Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

SOTALOL 80 MG TABLET

Facility

$143.35

Service Code	NDC 60505008000
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$143.35
Rate for Payer: Aetna Commercial	$129.01
Rate for Payer: Aetna Medicare	$53.04
Rate for Payer: ASR ASR	$139.05
Rate for Payer: BCBS Complete	$57.34
Rate for Payer: BCBS Trust/PPO	$118.19
Rate for Payer: BCN Commercial	$118.19
Rate for Payer: Cash Price	$114.68
Rate for Payer: Cofinity Commercial	$134.75
Rate for Payer: Encore Health Key Benefits Commercial	$114.68
Rate for Payer: Healthscope Commercial	$139.05
Rate for Payer: Healthscope Whirlpool	$143.35
Rate for Payer: Mclaren Commercial	$129.01
Rate for Payer: MI Amish Medical Board Commercial	$114.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$121.85
Rate for Payer: Nomi Health Commercial	$117.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$107.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$125.60
Rate for Payer: Priority Health Narrow Network	$100.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$126.15

SOTALOL 80 MG TABLET

Facility

$4.44

Service Code	NDC 245001289
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$3.33
Max. Negotiated Rate	$4.44
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: ASR ASR	$4.31
Rate for Payer: BCBS Trust/PPO	$3.65
Rate for Payer: BCN Commercial	$3.65
Rate for Payer: Cash Price	$3.55
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Encore Health Key Benefits Commercial	$3.55
Rate for Payer: Healthscope Commercial	$4.31
Rate for Payer: Healthscope Whirlpool	$4.44
Rate for Payer: Mclaren Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.77
Rate for Payer: Nomi Health Commercial	$3.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.91

SOTALOL 80 MG TABLET

Facility

$444.00

Service Code	NDC 245001201
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$164.28
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$399.60
Rate for Payer: Aetna Medicare	$164.28
Rate for Payer: ASR ASR	$430.68
Rate for Payer: BCBS Complete	$177.60
Rate for Payer: BCBS Trust/PPO	$366.08
Rate for Payer: BCN Commercial	$366.08
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cofinity Commercial	$417.36
Rate for Payer: Encore Health Key Benefits Commercial	$355.20
Rate for Payer: Healthscope Commercial	$430.68
Rate for Payer: Healthscope Whirlpool	$444.00
Rate for Payer: Mclaren Commercial	$399.60
Rate for Payer: MI Amish Medical Board Commercial	$355.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.40
Rate for Payer: Nomi Health Commercial	$364.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$333.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$389.03
Rate for Payer: Priority Health Narrow Network	$311.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$390.72

SOTALOL 80 MG TABLET

Facility

$444.00

Service Code	NDC 245001201
Hospital Charge Code	11421
Hospital Revenue Code	637
Min. Negotiated Rate	$333.00
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$399.60
Rate for Payer: ASR ASR	$430.68
Rate for Payer: BCBS Trust/PPO	$364.61
Rate for Payer: BCN Commercial	$364.61
Rate for Payer: Cash Price	$355.20
Rate for Payer: Cofinity Commercial	$417.36
Rate for Payer: Encore Health Key Benefits Commercial	$355.20
Rate for Payer: Healthscope Commercial	$430.68
Rate for Payer: Healthscope Whirlpool	$444.00
Rate for Payer: Mclaren Commercial	$399.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.40
Rate for Payer: Nomi Health Commercial	$364.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$333.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$390.72

SPINAL DISORDERS AND INJURIES

Facility

$8,905.03

Service Code	APR-DRG 0402
Min. Negotiated Rate	$8,051.21
Max. Negotiated Rate	$8,905.03
Rate for Payer: BCBS Complete	$8,905.03
Rate for Payer: Mclaren Medicaid	$8,480.98
Rate for Payer: Meridian Medicaid	$8,905.03
Rate for Payer: PHP Medicaid	$8,051.21
Rate for Payer: Priority Health Choice Medicaid	$8,480.98
Rate for Payer: UHC Medicaid	$8,480.98
Rate for Payer: UHCCP Medicaid	$8,480.98

