Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC

Facility

$33,776.84

Service Code	MSDRG 982
Min. Negotiated Rate	$18,485.78
Max. Negotiated Rate	$33,776.84
Rate for Payer: Aetna Medicare	$19,458.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$24,323.40
Rate for Payer: Amish Plain Church Group Commercial	$24,323.40
Rate for Payer: BCBS MAPPO	$19,458.72
Rate for Payer: BCN Medicare Advantage	$19,458.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$19,458.72
Rate for Payer: Humana Choice PPO Medicare	$19,458.72
Rate for Payer: Mclaren Medicare	$19,458.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20,431.66
Rate for Payer: MI Amish Medical Board Commercial	$22,377.53
Rate for Payer: Molina Medicare/Medicaid	$21,404.59
Rate for Payer: PACE Medicare	$18,485.78
Rate for Payer: PACE SWMI	$19,458.72
Rate for Payer: PHP Commercial	$21,404.59
Rate for Payer: PHP Medicare Advantage	$19,458.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$33,776.84
Rate for Payer: Priority Health Medicare	$19,458.72
Rate for Payer: Priority Health Narrow Network	$27,021.47
Rate for Payer: Railroad Medicare Medicare	$19,458.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$19,458.72
Rate for Payer: UHC Exchange	$30,161.02
Rate for Payer: UHCCP DNSP	$19,458.72
Rate for Payer: VA VA	$19,458.72

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC

Facility

$64,459.70

Service Code	MSDRG 981
Min. Negotiated Rate	$33,764.19
Max. Negotiated Rate	$64,459.70
Rate for Payer: Aetna Medicare	$35,541.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$44,426.56
Rate for Payer: Amish Plain Church Group Commercial	$44,426.56
Rate for Payer: BCBS MAPPO	$35,541.25
Rate for Payer: BCN Medicare Advantage	$35,541.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$35,541.25
Rate for Payer: Humana Choice PPO Medicare	$35,541.25
Rate for Payer: Mclaren Medicare	$35,541.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37,318.31
Rate for Payer: MI Amish Medical Board Commercial	$40,872.44
Rate for Payer: Molina Medicare/Medicaid	$39,095.38
Rate for Payer: PACE Medicare	$33,764.19
Rate for Payer: PACE SWMI	$35,541.25
Rate for Payer: PHP Commercial	$39,095.38
Rate for Payer: PHP Medicare Advantage	$35,541.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$64,459.70
Rate for Payer: Priority Health Medicare	$35,541.25
Rate for Payer: Priority Health Narrow Network	$51,567.76
Rate for Payer: Railroad Medicare Medicare	$35,541.25
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$35,541.25
Rate for Payer: UHC Exchange	$55,088.94
Rate for Payer: UHCCP DNSP	$35,541.25
Rate for Payer: VA VA	$35,541.25

EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC

Facility

$23,548.30

Service Code	MSDRG 983
Min. Negotiated Rate	$13,392.52
Max. Negotiated Rate	$23,548.30
Rate for Payer: Aetna Medicare	$14,097.39
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,621.74
Rate for Payer: Amish Plain Church Group Commercial	$17,621.74
Rate for Payer: BCBS MAPPO	$14,097.39
Rate for Payer: BCN Medicare Advantage	$14,097.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,097.39
Rate for Payer: Humana Choice PPO Medicare	$14,097.39
Rate for Payer: Mclaren Medicare	$14,097.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,802.26
Rate for Payer: MI Amish Medical Board Commercial	$16,212.00
Rate for Payer: Molina Medicare/Medicaid	$15,507.13
Rate for Payer: PACE Medicare	$13,392.52
Rate for Payer: PACE SWMI	$14,097.39
Rate for Payer: PHP Commercial	$15,507.13
Rate for Payer: PHP Medicare Advantage	$14,097.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$23,548.30
Rate for Payer: Priority Health Medicare	$14,097.39
Rate for Payer: Priority Health Narrow Network	$18,838.64
Rate for Payer: Railroad Medicare Medicare	$14,097.39
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,097.39
Rate for Payer: UHC Exchange	$21,850.95
Rate for Payer: UHCCP DNSP	$14,097.39
Rate for Payer: VA VA	$14,097.39

