Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC

Facility

$14,052.11

Service Code	MSDRG 136
Min. Negotiated Rate	$8,612.59
Max. Negotiated Rate	$14,052.11
Rate for Payer: Aetna Medicare	$9,065.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,332.35
Rate for Payer: Amish Plain Church Group Commercial	$11,332.35
Rate for Payer: BCBS MAPPO	$9,065.88
Rate for Payer: BCN Medicare Advantage	$9,065.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,065.88
Rate for Payer: Humana Choice PPO Medicare	$9,065.88
Rate for Payer: Mclaren Medicare	$9,065.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,519.17
Rate for Payer: MI Amish Medical Board Commercial	$10,425.76
Rate for Payer: Molina Medicare/Medicaid	$9,972.47
Rate for Payer: PACE Medicare	$8,612.59
Rate for Payer: PACE SWMI	$9,065.88
Rate for Payer: PHP Commercial	$9,972.47
Rate for Payer: PHP Medicare Advantage	$9,065.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,949.00
Rate for Payer: Priority Health Medicare	$9,065.88
Rate for Payer: Priority Health Narrow Network	$11,159.20
Rate for Payer: Railroad Medicare Medicare	$9,065.88
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,065.88
Rate for Payer: UHC Exchange	$14,052.11
Rate for Payer: UHCCP DNSP	$9,065.88
Rate for Payer: VA VA	$9,065.88

SITAGLIPTIN PHOSPHATE 100 MG TABLET

Facility

$1,135.31

Service Code	NDC 6027731
Hospital Charge Code	77617
Hospital Revenue Code	637
Min. Negotiated Rate	$420.06
Max. Negotiated Rate	$1,135.31
Rate for Payer: Aetna Commercial	$1,021.78
Rate for Payer: Aetna Medicare	$420.06
Rate for Payer: ASR ASR	$1,101.25
Rate for Payer: BCBS Complete	$454.12
Rate for Payer: BCBS Trust/PPO	$936.06
Rate for Payer: BCN Commercial	$936.06
Rate for Payer: Cash Price	$908.25
Rate for Payer: Cofinity Commercial	$1,067.19
Rate for Payer: Encore Health Key Benefits Commercial	$908.25
Rate for Payer: Healthscope Commercial	$1,101.25
Rate for Payer: Healthscope Whirlpool	$1,135.31
Rate for Payer: Mclaren Commercial	$1,021.78
Rate for Payer: MI Amish Medical Board Commercial	$908.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$965.01
Rate for Payer: Nomi Health Commercial	$930.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$851.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$994.76
Rate for Payer: Priority Health Narrow Network	$795.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$999.07

SITAGLIPTIN PHOSPHATE 100 MG TABLET

Facility

$1,135.31

Service Code	NDC 6027731
Hospital Charge Code	77617
Hospital Revenue Code	637
Min. Negotiated Rate	$851.48
Max. Negotiated Rate	$1,135.31
Rate for Payer: Aetna Commercial	$1,021.78
Rate for Payer: ASR ASR	$1,101.25
Rate for Payer: BCBS Trust/PPO	$932.31
Rate for Payer: BCN Commercial	$932.31
Rate for Payer: Cash Price	$908.25
Rate for Payer: Cofinity Commercial	$1,067.19
Rate for Payer: Encore Health Key Benefits Commercial	$908.25
Rate for Payer: Healthscope Commercial	$1,101.25
Rate for Payer: Healthscope Whirlpool	$1,135.31
Rate for Payer: Mclaren Commercial	$1,021.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$965.01
Rate for Payer: Nomi Health Commercial	$930.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$851.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$999.07

SITAGLIPTIN PHOSPHATE 25 MG TABLET

Facility

$3,406.26

Service Code	NDC 6022154
Hospital Charge Code	77615
Hospital Revenue Code	637
Min. Negotiated Rate	$1,260.32
Max. Negotiated Rate	$3,406.26
Rate for Payer: Aetna Commercial	$3,065.63
Rate for Payer: Aetna Medicare	$1,260.32
Rate for Payer: ASR ASR	$3,304.07
Rate for Payer: BCBS Complete	$1,362.50
Rate for Payer: BCBS Trust/PPO	$2,808.46
Rate for Payer: BCN Commercial	$2,808.46
Rate for Payer: Cash Price	$2,725.01
Rate for Payer: Cofinity Commercial	$3,201.88
Rate for Payer: Encore Health Key Benefits Commercial	$2,725.01
Rate for Payer: Healthscope Commercial	$3,304.07
Rate for Payer: Healthscope Whirlpool	$3,406.26
Rate for Payer: Mclaren Commercial	$3,065.63
Rate for Payer: MI Amish Medical Board Commercial	$2,725.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,895.32
Rate for Payer: Nomi Health Commercial	$2,793.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,554.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$2,984.56
Rate for Payer: Priority Health Narrow Network	$2,387.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,997.51