SPINAL DISORDERS AND INJURIES

Facility

$13,871.16

Service Code	APR-DRG 0404
Min. Negotiated Rate	$12,541.19
Max. Negotiated Rate	$13,871.16
Rate for Payer: BCBS Complete	$13,871.16
Rate for Payer: Mclaren Medicaid	$13,210.63
Rate for Payer: Meridian Medicaid	$13,871.16
Rate for Payer: PHP Medicaid	$12,541.19
Rate for Payer: Priority Health Choice Medicaid	$13,210.63
Rate for Payer: UHC Medicaid	$13,210.63
Rate for Payer: UHCCP Medicaid	$13,210.63

SPINAL DISORDERS AND INJURIES

Facility

$6,858.74

Service Code	APR-DRG 0401
Min. Negotiated Rate	$6,201.12
Max. Negotiated Rate	$6,858.74
Rate for Payer: BCBS Complete	$6,858.74
Rate for Payer: Mclaren Medicaid	$6,532.13
Rate for Payer: Meridian Medicaid	$6,858.74
Rate for Payer: PHP Medicaid	$6,201.12
Rate for Payer: Priority Health Choice Medicaid	$6,532.13
Rate for Payer: UHC Medicaid	$6,532.13
Rate for Payer: UHCCP Medicaid	$6,532.13

SPINAL DISORDERS AND INJURIES

Facility

$10,469.03

Service Code	APR-DRG 0403
Min. Negotiated Rate	$9,465.26
Max. Negotiated Rate	$10,469.03
Rate for Payer: BCBS Complete	$10,469.03
Rate for Payer: Mclaren Medicaid	$9,970.51
Rate for Payer: Meridian Medicaid	$10,469.03
Rate for Payer: PHP Medicaid	$9,465.26
Rate for Payer: Priority Health Choice Medicaid	$9,970.51
Rate for Payer: UHC Medicaid	$9,970.51
Rate for Payer: UHCCP Medicaid	$9,970.51

SPINAL DISORDERS AND INJURIES WITH CC/MCC

Facility

$24,885.09

Service Code	MSDRG 052
Min. Negotiated Rate	$14,058.17
Max. Negotiated Rate	$24,885.09
Rate for Payer: Aetna Medicare	$14,798.07
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,497.59
Rate for Payer: Amish Plain Church Group Commercial	$18,497.59
Rate for Payer: BCBS MAPPO	$14,798.07
Rate for Payer: BCN Medicare Advantage	$14,798.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,798.07
Rate for Payer: Humana Choice PPO Medicare	$14,798.07
Rate for Payer: Mclaren Medicare	$14,798.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,537.97
Rate for Payer: MI Amish Medical Board Commercial	$17,017.78
Rate for Payer: Molina Medicare/Medicaid	$16,277.88
Rate for Payer: PACE Medicare	$14,058.17
Rate for Payer: PACE SWMI	$14,798.07
Rate for Payer: PHP Commercial	$16,277.88
Rate for Payer: PHP Medicare Advantage	$14,798.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,885.09
Rate for Payer: Priority Health Medicare	$14,798.07
Rate for Payer: Priority Health Narrow Network	$19,908.07
Rate for Payer: Railroad Medicare Medicare	$14,798.07
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,798.07
Rate for Payer: UHC Exchange	$22,937.01
Rate for Payer: UHCCP DNSP	$14,798.07
Rate for Payer: VA VA	$14,798.07

SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC

Facility

$13,649.18

Service Code	MSDRG 053
Min. Negotiated Rate	$8,365.62
Max. Negotiated Rate	$13,649.18
Rate for Payer: Aetna Medicare	$8,805.92
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,007.40
Rate for Payer: Amish Plain Church Group Commercial	$11,007.40
Rate for Payer: BCBS MAPPO	$8,805.92
Rate for Payer: BCN Medicare Advantage	$8,805.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,805.92
Rate for Payer: Humana Choice PPO Medicare	$8,805.92
Rate for Payer: Mclaren Medicare	$8,805.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,246.22
Rate for Payer: MI Amish Medical Board Commercial	$10,126.81
Rate for Payer: Molina Medicare/Medicaid	$9,686.51
Rate for Payer: PACE Medicare	$8,365.62
Rate for Payer: PACE SWMI	$8,805.92
Rate for Payer: PHP Commercial	$9,686.51
Rate for Payer: PHP Medicare Advantage	$8,805.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$13,453.03
Rate for Payer: Priority Health Medicare	$8,805.92
Rate for Payer: Priority Health Narrow Network	$10,762.43
Rate for Payer: Railroad Medicare Medicare	$8,805.92
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,805.92
Rate for Payer: UHC Exchange	$13,649.18
Rate for Payer: UHCCP DNSP	$8,805.92
Rate for Payer: VA VA	$8,805.92

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$25,130.37

Service Code	APR-DRG 3214
Min. Negotiated Rate	$22,720.86
Max. Negotiated Rate	$25,130.37
Rate for Payer: BCBS Complete	$25,130.37
Rate for Payer: Mclaren Medicaid	$23,933.69
Rate for Payer: Meridian Medicaid	$25,130.37
Rate for Payer: PHP Medicaid	$22,720.86
Rate for Payer: Priority Health Choice Medicaid	$23,933.69
Rate for Payer: UHC Medicaid	$23,933.69
Rate for Payer: UHCCP Medicaid	$23,933.69

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$12,645.02

Service Code	APR-DRG 3212
Min. Negotiated Rate	$11,432.61
Max. Negotiated Rate	$12,645.02
Rate for Payer: BCBS Complete	$12,645.02
Rate for Payer: Mclaren Medicaid	$12,042.88
Rate for Payer: Meridian Medicaid	$12,645.02
Rate for Payer: PHP Medicaid	$11,432.61
Rate for Payer: Priority Health Choice Medicaid	$12,042.88
Rate for Payer: UHC Medicaid	$12,042.88
Rate for Payer: UHCCP Medicaid	$12,042.88

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$9,648.34

Service Code	APR-DRG 3211
Min. Negotiated Rate	$8,723.25
Max. Negotiated Rate	$9,648.34
Rate for Payer: BCBS Complete	$9,648.34
Rate for Payer: Mclaren Medicaid	$9,188.90
Rate for Payer: Meridian Medicaid	$9,648.34
Rate for Payer: PHP Medicaid	$8,723.25
Rate for Payer: Priority Health Choice Medicaid	$9,188.90
Rate for Payer: UHC Medicaid	$9,188.90
Rate for Payer: UHCCP Medicaid	$9,188.90

SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES

Facility

$20,809.46

Service Code	APR-DRG 3213
Min. Negotiated Rate	$18,814.24
Max. Negotiated Rate	$20,809.46
Rate for Payer: BCBS Complete	$20,809.46
Rate for Payer: Mclaren Medicaid	$19,818.53
Rate for Payer: Meridian Medicaid	$20,809.46
Rate for Payer: PHP Medicaid	$18,814.24
Rate for Payer: Priority Health Choice Medicaid	$19,818.53
Rate for Payer: UHC Medicaid	$19,818.53
Rate for Payer: UHCCP Medicaid	$19,818.53

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC

Facility

$81,925.84

Service Code	MSDRG 457
Min. Negotiated Rate	$42,461.38
Max. Negotiated Rate	$81,925.84
Rate for Payer: Aetna Medicare	$44,696.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$55,870.24
Rate for Payer: Amish Plain Church Group Commercial	$55,870.24
Rate for Payer: BCBS MAPPO	$44,696.19
Rate for Payer: BCN Medicare Advantage	$44,696.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$44,696.19
Rate for Payer: Humana Choice PPO Medicare	$44,696.19
Rate for Payer: Mclaren Medicare	$44,696.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$46,931.00
Rate for Payer: MI Amish Medical Board Commercial	$51,400.62
Rate for Payer: Molina Medicare/Medicaid	$49,165.81
Rate for Payer: PACE Medicare	$42,461.38
Rate for Payer: PACE SWMI	$44,696.19
Rate for Payer: PHP Commercial	$49,165.81
Rate for Payer: PHP Medicare Advantage	$44,696.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$81,925.84
Rate for Payer: Priority Health Medicare	$44,696.19
Rate for Payer: Priority Health Narrow Network	$65,540.67
Rate for Payer: Railroad Medicare Medicare	$44,696.19
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$44,696.19
Rate for Payer: UHC Exchange	$69,279.09
Rate for Payer: UHCCP DNSP	$44,696.19
Rate for Payer: VA VA	$44,696.19