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,164.37

Service Code	APR-DRG 9502
Min. Negotiated Rate	$10,998.05
Max. Negotiated Rate	$12,164.37
Rate for Payer: BCBS Complete	$12,164.37
Rate for Payer: Mclaren Medicaid	$11,585.12
Rate for Payer: Meridian Medicaid	$12,164.37
Rate for Payer: PHP Medicaid	$10,998.05
Rate for Payer: Priority Health Choice Medicaid	$11,585.12
Rate for Payer: UHC Medicaid	$11,585.12
Rate for Payer: UHCCP Medicaid	$11,585.12

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$27,800.08

Service Code	APR-DRG 9504
Min. Negotiated Rate	$25,134.60
Max. Negotiated Rate	$27,800.08
Rate for Payer: BCBS Complete	$27,800.08
Rate for Payer: Mclaren Medicaid	$26,476.27
Rate for Payer: Meridian Medicaid	$27,800.08
Rate for Payer: PHP Medicaid	$25,134.60
Rate for Payer: Priority Health Choice Medicaid	$26,476.27
Rate for Payer: UHC Medicaid	$26,476.27
Rate for Payer: UHCCP Medicaid	$26,476.27

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$8,610.21

Service Code	APR-DRG 9501
Min. Negotiated Rate	$7,784.66
Max. Negotiated Rate	$8,610.21
Rate for Payer: BCBS Complete	$8,610.21
Rate for Payer: Mclaren Medicaid	$8,200.20
Rate for Payer: Meridian Medicaid	$8,610.21
Rate for Payer: PHP Medicaid	$7,784.66
Rate for Payer: Priority Health Choice Medicaid	$8,200.20
Rate for Payer: UHC Medicaid	$8,200.20
Rate for Payer: UHCCP Medicaid	$8,200.20

EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$17,532.68

Service Code	APR-DRG 9503
Min. Negotiated Rate	$15,851.64
Max. Negotiated Rate	$17,532.68
Rate for Payer: BCBS Complete	$17,532.68
Rate for Payer: Mclaren Medicaid	$16,697.79
Rate for Payer: Meridian Medicaid	$17,532.68
Rate for Payer: PHP Medicaid	$15,851.64
Rate for Payer: Priority Health Choice Medicaid	$16,697.79
Rate for Payer: UHC Medicaid	$16,697.79
Rate for Payer: UHCCP Medicaid	$16,697.79

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$25,445.90

Service Code	APR-DRG 8434
Min. Negotiated Rate	$23,006.13
Max. Negotiated Rate	$25,445.90
Rate for Payer: BCBS Complete	$25,445.90
Rate for Payer: Mclaren Medicaid	$24,234.19
Rate for Payer: Meridian Medicaid	$25,445.90
Rate for Payer: PHP Medicaid	$23,006.13
Rate for Payer: Priority Health Choice Medicaid	$24,234.19
Rate for Payer: UHC Medicaid	$24,234.19
Rate for Payer: UHCCP Medicaid	$24,234.19

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$5,655.49

Service Code	APR-DRG 8432
Min. Negotiated Rate	$5,113.24
Max. Negotiated Rate	$5,655.49
Rate for Payer: BCBS Complete	$5,655.49
Rate for Payer: Mclaren Medicaid	$5,386.18
Rate for Payer: Meridian Medicaid	$5,655.49
Rate for Payer: PHP Medicaid	$5,113.24
Rate for Payer: Priority Health Choice Medicaid	$5,386.18
Rate for Payer: UHC Medicaid	$5,386.18
Rate for Payer: UHCCP Medicaid	$5,386.18

