Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

URSODIOL 300 MG CAPSULE

Facility

$402.80

Service Code	NDC 42806050301
Hospital Charge Code	11624
Hospital Revenue Code	637
Min. Negotiated Rate	$302.10
Max. Negotiated Rate	$402.80
Rate for Payer: Aetna Commercial	$362.52
Rate for Payer: ASR ASR	$390.72
Rate for Payer: BCBS Trust/PPO	$330.78
Rate for Payer: BCN Commercial	$330.78
Rate for Payer: Cash Price	$322.24
Rate for Payer: Cofinity Commercial	$378.63
Rate for Payer: Encore Health Key Benefits Commercial	$322.24
Rate for Payer: Healthscope Commercial	$390.72
Rate for Payer: Healthscope Whirlpool	$402.80
Rate for Payer: Mclaren Commercial	$362.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$342.38
Rate for Payer: Nomi Health Commercial	$330.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$302.10
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$354.46

URSODIOL 300 MG CAPSULE

Facility

$402.80

Service Code	NDC 42806050301
Hospital Charge Code	11624
Hospital Revenue Code	637
Min. Negotiated Rate	$149.04
Max. Negotiated Rate	$402.80
Rate for Payer: Aetna Commercial	$362.52
Rate for Payer: Aetna Medicare	$149.04
Rate for Payer: ASR ASR	$390.72
Rate for Payer: BCBS Complete	$161.12
Rate for Payer: BCBS Trust/PPO	$332.11
Rate for Payer: BCN Commercial	$332.11
Rate for Payer: Cash Price	$322.24
Rate for Payer: Cofinity Commercial	$378.63
Rate for Payer: Encore Health Key Benefits Commercial	$322.24
Rate for Payer: Healthscope Commercial	$390.72
Rate for Payer: Healthscope Whirlpool	$402.80
Rate for Payer: Mclaren Commercial	$362.52
Rate for Payer: MI Amish Medical Board Commercial	$322.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$342.38
Rate for Payer: Nomi Health Commercial	$330.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$302.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$352.93
Rate for Payer: Priority Health Narrow Network	$282.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$354.46

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC

Facility

$25,207.95

Service Code	MSDRG 742
Min. Negotiated Rate	$14,218.93
Max. Negotiated Rate	$25,207.95
Rate for Payer: Aetna Medicare	$14,967.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,709.12
Rate for Payer: Amish Plain Church Group Commercial	$18,709.12
Rate for Payer: BCBS MAPPO	$14,967.30
Rate for Payer: BCN Medicare Advantage	$14,967.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,967.30
Rate for Payer: Humana Choice PPO Medicare	$14,967.30
Rate for Payer: Mclaren Medicare	$14,967.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,715.67
Rate for Payer: MI Amish Medical Board Commercial	$17,212.40
Rate for Payer: Molina Medicare/Medicaid	$16,464.03
Rate for Payer: PACE Medicare	$14,218.93
Rate for Payer: PACE SWMI	$14,967.30
Rate for Payer: PHP Commercial	$16,464.03
Rate for Payer: PHP Medicare Advantage	$14,967.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$25,207.95
Rate for Payer: Priority Health Medicare	$14,967.30
Rate for Payer: Priority Health Narrow Network	$20,166.36
Rate for Payer: Railroad Medicare Medicare	$14,967.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,967.30
Rate for Payer: UHC Exchange	$23,199.31
Rate for Payer: UHCCP DNSP	$14,967.30
Rate for Payer: VA VA	$14,967.30

UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC

Facility

$17,045.73

Service Code	MSDRG 743
Min. Negotiated Rate	$10,154.60
Max. Negotiated Rate	$17,045.73
Rate for Payer: Aetna Medicare	$10,689.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,361.31
Rate for Payer: Amish Plain Church Group Commercial	$13,361.31
Rate for Payer: BCBS MAPPO	$10,689.05
Rate for Payer: BCN Medicare Advantage	$10,689.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,689.05
Rate for Payer: Humana Choice PPO Medicare	$10,689.05
Rate for Payer: Mclaren Medicare	$10,689.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,223.50
Rate for Payer: MI Amish Medical Board Commercial	$12,292.41
Rate for Payer: Molina Medicare/Medicaid	$11,757.95
Rate for Payer: PACE Medicare	$10,154.60
Rate for Payer: PACE SWMI	$10,689.05
Rate for Payer: PHP Commercial	$11,757.95
Rate for Payer: PHP Medicare Advantage	$10,689.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$17,045.73
Rate for Payer: Priority Health Medicare	$10,689.05
Rate for Payer: Priority Health Narrow Network	$13,636.58
Rate for Payer: Railroad Medicare Medicare	$10,689.05
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,689.05
Rate for Payer: UHC Exchange	$16,568.03
Rate for Payer: UHCCP DNSP	$10,689.05
Rate for Payer: VA VA	$10,689.05

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC

Facility

$24,861.73

Service Code	MSDRG 740
Min. Negotiated Rate	$14,046.55
Max. Negotiated Rate	$24,861.73
Rate for Payer: Aetna Medicare	$14,785.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,482.30
Rate for Payer: Amish Plain Church Group Commercial	$18,482.30
Rate for Payer: BCBS MAPPO	$14,785.84
Rate for Payer: BCN Medicare Advantage	$14,785.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,785.84
Rate for Payer: Humana Choice PPO Medicare	$14,785.84
Rate for Payer: Mclaren Medicare	$14,785.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,525.13
Rate for Payer: MI Amish Medical Board Commercial	$17,003.72
Rate for Payer: Molina Medicare/Medicaid	$16,264.42
Rate for Payer: PACE Medicare	$14,046.55
Rate for Payer: PACE SWMI	$14,785.84
Rate for Payer: PHP Commercial	$16,264.42
Rate for Payer: PHP Medicare Advantage	$14,785.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,861.73
Rate for Payer: Priority Health Medicare	$14,785.84
Rate for Payer: Priority Health Narrow Network	$19,889.39
Rate for Payer: Railroad Medicare Medicare	$14,785.84
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,785.84
Rate for Payer: UHC Exchange	$22,918.05
Rate for Payer: UHCCP DNSP	$14,785.84
Rate for Payer: VA VA	$14,785.84

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC

Facility

$49,223.37

Service Code	MSDRG 739
Min. Negotiated Rate	$26,177.33
Max. Negotiated Rate	$49,223.37
Rate for Payer: Aetna Medicare	$27,555.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,443.85
Rate for Payer: Amish Plain Church Group Commercial	$34,443.85
Rate for Payer: BCBS MAPPO	$27,555.08
Rate for Payer: BCN Medicare Advantage	$27,555.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,555.08
Rate for Payer: Humana Choice PPO Medicare	$27,555.08
Rate for Payer: Mclaren Medicare	$27,555.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,932.83
Rate for Payer: MI Amish Medical Board Commercial	$31,688.34
Rate for Payer: Molina Medicare/Medicaid	$30,310.59
Rate for Payer: PACE Medicare	$26,177.33
Rate for Payer: PACE SWMI	$27,555.08
Rate for Payer: PHP Commercial	$30,310.59
Rate for Payer: PHP Medicare Advantage	$27,555.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$49,223.37
Rate for Payer: Priority Health Medicare	$27,555.08
Rate for Payer: Priority Health Narrow Network	$39,378.70
Rate for Payer: Railroad Medicare Medicare	$27,555.08
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,555.08
Rate for Payer: UHC Exchange	$42,710.37
Rate for Payer: UHCCP DNSP	$27,555.08
Rate for Payer: VA VA	$27,555.08

UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$19,592.90

Service Code	MSDRG 741
Min. Negotiated Rate	$11,422.95
Max. Negotiated Rate	$19,592.90
Rate for Payer: Aetna Medicare	$12,024.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,030.20
Rate for Payer: Amish Plain Church Group Commercial	$15,030.20
Rate for Payer: BCBS MAPPO	$12,024.16
Rate for Payer: BCN Medicare Advantage	$12,024.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,024.16
Rate for Payer: Humana Choice PPO Medicare	$12,024.16
Rate for Payer: Mclaren Medicare	$12,024.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,625.37
Rate for Payer: MI Amish Medical Board Commercial	$13,827.78
Rate for Payer: Molina Medicare/Medicaid	$13,226.58
Rate for Payer: PACE Medicare	$11,422.95
Rate for Payer: PACE SWMI	$12,024.16
Rate for Payer: PHP Commercial	$13,226.58
Rate for Payer: PHP Medicare Advantage	$12,024.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19,592.90
Rate for Payer: Priority Health Medicare	$12,024.16
Rate for Payer: Priority Health Narrow Network	$15,674.32
Rate for Payer: Railroad Medicare Medicare	$12,024.16
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,024.16
Rate for Payer: UHC Exchange	$18,637.45
Rate for Payer: UHCCP DNSP	$12,024.16
Rate for Payer: VA VA	$12,024.16

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC

Facility

$28,310.17

Service Code	MSDRG 737
Min. Negotiated Rate	$15,763.67
Max. Negotiated Rate	$28,310.17
Rate for Payer: Aetna Medicare	$16,593.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,741.67
Rate for Payer: Amish Plain Church Group Commercial	$20,741.67
Rate for Payer: BCBS MAPPO	$16,593.34
Rate for Payer: BCN Medicare Advantage	$16,593.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,593.34
Rate for Payer: Humana Choice PPO Medicare	$16,593.34
Rate for Payer: Mclaren Medicare	$16,593.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17,423.01
Rate for Payer: MI Amish Medical Board Commercial	$19,082.34
Rate for Payer: Molina Medicare/Medicaid	$18,252.67
Rate for Payer: PACE Medicare	$15,763.67
Rate for Payer: PACE SWMI	$16,593.34
Rate for Payer: PHP Commercial	$18,252.67
Rate for Payer: PHP Medicare Advantage	$16,593.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$28,310.17
Rate for Payer: Priority Health Medicare	$16,593.34
Rate for Payer: Priority Health Narrow Network	$22,648.14
Rate for Payer: Railroad Medicare Medicare	$16,593.34
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,593.34
Rate for Payer: UHC Exchange	$25,719.68
Rate for Payer: UHCCP DNSP	$16,593.34
Rate for Payer: VA VA	$16,593.34

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC

Facility

$49,109.34

Service Code	MSDRG 736
Min. Negotiated Rate	$26,120.53
Max. Negotiated Rate	$49,109.34
Rate for Payer: Aetna Medicare	$27,495.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$34,369.12
Rate for Payer: Amish Plain Church Group Commercial	$34,369.12
Rate for Payer: BCBS MAPPO	$27,495.30
Rate for Payer: BCN Medicare Advantage	$27,495.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$27,495.30
Rate for Payer: Humana Choice PPO Medicare	$27,495.30
Rate for Payer: Mclaren Medicare	$27,495.30
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28,870.06
Rate for Payer: MI Amish Medical Board Commercial	$31,619.60
Rate for Payer: Molina Medicare/Medicaid	$30,244.83
Rate for Payer: PACE Medicare	$26,120.53
Rate for Payer: PACE SWMI	$27,495.30
Rate for Payer: PHP Commercial	$30,244.83
Rate for Payer: PHP Medicare Advantage	$27,495.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$49,109.34
Rate for Payer: Priority Health Medicare	$27,495.30
Rate for Payer: Priority Health Narrow Network	$39,287.47
Rate for Payer: Railroad Medicare Medicare	$27,495.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$27,495.30
Rate for Payer: UHC Exchange	$42,617.71
Rate for Payer: UHCCP DNSP	$27,495.30
Rate for Payer: VA VA	$27,495.30

UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC

Facility

$20,175.43

Service Code	MSDRG 738
Min. Negotiated Rate	$11,713.02
Max. Negotiated Rate	$20,175.43
Rate for Payer: Aetna Medicare	$12,329.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,411.86
Rate for Payer: Amish Plain Church Group Commercial	$15,411.86
Rate for Payer: BCBS MAPPO	$12,329.49
Rate for Payer: BCN Medicare Advantage	$12,329.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,329.49
Rate for Payer: Humana Choice PPO Medicare	$12,329.49
Rate for Payer: Mclaren Medicare	$12,329.49
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12,945.96
Rate for Payer: MI Amish Medical Board Commercial	$14,178.91
Rate for Payer: Molina Medicare/Medicaid	$13,562.44
Rate for Payer: PACE Medicare	$11,713.02
Rate for Payer: PACE SWMI	$12,329.49
Rate for Payer: PHP Commercial	$13,562.44
Rate for Payer: PHP Medicare Advantage	$12,329.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$20,175.43
Rate for Payer: Priority Health Medicare	$12,329.49
Rate for Payer: Priority Health Narrow Network	$16,140.34
Rate for Payer: Railroad Medicare Medicare	$12,329.49
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$12,329.49
Rate for Payer: UHC Exchange	$19,110.71
Rate for Payer: UHCCP DNSP	$12,329.49
Rate for Payer: VA VA	$12,329.49

VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC

Facility

$23,865.67

Service Code	MSDRG 746
Min. Negotiated Rate	$13,550.56
Max. Negotiated Rate	$23,865.67
Rate for Payer: Aetna Medicare	$14,263.75
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,829.69
Rate for Payer: Amish Plain Church Group Commercial	$17,829.69
Rate for Payer: BCBS MAPPO	$14,263.75
Rate for Payer: BCN Medicare Advantage	$14,263.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,263.75
Rate for Payer: Humana Choice PPO Medicare	$14,263.75
Rate for Payer: Mclaren Medicare	$14,263.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,976.94
Rate for Payer: MI Amish Medical Board Commercial	$16,403.31
Rate for Payer: Molina Medicare/Medicaid	$15,690.12
Rate for Payer: PACE Medicare	$13,550.56
Rate for Payer: PACE SWMI	$14,263.75
Rate for Payer: PHP Commercial	$15,690.12
Rate for Payer: PHP Medicare Advantage	$14,263.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$23,865.67
Rate for Payer: Priority Health Medicare	$14,263.75
Rate for Payer: Priority Health Narrow Network	$19,092.54
Rate for Payer: Railroad Medicare Medicare	$14,263.75
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,263.75
Rate for Payer: UHC Exchange	$22,108.81
Rate for Payer: UHCCP DNSP	$14,263.75
Rate for Payer: VA VA	$14,263.75

VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC

Facility

$12,315.32

Service Code	MSDRG 747
Min. Negotiated Rate	$7,548.10
Max. Negotiated Rate	$12,315.32
Rate for Payer: Aetna Medicare	$7,945.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,931.71
Rate for Payer: Amish Plain Church Group Commercial	$9,931.71
Rate for Payer: BCBS MAPPO	$7,945.37
Rate for Payer: BCN Medicare Advantage	$7,945.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,945.37
Rate for Payer: Humana Choice PPO Medicare	$7,945.37
Rate for Payer: Mclaren Medicare	$7,945.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,342.64
Rate for Payer: MI Amish Medical Board Commercial	$9,137.18
Rate for Payer: Molina Medicare/Medicaid	$8,739.91
Rate for Payer: PACE Medicare	$7,548.10
Rate for Payer: PACE SWMI	$7,945.37
Rate for Payer: PHP Commercial	$8,739.91
Rate for Payer: PHP Medicare Advantage	$7,945.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$11,811.25
Rate for Payer: Priority Health Medicare	$7,945.37
Rate for Payer: Priority Health Narrow Network	$9,449.00
Rate for Payer: Railroad Medicare Medicare	$7,945.37
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,945.37
Rate for Payer: UHC Exchange	$12,315.32
Rate for Payer: UHCCP DNSP	$7,945.37
Rate for Payer: VA VA	$7,945.37