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC

Facility

$115,452.63

Service Code	MSDRG 456
Min. Negotiated Rate	$59,155.92
Max. Negotiated Rate	$115,452.63
Rate for Payer: Aetna Medicare	$62,269.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$77,836.74
Rate for Payer: Amish Plain Church Group Commercial	$77,836.74
Rate for Payer: BCBS MAPPO	$62,269.39
Rate for Payer: BCN Medicare Advantage	$62,269.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$62,269.39
Rate for Payer: Humana Choice PPO Medicare	$62,269.39
Rate for Payer: Mclaren Medicare	$62,269.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65,382.86
Rate for Payer: MI Amish Medical Board Commercial	$71,609.80
Rate for Payer: Molina Medicare/Medicaid	$68,496.33
Rate for Payer: PACE Medicare	$59,155.92
Rate for Payer: PACE SWMI	$62,269.39
Rate for Payer: PHP Commercial	$68,496.33
Rate for Payer: PHP Medicare Advantage	$62,269.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$115,452.63
Rate for Payer: Priority Health Medicare	$62,269.39
Rate for Payer: Priority Health Narrow Network	$92,362.11
Rate for Payer: Railroad Medicare Medicare	$62,269.39
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$62,269.39
Rate for Payer: UHC Exchange	$96,517.55
Rate for Payer: UHCCP DNSP	$62,269.39
Rate for Payer: VA VA	$62,269.39

SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC

Facility

$57,326.52

Service Code	MSDRG 458
Min. Negotiated Rate	$30,212.25
Max. Negotiated Rate	$57,326.52
Rate for Payer: Aetna Medicare	$31,802.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$39,752.96
Rate for Payer: Amish Plain Church Group Commercial	$39,752.96
Rate for Payer: BCBS MAPPO	$31,802.37
Rate for Payer: BCN Medicare Advantage	$31,802.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$31,802.37
Rate for Payer: Humana Choice PPO Medicare	$31,802.37
Rate for Payer: Mclaren Medicare	$31,802.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$33,392.49
Rate for Payer: MI Amish Medical Board Commercial	$36,572.73
Rate for Payer: Molina Medicare/Medicaid	$34,982.61
Rate for Payer: PACE Medicare	$30,212.25
Rate for Payer: PACE SWMI	$31,802.37
Rate for Payer: PHP Commercial	$34,982.61
Rate for Payer: PHP Medicare Advantage	$31,802.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$57,326.52
Rate for Payer: Priority Health Medicare	$31,802.37
Rate for Payer: Priority Health Narrow Network	$45,861.21
Rate for Payer: Railroad Medicare Medicare	$31,802.37
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$31,802.37
Rate for Payer: UHC Exchange	$49,293.67
Rate for Payer: UHCCP DNSP	$31,802.37
Rate for Payer: VA VA	$31,802.37

SPINAL PROCEDURES

Facility

$27,991.36

Service Code	APR-DRG 0234
Min. Negotiated Rate	$25,307.54
Max. Negotiated Rate	$27,991.36
Rate for Payer: BCBS Complete	$27,991.36
Rate for Payer: Mclaren Medicaid	$26,658.44
Rate for Payer: Meridian Medicaid	$27,991.36
Rate for Payer: PHP Medicaid	$25,307.54
Rate for Payer: Priority Health Choice Medicaid	$26,658.44
Rate for Payer: UHC Medicaid	$26,658.44
Rate for Payer: UHCCP Medicaid	$26,658.44