SITAGLIPTIN PHOSPHATE 25 MG TABLET

Facility

$3,406.26

Service Code	NDC 6022154
Hospital Charge Code	77615
Hospital Revenue Code	637
Min. Negotiated Rate	$2,554.69
Max. Negotiated Rate	$3,406.26
Rate for Payer: Aetna Commercial	$3,065.63
Rate for Payer: ASR ASR	$3,304.07
Rate for Payer: BCBS Trust/PPO	$2,797.22
Rate for Payer: BCN Commercial	$2,797.22
Rate for Payer: Cash Price	$2,725.01
Rate for Payer: Cofinity Commercial	$3,201.88
Rate for Payer: Encore Health Key Benefits Commercial	$2,725.01
Rate for Payer: Healthscope Commercial	$3,304.07
Rate for Payer: Healthscope Whirlpool	$3,406.26
Rate for Payer: Mclaren Commercial	$3,065.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,895.32
Rate for Payer: Nomi Health Commercial	$2,793.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,554.69
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,997.51

SKIN CARE CONSULT

Professional

Both

$27.00

Hospital Revenue Code	960
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$20.25
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

SKIN DEBRIDEMENT WITH CC

Facility

$23,211.70

Service Code	MSDRG 571
Min. Negotiated Rate	$13,224.90
Max. Negotiated Rate	$23,211.70
Rate for Payer: Aetna Medicare	$13,920.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,401.19
Rate for Payer: Amish Plain Church Group Commercial	$17,401.19
Rate for Payer: BCBS MAPPO	$13,920.95
Rate for Payer: BCN Medicare Advantage	$13,920.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,920.95
Rate for Payer: Humana Choice PPO Medicare	$13,920.95
Rate for Payer: Mclaren Medicare	$13,920.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,617.00
Rate for Payer: MI Amish Medical Board Commercial	$16,009.09
Rate for Payer: Molina Medicare/Medicaid	$15,313.05
Rate for Payer: PACE Medicare	$13,224.90
Rate for Payer: PACE SWMI	$13,920.95
Rate for Payer: PHP Commercial	$15,313.05
Rate for Payer: PHP Medicare Advantage	$13,920.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$23,211.70
Rate for Payer: Priority Health Medicare	$13,920.95
Rate for Payer: Priority Health Narrow Network	$18,569.36
Rate for Payer: Railroad Medicare Medicare	$13,920.95
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,920.95
Rate for Payer: UHC Exchange	$21,577.47
Rate for Payer: UHCCP DNSP	$13,920.95
Rate for Payer: VA VA	$13,920.95

SKIN DEBRIDEMENT WITH MCC

Facility

$40,407.18

Service Code	MSDRG 570
Min. Negotiated Rate	$21,787.33
Max. Negotiated Rate	$40,407.18
Rate for Payer: Aetna Medicare	$22,934.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$28,667.54
Rate for Payer: Amish Plain Church Group Commercial	$28,667.54
Rate for Payer: BCBS MAPPO	$22,934.03
Rate for Payer: BCN Medicare Advantage	$22,934.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$22,934.03
Rate for Payer: Humana Choice PPO Medicare	$22,934.03
Rate for Payer: Mclaren Medicare	$22,934.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$24,080.73
Rate for Payer: MI Amish Medical Board Commercial	$26,374.13
Rate for Payer: Molina Medicare/Medicaid	$25,227.43
Rate for Payer: PACE Medicare	$21,787.33
Rate for Payer: PACE SWMI	$22,934.03
Rate for Payer: PHP Commercial	$25,227.43
Rate for Payer: PHP Medicare Advantage	$22,934.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$40,407.18
Rate for Payer: Priority Health Medicare	$22,934.03
Rate for Payer: Priority Health Narrow Network	$32,325.75
Rate for Payer: Railroad Medicare Medicare	$22,934.03
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$22,934.03
Rate for Payer: UHC Exchange	$35,547.75
Rate for Payer: UHCCP DNSP	$22,934.03
Rate for Payer: VA VA	$22,934.03