VAGINAL DELIVERY

Facility

$3,763.42

Service Code	APR-DRG 5603
Min. Negotiated Rate	$3,402.59
Max. Negotiated Rate	$3,763.42
Rate for Payer: BCBS Complete	$3,763.42
Rate for Payer: Mclaren Medicaid	$3,584.21
Rate for Payer: Meridian Medicaid	$3,763.42
Rate for Payer: PHP Medicaid	$3,402.59
Rate for Payer: Priority Health Choice Medicaid	$3,584.21
Rate for Payer: UHC Medicaid	$3,584.21
Rate for Payer: UHCCP Medicaid	$3,584.21

VAGINAL DELIVERY

Facility

$8,555.17

Service Code	APR-DRG 5604
Min. Negotiated Rate	$7,734.90
Max. Negotiated Rate	$8,555.17
Rate for Payer: BCBS Complete	$8,555.17
Rate for Payer: Mclaren Medicaid	$8,147.78
Rate for Payer: Meridian Medicaid	$8,555.17
Rate for Payer: PHP Medicaid	$7,734.90
Rate for Payer: Priority Health Choice Medicaid	$8,147.78
Rate for Payer: UHC Medicaid	$8,147.78
Rate for Payer: UHCCP Medicaid	$8,147.78

VAGINAL DELIVERY

Facility

$2,300.78

Service Code	APR-DRG 5601
Min. Negotiated Rate	$2,080.18
Max. Negotiated Rate	$2,300.78
Rate for Payer: BCBS Complete	$2,300.78
Rate for Payer: Mclaren Medicaid	$2,191.22
Rate for Payer: Meridian Medicaid	$2,300.78
Rate for Payer: PHP Medicaid	$2,080.18
Rate for Payer: Priority Health Choice Medicaid	$2,191.22
Rate for Payer: UHC Medicaid	$2,191.22
Rate for Payer: UHCCP Medicaid	$2,191.22

VAGINAL DELIVERY

Facility

$2,713.85

Service Code	APR-DRG 5602
Min. Negotiated Rate	$2,453.65
Max. Negotiated Rate	$2,713.85
Rate for Payer: BCBS Complete	$2,713.85
Rate for Payer: Mclaren Medicaid	$2,584.62
Rate for Payer: Meridian Medicaid	$2,713.85
Rate for Payer: PHP Medicaid	$2,453.65
Rate for Payer: Priority Health Choice Medicaid	$2,584.62
Rate for Payer: UHC Medicaid	$2,584.62
Rate for Payer: UHCCP Medicaid	$2,584.62

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$11,975.28

Service Code	APR-DRG 5424
Min. Negotiated Rate	$10,827.08
Max. Negotiated Rate	$11,975.28
Rate for Payer: BCBS Complete	$11,975.28
Rate for Payer: Mclaren Medicaid	$11,405.02
Rate for Payer: Meridian Medicaid	$11,975.28
Rate for Payer: PHP Medicaid	$10,827.08
Rate for Payer: Priority Health Choice Medicaid	$11,405.02
Rate for Payer: UHC Medicaid	$11,405.02
Rate for Payer: UHCCP Medicaid	$11,405.02