SPINAL PROCEDURES

Facility

$21,930.97

Service Code	APR-DRG 0233
Min. Negotiated Rate	$19,828.22
Max. Negotiated Rate	$21,930.97
Rate for Payer: BCBS Complete	$21,930.97
Rate for Payer: Mclaren Medicaid	$20,886.64
Rate for Payer: Meridian Medicaid	$21,930.97
Rate for Payer: PHP Medicaid	$19,828.22
Rate for Payer: Priority Health Choice Medicaid	$20,886.64
Rate for Payer: UHC Medicaid	$20,886.64
Rate for Payer: UHCCP Medicaid	$20,886.64

SPINAL PROCEDURES

Facility

$14,047.72

Service Code	APR-DRG 0232
Min. Negotiated Rate	$12,700.82
Max. Negotiated Rate	$14,047.72
Rate for Payer: BCBS Complete	$14,047.72
Rate for Payer: Mclaren Medicaid	$13,378.78
Rate for Payer: Meridian Medicaid	$14,047.72
Rate for Payer: PHP Medicaid	$12,700.82
Rate for Payer: Priority Health Choice Medicaid	$13,378.78
Rate for Payer: UHC Medicaid	$13,378.78
Rate for Payer: UHCCP Medicaid	$13,378.78

SPINAL PROCEDURES

Facility

$9,271.78

Service Code	APR-DRG 0231
Min. Negotiated Rate	$8,382.80
Max. Negotiated Rate	$9,271.78
Rate for Payer: BCBS Complete	$9,271.78
Rate for Payer: Mclaren Medicaid	$8,830.27
Rate for Payer: Meridian Medicaid	$9,271.78
Rate for Payer: PHP Medicaid	$8,382.80
Rate for Payer: Priority Health Choice Medicaid	$8,830.27
Rate for Payer: UHC Medicaid	$8,830.27
Rate for Payer: UHCCP Medicaid	$8,830.27

SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS

Facility

$46,871.29

Service Code	MSDRG 029
Min. Negotiated Rate	$25,006.11
Max. Negotiated Rate	$46,871.29
Rate for Payer: Aetna Medicare	$26,322.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$32,902.78
Rate for Payer: Amish Plain Church Group Commercial	$32,902.78
Rate for Payer: BCBS MAPPO	$26,322.22
Rate for Payer: BCN Medicare Advantage	$26,322.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,322.22
Rate for Payer: Humana Choice PPO Medicare	$26,322.22
Rate for Payer: Mclaren Medicare	$26,322.22
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$27,638.33
Rate for Payer: MI Amish Medical Board Commercial	$30,270.55
Rate for Payer: Molina Medicare/Medicaid	$28,954.44
Rate for Payer: PACE Medicare	$25,006.11
Rate for Payer: PACE SWMI	$26,322.22
Rate for Payer: PHP Commercial	$28,954.44
Rate for Payer: PHP Medicare Advantage	$26,322.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$46,871.29
Rate for Payer: Priority Health Medicare	$26,322.22
Rate for Payer: Priority Health Narrow Network	$37,497.03
Rate for Payer: Railroad Medicare Medicare	$26,322.22
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$26,322.22
Rate for Payer: UHC Exchange	$40,799.44
Rate for Payer: UHCCP DNSP	$26,322.22
Rate for Payer: VA VA	$26,322.22