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$3,688.22

Service Code	APR-DRG 8431
Min. Negotiated Rate	$3,334.59
Max. Negotiated Rate	$3,688.22
Rate for Payer: BCBS Complete	$3,688.22
Rate for Payer: Mclaren Medicaid	$3,512.59
Rate for Payer: Meridian Medicaid	$3,688.22
Rate for Payer: PHP Medicaid	$3,334.59
Rate for Payer: Priority Health Choice Medicaid	$3,512.59
Rate for Payer: UHC Medicaid	$3,512.59
Rate for Payer: UHCCP Medicaid	$3,512.59

EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT

Facility

$16,973.01

Service Code	APR-DRG 8433
Min. Negotiated Rate	$15,345.63
Max. Negotiated Rate	$16,973.01
Rate for Payer: BCBS Complete	$16,973.01
Rate for Payer: Mclaren Medicaid	$16,164.77
Rate for Payer: Meridian Medicaid	$16,973.01
Rate for Payer: PHP Medicaid	$15,345.63
Rate for Payer: Priority Health Choice Medicaid	$16,164.77
Rate for Payer: UHC Medicaid	$16,164.77
Rate for Payer: UHCCP Medicaid	$16,164.77

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$50,728.85

Service Code	APR-DRG 8413
Min. Negotiated Rate	$45,864.95
Max. Negotiated Rate	$50,728.85
Rate for Payer: BCBS Complete	$50,728.85
Rate for Payer: Mclaren Medicaid	$48,313.19
Rate for Payer: Meridian Medicaid	$50,728.85
Rate for Payer: PHP Medicaid	$45,864.95
Rate for Payer: Priority Health Choice Medicaid	$48,313.19
Rate for Payer: UHC Medicaid	$48,313.19
Rate for Payer: UHCCP Medicaid	$48,313.19

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$33,343.86

Service Code	APR-DRG 8412
Min. Negotiated Rate	$30,146.83
Max. Negotiated Rate	$33,343.86
Rate for Payer: BCBS Complete	$33,343.86
Rate for Payer: Mclaren Medicaid	$31,756.05
Rate for Payer: Meridian Medicaid	$33,343.86
Rate for Payer: PHP Medicaid	$30,146.83
Rate for Payer: Priority Health Choice Medicaid	$31,756.05
Rate for Payer: UHC Medicaid	$31,756.05
Rate for Payer: UHCCP Medicaid	$31,756.05

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$139,931.17

Service Code	APR-DRG 8414
Min. Negotiated Rate	$126,514.52
Max. Negotiated Rate	$139,931.17
Rate for Payer: BCBS Complete	$139,931.17
Rate for Payer: Mclaren Medicaid	$133,267.78
Rate for Payer: Meridian Medicaid	$139,931.17
Rate for Payer: PHP Medicaid	$126,514.52
Rate for Payer: Priority Health Choice Medicaid	$133,267.78
Rate for Payer: UHC Medicaid	$133,267.78
Rate for Payer: UHCCP Medicaid	$133,267.78

EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT

Facility

$31,253.43

Service Code	APR-DRG 8411
Min. Negotiated Rate	$28,256.84
Max. Negotiated Rate	$31,253.43
Rate for Payer: BCBS Complete	$31,253.43
Rate for Payer: Mclaren Medicaid	$29,765.17
Rate for Payer: Meridian Medicaid	$31,253.43
Rate for Payer: PHP Medicaid	$28,256.84
Rate for Payer: Priority Health Choice Medicaid	$29,765.17
Rate for Payer: UHC Medicaid	$29,765.17
Rate for Payer: UHCCP Medicaid	$29,765.17