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$4,436.98

Service Code	APR-DRG 5423
Min. Negotiated Rate	$4,011.56
Max. Negotiated Rate	$4,436.98
Rate for Payer: BCBS Complete	$4,436.98
Rate for Payer: Mclaren Medicaid	$4,225.70
Rate for Payer: Meridian Medicaid	$4,436.98
Rate for Payer: PHP Medicaid	$4,011.56
Rate for Payer: Priority Health Choice Medicaid	$4,225.70
Rate for Payer: UHC Medicaid	$4,225.70
Rate for Payer: UHCCP Medicaid	$4,225.70

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$3,341.63

Service Code	APR-DRG 5422
Min. Negotiated Rate	$3,021.24
Max. Negotiated Rate	$3,341.63
Rate for Payer: BCBS Complete	$3,341.63
Rate for Payer: Mclaren Medicaid	$3,182.51
Rate for Payer: Meridian Medicaid	$3,341.63
Rate for Payer: PHP Medicaid	$3,021.24
Rate for Payer: Priority Health Choice Medicaid	$3,182.51
Rate for Payer: UHC Medicaid	$3,182.51
Rate for Payer: UHCCP Medicaid	$3,182.51

VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C

Facility

$2,723.66

Service Code	APR-DRG 5421
Min. Negotiated Rate	$2,462.51
Max. Negotiated Rate	$2,723.66
Rate for Payer: BCBS Complete	$2,723.66
Rate for Payer: Mclaren Medicaid	$2,593.96
Rate for Payer: Meridian Medicaid	$2,723.66
Rate for Payer: PHP Medicaid	$2,462.51
Rate for Payer: Priority Health Choice Medicaid	$2,593.96
Rate for Payer: UHC Medicaid	$2,593.96
Rate for Payer: UHCCP Medicaid	$2,593.96

VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C

Facility

$14,711.51

Service Code	MSDRG 768
Min. Negotiated Rate	$8,997.74
Max. Negotiated Rate	$14,711.51
Rate for Payer: Aetna Medicare	$9,471.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,839.14
Rate for Payer: Amish Plain Church Group Commercial	$11,839.14
Rate for Payer: BCBS MAPPO	$9,471.31
Rate for Payer: BCN Medicare Advantage	$9,471.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,471.31
Rate for Payer: Humana Choice PPO Medicare	$9,471.31
Rate for Payer: Mclaren Medicare	$9,471.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,944.88
Rate for Payer: MI Amish Medical Board Commercial	$10,892.01
Rate for Payer: Molina Medicare/Medicaid	$10,418.44
Rate for Payer: PACE Medicare	$8,997.74
Rate for Payer: PACE SWMI	$9,471.31
Rate for Payer: PHP Commercial	$10,418.44
Rate for Payer: PHP Medicare Advantage	$9,471.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,711.51
Rate for Payer: Priority Health Medicare	$9,471.31
Rate for Payer: Priority Health Narrow Network	$11,769.21
Rate for Payer: Railroad Medicare Medicare	$9,471.31
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,471.31
Rate for Payer: UHC Exchange	$14,680.53
Rate for Payer: UHCCP DNSP	$9,471.31
Rate for Payer: VA VA	$9,471.31

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC

Facility

$11,135.49

Service Code	MSDRG 806
Min. Negotiated Rate	$4,836.06
Max. Negotiated Rate	$11,135.49
Rate for Payer: Aetna Medicare	$7,184.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,980.24
Rate for Payer: Amish Plain Church Group Commercial	$8,980.24
Rate for Payer: BCBS MAPPO	$7,184.19
Rate for Payer: BCN Medicare Advantage	$7,184.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,184.19
Rate for Payer: Humana Choice PPO Medicare	$7,184.19
Rate for Payer: Mclaren Medicare	$7,184.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,543.40
Rate for Payer: MI Amish Medical Board Commercial	$8,261.82
Rate for Payer: Molina Medicare/Medicaid	$7,902.61
Rate for Payer: PACE Medicare	$6,824.98
Rate for Payer: PACE SWMI	$7,184.19
Rate for Payer: PHP Commercial	$7,902.61
Rate for Payer: PHP Medicare Advantage	$7,184.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$6,045.07
Rate for Payer: Priority Health Medicare	$7,184.19
Rate for Payer: Priority Health Narrow Network	$4,836.06
Rate for Payer: Railroad Medicare Medicare	$7,184.19
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,184.19
Rate for Payer: UHC Exchange	$11,135.49
Rate for Payer: UHCCP DNSP	$7,184.19
Rate for Payer: VA VA	$7,184.19