SPINAL PROCEDURES WITH MCC

Facility

$82,546.83

Service Code	MSDRG 028
Min. Negotiated Rate	$42,770.61
Max. Negotiated Rate	$82,546.83
Rate for Payer: Aetna Medicare	$45,021.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$56,277.11
Rate for Payer: Amish Plain Church Group Commercial	$56,277.11
Rate for Payer: BCBS MAPPO	$45,021.69
Rate for Payer: BCN Medicare Advantage	$45,021.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$45,021.69
Rate for Payer: Humana Choice PPO Medicare	$45,021.69
Rate for Payer: Mclaren Medicare	$45,021.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$47,272.77
Rate for Payer: MI Amish Medical Board Commercial	$51,774.94
Rate for Payer: Molina Medicare/Medicaid	$49,523.86
Rate for Payer: PACE Medicare	$42,770.61
Rate for Payer: PACE SWMI	$45,021.69
Rate for Payer: PHP Commercial	$49,523.86
Rate for Payer: PHP Medicare Advantage	$45,021.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$82,546.83
Rate for Payer: Priority Health Medicare	$45,021.69
Rate for Payer: Priority Health Narrow Network	$66,037.47
Rate for Payer: Railroad Medicare Medicare	$45,021.69
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$45,021.69
Rate for Payer: UHC Exchange	$69,783.62
Rate for Payer: UHCCP DNSP	$45,021.69
Rate for Payer: VA VA	$45,021.69

SPINAL PROCEDURES WITHOUT CC/MCC

Facility

$30,159.41

Service Code	MSDRG 030
Min. Negotiated Rate	$16,684.50
Max. Negotiated Rate	$30,159.41
Rate for Payer: Aetna Medicare	$17,562.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$21,953.29
Rate for Payer: Amish Plain Church Group Commercial	$21,953.29
Rate for Payer: BCBS MAPPO	$17,562.63
Rate for Payer: BCN Medicare Advantage	$17,562.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,562.63
Rate for Payer: Humana Choice PPO Medicare	$17,562.63
Rate for Payer: Mclaren Medicare	$17,562.63
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,440.76
Rate for Payer: MI Amish Medical Board Commercial	$20,197.02
Rate for Payer: Molina Medicare/Medicaid	$19,318.89
Rate for Payer: PACE Medicare	$16,684.50
Rate for Payer: PACE SWMI	$17,562.63
Rate for Payer: PHP Commercial	$19,318.89
Rate for Payer: PHP Medicare Advantage	$17,562.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$30,159.41
Rate for Payer: Priority Health Medicare	$17,562.63
Rate for Payer: Priority Health Narrow Network	$24,127.53
Rate for Payer: Railroad Medicare Medicare	$17,562.63
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$17,562.63
Rate for Payer: UHC Exchange	$27,222.08
Rate for Payer: UHCCP DNSP	$17,562.63
Rate for Payer: VA VA	$17,562.63

SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;

Facility

$1,090.18

Service Code	CPT 62270
Hospital Revenue Code	361
Min. Negotiated Rate	$367.85
Max. Negotiated Rate	$1,090.18
Rate for Payer: Aetna Medicare	$703.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$879.17
Rate for Payer: Amish Plain Church Group Commercial	$879.17
Rate for Payer: BCBS Complete	$386.27
Rate for Payer: BCBS MAPPO	$703.34
Rate for Payer: BCN Medicare Advantage	$703.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$703.34
Rate for Payer: Humana Choice PPO Medicare	$703.34
Rate for Payer: Mclaren Medicaid	$703.34
Rate for Payer: Mclaren Medicare	$703.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$738.51
Rate for Payer: Meridian Medicaid	$386.27
Rate for Payer: MI Amish Medical Board Commercial	$808.84
Rate for Payer: Molina Medicare/Medicaid	$773.67
Rate for Payer: PACE Medicare	$668.17
Rate for Payer: PACE SWMI	$703.34
Rate for Payer: PHP Commercial	$773.67
Rate for Payer: PHP Medicaid	$376.99
Rate for Payer: PHP Medicare Advantage	$703.34
Rate for Payer: Priority Health Choice Medicaid	$367.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$647.65
Rate for Payer: Priority Health Medicare	$703.34
Rate for Payer: Priority Health Narrow Network	$518.12
Rate for Payer: Railroad Medicare Medicare	$703.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$703.34
Rate for Payer: UHC Exchange	$1,090.18
Rate for Payer: UHC Medicaid	$367.85
Rate for Payer: UHCCP DNSP	$703.34
Rate for Payer: UHCCP Medicaid	$367.85
Rate for Payer: VA VA	$703.34

Know your out-of-pocket cost for care.

All Charges