EXTERNAL HEART ASSIST DEVICES

Facility

$24,540.73

Service Code	APR-DRG 1782
Min. Negotiated Rate	$22,187.76
Max. Negotiated Rate	$24,540.73
Rate for Payer: BCBS Complete	$24,540.73
Rate for Payer: Mclaren Medicaid	$23,372.13
Rate for Payer: Meridian Medicaid	$24,540.73
Rate for Payer: PHP Medicaid	$22,187.76
Rate for Payer: Priority Health Choice Medicaid	$23,372.13
Rate for Payer: UHC Medicaid	$23,372.13
Rate for Payer: UHCCP Medicaid	$23,372.13

EXTERNAL HEART ASSIST DEVICES

Facility

$29,962.99

Service Code	APR-DRG 1783
Min. Negotiated Rate	$27,090.12
Max. Negotiated Rate	$29,962.99
Rate for Payer: BCBS Complete	$29,962.99
Rate for Payer: Mclaren Medicaid	$28,536.18
Rate for Payer: Meridian Medicaid	$29,962.99
Rate for Payer: PHP Medicaid	$27,090.12
Rate for Payer: Priority Health Choice Medicaid	$28,536.18
Rate for Payer: UHC Medicaid	$28,536.18
Rate for Payer: UHCCP Medicaid	$28,536.18

EXTERNAL HEART ASSIST DEVICES

Facility

$38,918.15

Service Code	APR-DRG 1784
Min. Negotiated Rate	$35,186.66
Max. Negotiated Rate	$38,918.15
Rate for Payer: BCBS Complete	$38,918.15
Rate for Payer: Mclaren Medicaid	$37,064.90
Rate for Payer: Meridian Medicaid	$38,918.15
Rate for Payer: PHP Medicaid	$35,186.66
Rate for Payer: Priority Health Choice Medicaid	$37,064.90
Rate for Payer: UHC Medicaid	$37,064.90
Rate for Payer: UHCCP Medicaid	$37,064.90

EXTERNAL HEART ASSIST DEVICES

Facility

$22,122.79

Service Code	APR-DRG 1781
Min. Negotiated Rate	$20,001.65
Max. Negotiated Rate	$22,122.79
Rate for Payer: BCBS Complete	$22,122.79
Rate for Payer: Mclaren Medicaid	$21,069.32
Rate for Payer: Meridian Medicaid	$22,122.79
Rate for Payer: PHP Medicaid	$20,001.65
Rate for Payer: Priority Health Choice Medicaid	$21,069.32
Rate for Payer: UHC Medicaid	$21,069.32
Rate for Payer: UHCCP Medicaid	$21,069.32

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$120,816.50

Service Code	APR-DRG 0094
Min. Negotiated Rate	$109,232.58
Max. Negotiated Rate	$120,816.50
Rate for Payer: BCBS Complete	$120,816.50
Rate for Payer: Mclaren Medicaid	$115,063.34
Rate for Payer: Meridian Medicaid	$120,816.50
Rate for Payer: PHP Medicaid	$109,232.58
Rate for Payer: Priority Health Choice Medicaid	$115,063.34
Rate for Payer: UHC Medicaid	$115,063.34
Rate for Payer: UHCCP Medicaid	$115,063.34

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$72,662.54

Service Code	APR-DRG 0093
Min. Negotiated Rate	$65,695.63
Max. Negotiated Rate	$72,662.54
Rate for Payer: BCBS Complete	$72,662.54
Rate for Payer: Mclaren Medicaid	$69,202.42
Rate for Payer: Meridian Medicaid	$72,662.54
Rate for Payer: PHP Medicaid	$65,695.63
Rate for Payer: Priority Health Choice Medicaid	$69,202.42
Rate for Payer: UHC Medicaid	$69,202.42
Rate for Payer: UHCCP Medicaid	$69,202.42

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$33,553.12

Service Code	APR-DRG 0091
Min. Negotiated Rate	$30,336.03
Max. Negotiated Rate	$33,553.12
Rate for Payer: BCBS Complete	$33,553.12
Rate for Payer: Mclaren Medicaid	$31,955.35
Rate for Payer: Meridian Medicaid	$33,553.12
Rate for Payer: PHP Medicaid	$30,336.03
Rate for Payer: Priority Health Choice Medicaid	$31,955.35
Rate for Payer: UHC Medicaid	$31,955.35
Rate for Payer: UHCCP Medicaid	$31,955.35