SKIN DEBRIDEMENT WITHOUT CC/MCC

Facility

$15,748.79

Service Code	MSDRG 572
Min. Negotiated Rate	$9,508.78
Max. Negotiated Rate	$15,748.79
Rate for Payer: Aetna Medicare	$10,009.24
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,511.55
Rate for Payer: Amish Plain Church Group Commercial	$12,511.55
Rate for Payer: BCBS MAPPO	$10,009.24
Rate for Payer: BCN Medicare Advantage	$10,009.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,009.24
Rate for Payer: Humana Choice PPO Medicare	$10,009.24
Rate for Payer: Mclaren Medicare	$10,009.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,509.70
Rate for Payer: MI Amish Medical Board Commercial	$11,510.63
Rate for Payer: Molina Medicare/Medicaid	$11,010.16
Rate for Payer: PACE Medicare	$9,508.78
Rate for Payer: PACE SWMI	$10,009.24
Rate for Payer: PHP Commercial	$11,010.16
Rate for Payer: PHP Medicare Advantage	$10,009.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$15,748.79
Rate for Payer: Priority Health Medicare	$10,009.24
Rate for Payer: Priority Health Narrow Network	$12,599.03
Rate for Payer: Railroad Medicare Medicare	$10,009.24
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,009.24
Rate for Payer: UHC Exchange	$15,514.32
Rate for Payer: UHCCP DNSP	$10,009.24
Rate for Payer: VA VA	$10,009.24

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$36,417.44

Service Code	MSDRG 577
Min. Negotiated Rate	$19,800.66
Max. Negotiated Rate	$36,417.44
Rate for Payer: Aetna Medicare	$20,842.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$26,053.50
Rate for Payer: Amish Plain Church Group Commercial	$26,053.50
Rate for Payer: BCBS MAPPO	$20,842.80
Rate for Payer: BCN Medicare Advantage	$20,842.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,842.80
Rate for Payer: Humana Choice PPO Medicare	$20,842.80
Rate for Payer: Mclaren Medicare	$20,842.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21,884.94
Rate for Payer: MI Amish Medical Board Commercial	$23,969.22
Rate for Payer: Molina Medicare/Medicaid	$22,927.08
Rate for Payer: PACE Medicare	$19,800.66
Rate for Payer: PACE SWMI	$20,842.80
Rate for Payer: PHP Commercial	$22,927.08
Rate for Payer: PHP Medicare Advantage	$20,842.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$36,417.44
Rate for Payer: Priority Health Medicare	$20,842.80
Rate for Payer: Priority Health Narrow Network	$29,133.95
Rate for Payer: Railroad Medicare Medicare	$20,842.80
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$20,842.80
Rate for Payer: UHC Exchange	$32,306.34
Rate for Payer: UHCCP DNSP	$20,842.80
Rate for Payer: VA VA	$20,842.80

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$67,336.61

Service Code	MSDRG 576
Min. Negotiated Rate	$35,196.74
Max. Negotiated Rate	$67,336.61
Rate for Payer: Aetna Medicare	$37,049.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$46,311.50
Rate for Payer: Amish Plain Church Group Commercial	$46,311.50
Rate for Payer: BCBS MAPPO	$37,049.20
Rate for Payer: BCN Medicare Advantage	$37,049.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$37,049.20
Rate for Payer: Humana Choice PPO Medicare	$37,049.20
Rate for Payer: Mclaren Medicare	$37,049.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$38,901.66
Rate for Payer: MI Amish Medical Board Commercial	$42,606.58
Rate for Payer: Molina Medicare/Medicaid	$40,754.12
Rate for Payer: PACE Medicare	$35,196.74
Rate for Payer: PACE SWMI	$37,049.20
Rate for Payer: PHP Commercial	$40,754.12
Rate for Payer: PHP Medicare Advantage	$37,049.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$67,336.61
Rate for Payer: Priority Health Medicare	$37,049.20
Rate for Payer: Priority Health Narrow Network	$53,869.29
Rate for Payer: Railroad Medicare Medicare	$37,049.20
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$37,049.20
Rate for Payer: UHC Exchange	$57,426.26
Rate for Payer: UHCCP DNSP	$37,049.20
Rate for Payer: VA VA	$37,049.20

SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$22,070.01

Service Code	MSDRG 578
Min. Negotiated Rate	$12,656.42
Max. Negotiated Rate	$22,070.01
Rate for Payer: Aetna Medicare	$13,322.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,653.19
Rate for Payer: Amish Plain Church Group Commercial	$16,653.19
Rate for Payer: BCBS MAPPO	$13,322.55
Rate for Payer: BCN Medicare Advantage	$13,322.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,322.55
Rate for Payer: Humana Choice PPO Medicare	$13,322.55
Rate for Payer: Mclaren Medicare	$13,322.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,988.68
Rate for Payer: MI Amish Medical Board Commercial	$15,320.93
Rate for Payer: Molina Medicare/Medicaid	$14,654.81
Rate for Payer: PACE Medicare	$12,656.42
Rate for Payer: PACE SWMI	$13,322.55
Rate for Payer: PHP Commercial	$14,654.81
Rate for Payer: PHP Medicare Advantage	$13,322.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22,070.01
Rate for Payer: Priority Health Medicare	$13,322.55
Rate for Payer: Priority Health Narrow Network	$17,656.01
Rate for Payer: Railroad Medicare Medicare	$13,322.55
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,322.55
Rate for Payer: UHC Exchange	$20,649.95
Rate for Payer: UHCCP DNSP	$13,322.55
Rate for Payer: VA VA	$13,322.55

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$36,484.95

Service Code	APR-DRG 3124
Min. Negotiated Rate	$32,986.76
Max. Negotiated Rate	$36,484.95
Rate for Payer: BCBS Complete	$36,484.95
Rate for Payer: Mclaren Medicaid	$34,747.57
Rate for Payer: Meridian Medicaid	$36,484.95
Rate for Payer: PHP Medicaid	$32,986.76
Rate for Payer: Priority Health Choice Medicaid	$34,747.57
Rate for Payer: UHC Medicaid	$34,747.57
Rate for Payer: UHCCP Medicaid	$34,747.57

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$10,124.08

Service Code	APR-DRG 3121
Min. Negotiated Rate	$9,153.38
Max. Negotiated Rate	$10,124.08
Rate for Payer: BCBS Complete	$10,124.08
Rate for Payer: Mclaren Medicaid	$9,641.98
Rate for Payer: Meridian Medicaid	$10,124.08
Rate for Payer: PHP Medicaid	$9,153.38
Rate for Payer: Priority Health Choice Medicaid	$9,641.98
Rate for Payer: UHC Medicaid	$9,641.98
Rate for Payer: UHCCP Medicaid	$9,641.98

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$19,284.69

Service Code	APR-DRG 3123
Min. Negotiated Rate	$17,435.67
Max. Negotiated Rate	$19,284.69
Rate for Payer: BCBS Complete	$19,284.69
Rate for Payer: Mclaren Medicaid	$18,366.37
Rate for Payer: Meridian Medicaid	$19,284.69
Rate for Payer: PHP Medicaid	$17,435.67
Rate for Payer: Priority Health Choice Medicaid	$18,366.37
Rate for Payer: UHC Medicaid	$18,366.37
Rate for Payer: UHCCP Medicaid	$18,366.37

SKIN GRAFT FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DIAGNOSES

Facility

$14,666.78

Service Code	APR-DRG 3122
Min. Negotiated Rate	$13,260.53
Max. Negotiated Rate	$14,666.78
Rate for Payer: BCBS Complete	$14,666.78
Rate for Payer: Mclaren Medicaid	$13,968.37
Rate for Payer: Meridian Medicaid	$14,666.78
Rate for Payer: PHP Medicaid	$13,260.53
Rate for Payer: Priority Health Choice Medicaid	$13,968.37
Rate for Payer: UHC Medicaid	$13,968.37
Rate for Payer: UHCCP Medicaid	$13,968.37

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$15,847.15

Service Code	APR-DRG 3612
Min. Negotiated Rate	$14,327.72
Max. Negotiated Rate	$15,847.15
Rate for Payer: BCBS Complete	$15,847.15
Rate for Payer: Mclaren Medicaid	$15,092.52
Rate for Payer: Meridian Medicaid	$15,847.15
Rate for Payer: PHP Medicaid	$14,327.72
Rate for Payer: Priority Health Choice Medicaid	$15,092.52
Rate for Payer: UHC Medicaid	$15,092.52
Rate for Payer: UHCCP Medicaid	$15,092.52

