate for Payer: UHCCP Medicaid	$4,874.45

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$10,710.45

Service Code	APR-DRG 1444
Min. Negotiated Rate	$9,683.53
Max. Negotiated Rate	$10,710.45
Rate for Payer: BCBS Complete	$10,710.45
Rate for Payer: Mclaren Medicaid	$10,200.43
Rate for Payer: Meridian Medicaid	$10,710.45
Rate for Payer: PHP Medicaid	$9,683.53
Rate for Payer: Priority Health Choice Medicaid	$10,200.43
Rate for Payer: UHC Medicaid	$10,200.43
Rate for Payer: UHCCP Medicaid	$10,200.43

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,802.07

Service Code	APR-DRG 1443
Min. Negotiated Rate	$6,149.88
Max. Negotiated Rate	$6,802.07
Rate for Payer: BCBS Complete	$6,802.07
Rate for Payer: Mclaren Medicaid	$6,478.16
Rate for Payer: Meridian Medicaid	$6,802.07
Rate for Payer: PHP Medicaid	$6,149.88
Rate for Payer: Priority Health Choice Medicaid	$6,478.16
Rate for Payer: UHC Medicaid	$6,478.16
Rate for Payer: UHCCP Medicaid	$6,478.16

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$2,876.25

Service Code	APR-DRG 1441
Min. Negotiated Rate	$2,600.47
Max. Negotiated Rate	$2,876.25
Rate for Payer: BCBS Complete	$2,876.25
Rate for Payer: Mclaren Medicaid	$2,739.28
Rate for Payer: Meridian Medicaid	$2,876.25
Rate for Payer: PHP Medicaid	$2,600.47
Rate for Payer: Priority Health Choice Medicaid	$2,739.28
Rate for Payer: UHC Medicaid	$2,739.28
Rate for Payer: UHCCP Medicaid	$2,739.28

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS

Facility

$37,763.84

Service Code	MSDRG 208
Min. Negotiated Rate	$20,471.09
Max. Negotiated Rate	$37,763.84
Rate for Payer: Aetna Medicare	$21,548.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,935.65
Rate for Payer: Amish Plain Church Group Commercial	$26,935.65
Rate for Payer: BCBS MAPPO	$21,548.52
Rate for Payer: BCN Medicare Advantage	$21,548.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$21,548.52
Rate for Payer: Humana Choice PPO Medicare	$21,548.52
Rate for Payer: Mclaren Medicare	$21,548.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$22,625.95
Rate for Payer: MI Amish Medical Board Commercial	$24,780.80
Rate for Payer: Molina Medicare/Medicaid	$23,703.37
Rate for Payer: PACE Medicare	$20,471.09
Rate for Payer: PACE SWMI	$21,548.52
Rate for Payer: PHP Commercial	$23,703.37
Rate for Payer: PHP Medicare Advantage	$21,548.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$37,763.84
Rate for Payer: Priority Health Medicare	$21,548.52
Rate for Payer: Priority Health Narrow Network	$30,211.07
Rate for Payer: Railroad Medicare Medicare	$21,548.52
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$21,548.52
Rate for Payer: UHC Exchange	$33,400.21
Rate for Payer: UHCCP DNSP	$21,548.52
Rate for Payer: VA VA	$21,548.52

Know your out-of-pocket cost for care.

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