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)

Facility

$36,145.44

Service Code	APR-DRG 0092
Min. Negotiated Rate	$32,679.81
Max. Negotiated Rate	$36,145.44
Rate for Payer: BCBS Complete	$36,145.44
Rate for Payer: Mclaren Medicaid	$34,424.23
Rate for Payer: Meridian Medicaid	$36,145.44
Rate for Payer: PHP Medicaid	$32,679.81
Rate for Payer: Priority Health Choice Medicaid	$34,424.23
Rate for Payer: UHC Medicaid	$34,424.23
Rate for Payer: UHCCP Medicaid	$34,424.23

EXTRACRANIAL PROCEDURES WITH CC

Facility

$22,292.58

Service Code	MSDRG 038
Min. Negotiated Rate	$12,767.24
Max. Negotiated Rate	$22,292.58
Rate for Payer: Aetna Medicare	$13,439.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,799.00
Rate for Payer: Amish Plain Church Group Commercial	$16,799.00
Rate for Payer: BCBS MAPPO	$13,439.20
Rate for Payer: BCN Medicare Advantage	$13,439.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,439.20
Rate for Payer: Humana Choice PPO Medicare	$13,439.20
Rate for Payer: Mclaren Medicare	$13,439.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,111.16
Rate for Payer: MI Amish Medical Board Commercial	$15,455.08
Rate for Payer: Molina Medicare/Medicaid	$14,783.12
Rate for Payer: PACE Medicare	$12,767.24
Rate for Payer: PACE SWMI	$13,439.20
Rate for Payer: PHP Commercial	$14,783.12
Rate for Payer: PHP Medicare Advantage	$13,439.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22,292.58
Rate for Payer: Priority Health Medicare	$13,439.20
Rate for Payer: Priority Health Narrow Network	$17,834.06
Rate for Payer: Railroad Medicare Medicare	$13,439.20
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,439.20
Rate for Payer: UHC Exchange	$20,830.76
Rate for Payer: UHCCP DNSP	$13,439.20
Rate for Payer: VA VA	$13,439.20

EXTRACRANIAL PROCEDURES WITH MCC

Facility

$45,229.50

Service Code	MSDRG 037
Min. Negotiated Rate	$24,188.59
Max. Negotiated Rate	$45,229.50
Rate for Payer: Aetna Medicare	$25,461.67
Rate for Payer: Allen County Amish Medical Aid Commercial	$31,827.09
Rate for Payer: Amish Plain Church Group Commercial	$31,827.09
Rate for Payer: BCBS MAPPO	$25,461.67
Rate for Payer: BCN Medicare Advantage	$25,461.67
Rate for Payer: Health Alliance Plan Medicare Advantage	$25,461.67
Rate for Payer: Humana Choice PPO Medicare	$25,461.67
Rate for Payer: Mclaren Medicare	$25,461.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$26,734.75
Rate for Payer: MI Amish Medical Board Commercial	$29,280.92
Rate for Payer: Molina Medicare/Medicaid	$28,007.84
Rate for Payer: PACE Medicare	$24,188.59
Rate for Payer: PACE SWMI	$25,461.67
Rate for Payer: PHP Commercial	$28,007.84
Rate for Payer: PHP Medicare Advantage	$25,461.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$45,229.50
Rate for Payer: Priority Health Medicare	$25,461.67
Rate for Payer: Priority Health Narrow Network	$36,183.60
Rate for Payer: Railroad Medicare Medicare	$25,461.67
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$25,461.67
Rate for Payer: UHC Exchange	$39,465.59
Rate for Payer: UHCCP DNSP	$25,461.67
Rate for Payer: VA VA	$25,461.67

Know your out-of-pocket cost for care.

All Charges