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$18,086.89

Service Code	APR-DRG 3613
Min. Negotiated Rate	$16,352.71
Max. Negotiated Rate	$18,086.89
Rate for Payer: BCBS Complete	$18,086.89
Rate for Payer: Mclaren Medicaid	$17,225.61
Rate for Payer: Meridian Medicaid	$18,086.89
Rate for Payer: PHP Medicaid	$16,352.71
Rate for Payer: Priority Health Choice Medicaid	$17,225.61
Rate for Payer: UHC Medicaid	$17,225.61
Rate for Payer: UHCCP Medicaid	$17,225.61

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$11,688.63

Service Code	APR-DRG 3611
Min. Negotiated Rate	$10,567.92
Max. Negotiated Rate	$11,688.63
Rate for Payer: BCBS Complete	$11,688.63
Rate for Payer: Mclaren Medicaid	$11,132.03
Rate for Payer: Meridian Medicaid	$11,688.63
Rate for Payer: PHP Medicaid	$10,567.92
Rate for Payer: Priority Health Choice Medicaid	$11,132.03
Rate for Payer: UHC Medicaid	$11,132.03
Rate for Payer: UHCCP Medicaid	$11,132.03

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$33,806.52

Service Code	APR-DRG 3614
Min. Negotiated Rate	$30,565.14
Max. Negotiated Rate	$33,806.52
Rate for Payer: BCBS Complete	$33,806.52
Rate for Payer: Mclaren Medicaid	$32,196.68
Rate for Payer: Meridian Medicaid	$33,806.52
Rate for Payer: PHP Medicaid	$30,565.14
Rate for Payer: Priority Health Choice Medicaid	$32,196.68
Rate for Payer: UHC Medicaid	$32,196.68
Rate for Payer: UHCCP Medicaid	$32,196.68

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$47,692.87

Service Code	MSDRG 574
Min. Negotiated Rate	$25,415.22
Max. Negotiated Rate	$47,692.87
Rate for Payer: Aetna Medicare	$26,752.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,441.07
Rate for Payer: Amish Plain Church Group Commercial	$33,441.07
Rate for Payer: BCBS MAPPO	$26,752.86
Rate for Payer: BCN Medicare Advantage	$26,752.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,752.86
Rate for Payer: Humana Choice PPO Medicare	$26,752.86
Rate for Payer: Mclaren Medicare	$26,752.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,090.50
Rate for Payer: MI Amish Medical Board Commercial	$30,765.79
Rate for Payer: Molina Medicare/Medicaid	$29,428.15
Rate for Payer: PACE Medicare	$25,415.22
Rate for Payer: PACE SWMI	$26,752.86
Rate for Payer: PHP Commercial	$29,428.15
Rate for Payer: PHP Medicare Advantage	$26,752.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$47,692.87
Rate for Payer: Priority Health Medicare	$26,752.86
Rate for Payer: Priority Health Narrow Network	$38,154.30
Rate for Payer: Railroad Medicare Medicare	$26,752.86
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,752.86
Rate for Payer: UHC Exchange	$41,466.93
Rate for Payer: UHCCP DNSP	$26,752.86
Rate for Payer: VA VA	$26,752.86

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$90,008.37

Service Code	MSDRG 573
Min. Negotiated Rate	$46,486.06
Max. Negotiated Rate	$90,008.37
Rate for Payer: Aetna Medicare	$48,932.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$61,165.86
Rate for Payer: Amish Plain Church Group Commercial	$61,165.86
Rate for Payer: BCBS MAPPO	$48,932.69
Rate for Payer: BCN Medicare Advantage	$48,932.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$48,932.69
Rate for Payer: Humana Choice PPO Medicare	$48,932.69
Rate for Payer: Mclaren Medicare	$48,932.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$51,379.32
Rate for Payer: MI Amish Medical Board Commercial	$56,272.59
Rate for Payer: Molina Medicare/Medicaid	$53,825.96
Rate for Payer: PACE Medicare	$46,486.06
Rate for Payer: PACE SWMI	$48,932.69
Rate for Payer: PHP Commercial	$53,825.96
Rate for Payer: PHP Medicare Advantage	$48,932.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$90,008.37
Rate for Payer: Priority Health Medicare	$48,932.69
Rate for Payer: Priority Health Narrow Network	$72,006.70
Rate for Payer: Railroad Medicare Medicare	$48,932.69
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$48,932.69
Rate for Payer: UHC Exchange	$75,845.67
Rate for Payer: UHCCP DNSP	$48,932.69
Rate for Payer: VA VA	$48,932.69