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC

Facility

$14,765.36

Service Code	MSDRG 805
Min. Negotiated Rate	$6,994.70
Max. Negotiated Rate	$14,765.36
Rate for Payer: Aetna Medicare	$9,526.04
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,907.55
Rate for Payer: Amish Plain Church Group Commercial	$11,907.55
Rate for Payer: BCBS MAPPO	$9,526.04
Rate for Payer: BCN Medicare Advantage	$9,526.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,526.04
Rate for Payer: Humana Choice PPO Medicare	$9,526.04
Rate for Payer: Mclaren Medicare	$9,526.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,002.34
Rate for Payer: MI Amish Medical Board Commercial	$10,954.95
Rate for Payer: Molina Medicare/Medicaid	$10,478.64
Rate for Payer: PACE Medicare	$9,049.74
Rate for Payer: PACE SWMI	$9,526.04
Rate for Payer: PHP Commercial	$10,478.64
Rate for Payer: PHP Medicare Advantage	$9,526.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$8,743.37
Rate for Payer: Priority Health Medicare	$9,526.04
Rate for Payer: Priority Health Narrow Network	$6,994.70
Rate for Payer: Railroad Medicare Medicare	$9,526.04
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,526.04
Rate for Payer: UHC Exchange	$14,765.36
Rate for Payer: UHCCP DNSP	$9,526.04
Rate for Payer: VA VA	$9,526.04

VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC

Facility

$10,244.79

Service Code	MSDRG 807
Min. Negotiated Rate	$4,197.48
Max. Negotiated Rate	$10,244.79
Rate for Payer: Aetna Medicare	$6,609.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,261.92
Rate for Payer: Amish Plain Church Group Commercial	$8,261.92
Rate for Payer: BCBS MAPPO	$6,609.54
Rate for Payer: BCN Medicare Advantage	$6,609.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,609.54
Rate for Payer: Humana Choice PPO Medicare	$6,609.54
Rate for Payer: Mclaren Medicare	$6,609.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,940.02
Rate for Payer: MI Amish Medical Board Commercial	$7,600.97
Rate for Payer: Molina Medicare/Medicaid	$7,270.49
Rate for Payer: PACE Medicare	$6,279.06
Rate for Payer: PACE SWMI	$6,609.54
Rate for Payer: PHP Commercial	$7,270.49
Rate for Payer: PHP Medicare Advantage	$6,609.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$5,246.85
Rate for Payer: Priority Health Medicare	$6,609.54
Rate for Payer: Priority Health Narrow Network	$4,197.48
Rate for Payer: Railroad Medicare Medicare	$6,609.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,609.54
Rate for Payer: UHC Exchange	$10,244.79
Rate for Payer: UHCCP DNSP	$6,609.54
Rate for Payer: VA VA	$6,609.54

VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C

Facility

$5,561.21

Service Code	APR-DRG 5414
Min. Negotiated Rate	$5,028.00
Max. Negotiated Rate	$5,561.21
Rate for Payer: BCBS Complete	$5,561.21
Rate for Payer: Mclaren Medicaid	$5,296.40
Rate for Payer: Meridian Medicaid	$5,561.21
Rate for Payer: PHP Medicaid	$5,028.00
Rate for Payer: Priority Health Choice Medicaid	$5,296.40
Rate for Payer: UHC Medicaid	$5,296.40
Rate for Payer: UHCCP Medicaid	$5,296.40

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