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$24,688.62

Service Code	MSDRG 575
Min. Negotiated Rate	$13,960.34
Max. Negotiated Rate	$24,688.62
Rate for Payer: Aetna Medicare	$14,695.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,368.88
Rate for Payer: Amish Plain Church Group Commercial	$18,368.88
Rate for Payer: BCBS MAPPO	$14,695.10
Rate for Payer: BCN Medicare Advantage	$14,695.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,695.10
Rate for Payer: Humana Choice PPO Medicare	$14,695.10
Rate for Payer: Mclaren Medicare	$14,695.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,429.85
Rate for Payer: MI Amish Medical Board Commercial	$16,899.37
Rate for Payer: Molina Medicare/Medicaid	$16,164.61
Rate for Payer: PACE Medicare	$13,960.34
Rate for Payer: PACE SWMI	$14,695.10
Rate for Payer: PHP Commercial	$16,164.61
Rate for Payer: PHP Medicare Advantage	$14,695.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,688.62
Rate for Payer: Priority Health Medicare	$14,695.10
Rate for Payer: Priority Health Narrow Network	$19,750.90
Rate for Payer: Railroad Medicare Medicare	$14,695.10
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,695.10
Rate for Payer: UHC Exchange	$22,777.40
Rate for Payer: UHCCP DNSP	$14,695.10
Rate for Payer: VA VA	$14,695.10

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$24,646.03

Service Code	MSDRG 623
Min. Negotiated Rate	$13,939.13
Max. Negotiated Rate	$24,646.03
Rate for Payer: Aetna Medicare	$14,672.77
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,340.96
Rate for Payer: Amish Plain Church Group Commercial	$18,340.96
Rate for Payer: BCBS MAPPO	$14,672.77
Rate for Payer: BCN Medicare Advantage	$14,672.77
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,672.77
Rate for Payer: Humana Choice PPO Medicare	$14,672.77
Rate for Payer: Mclaren Medicare	$14,672.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,406.41
Rate for Payer: MI Amish Medical Board Commercial	$16,873.69
Rate for Payer: Molina Medicare/Medicaid	$16,140.05
Rate for Payer: PACE Medicare	$13,939.13
Rate for Payer: PACE SWMI	$14,672.77
Rate for Payer: PHP Commercial	$16,140.05
Rate for Payer: PHP Medicare Advantage	$14,672.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,646.03
Rate for Payer: Priority Health Medicare	$14,672.77
Rate for Payer: Priority Health Narrow Network	$19,716.83
Rate for Payer: Railroad Medicare Medicare	$14,672.77
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,672.77
Rate for Payer: UHC Exchange	$22,742.79
Rate for Payer: UHCCP DNSP	$14,672.77
Rate for Payer: VA VA	$14,672.77

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$48,899.14

Service Code	MSDRG 622
Min. Negotiated Rate	$26,015.87
Max. Negotiated Rate	$48,899.14
Rate for Payer: Aetna Medicare	$27,385.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,231.41
Rate for Payer: Amish Plain Church Group Commercial	$34,231.41
Rate for Payer: BCBS MAPPO	$27,385.13
Rate for Payer: BCN Medicare Advantage	$27,385.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,385.13
Rate for Payer: Humana Choice PPO Medicare	$27,385.13
Rate for Payer: Mclaren Medicare	$27,385.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,754.39
Rate for Payer: MI Amish Medical Board Commercial	$31,492.90
Rate for Payer: Molina Medicare/Medicaid	$30,123.64
Rate for Payer: PACE Medicare	$26,015.87
Rate for Payer: PACE SWMI	$27,385.13
Rate for Payer: PHP Commercial	$30,123.64
Rate for Payer: PHP Medicare Advantage	$27,385.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$48,899.14
Rate for Payer: Priority Health Medicare	$27,385.13
Rate for Payer: Priority Health Narrow Network	$39,119.31
Rate for Payer: Railroad Medicare Medicare	$27,385.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,385.13
Rate for Payer: UHC Exchange	$42,446.95
Rate for Payer: UHCCP DNSP	$27,385.13
Rate for Payer: VA VA	$27,385.13

Know your out-of-pocket cost for care.

All Charges