Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$28,470.86

Service Code	APR-DRG 0434
Min. Negotiated Rate	$27,115.10
Max. Negotiated Rate	$28,470.86
Rate for Payer: BCBS Complete	$28,470.86
Rate for Payer: Mclaren Medicaid	$27,115.10
Rate for Payer: Meridian Medicaid	$28,470.86
Rate for Payer: Priority Health Choice Medicaid	$27,115.10
Rate for Payer: UHC Medicaid	$27,115.10
Rate for Payer: UHCCP Medicaid	$27,115.10

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$14,072.60

Service Code	APR-DRG 0433
Min. Negotiated Rate	$13,402.47
Max. Negotiated Rate	$14,072.60
Rate for Payer: BCBS Complete	$14,072.60
Rate for Payer: Mclaren Medicaid	$13,402.47
Rate for Payer: Meridian Medicaid	$14,072.60
Rate for Payer: Priority Health Choice Medicaid	$13,402.47
Rate for Payer: UHC Medicaid	$13,402.47
Rate for Payer: UHCCP Medicaid	$13,402.47

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$5,665.84

Service Code	APR-DRG 0432
Min. Negotiated Rate	$5,396.04
Max. Negotiated Rate	$5,665.84
Rate for Payer: BCBS Complete	$5,665.84
Rate for Payer: Mclaren Medicaid	$5,396.04
Rate for Payer: Meridian Medicaid	$5,665.84
Rate for Payer: Priority Health Choice Medicaid	$5,396.04
Rate for Payer: UHC Medicaid	$5,396.04
Rate for Payer: UHCCP Medicaid	$5,396.04

MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES

Facility

$4,688.85

Service Code	APR-DRG 0431
Min. Negotiated Rate	$4,465.57
Max. Negotiated Rate	$4,688.85
Rate for Payer: BCBS Complete	$4,688.85
Rate for Payer: Mclaren Medicaid	$4,465.57
Rate for Payer: Meridian Medicaid	$4,688.85
Rate for Payer: Priority Health Choice Medicaid	$4,465.57
Rate for Payer: UHC Medicaid	$4,465.57
Rate for Payer: UHCCP Medicaid	$4,465.57

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$11,682.77

Service Code	APR-DRG 9303
Min. Negotiated Rate	$11,126.45
Max. Negotiated Rate	$11,682.77
Rate for Payer: BCBS Complete	$11,682.77
Rate for Payer: Mclaren Medicaid	$11,126.45
Rate for Payer: Meridian Medicaid	$11,682.77
Rate for Payer: Priority Health Choice Medicaid	$11,126.45
Rate for Payer: UHC Medicaid	$11,126.45
Rate for Payer: UHCCP Medicaid	$11,126.45

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$5,030.25

Service Code	APR-DRG 9301
Min. Negotiated Rate	$4,790.72
Max. Negotiated Rate	$5,030.25
Rate for Payer: BCBS Complete	$5,030.25
Rate for Payer: Mclaren Medicaid	$4,790.72
Rate for Payer: Meridian Medicaid	$5,030.25
Rate for Payer: Priority Health Choice Medicaid	$4,790.72
Rate for Payer: UHC Medicaid	$4,790.72
Rate for Payer: UHCCP Medicaid	$4,790.72

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$15,748.74

Service Code	APR-DRG 9304
Min. Negotiated Rate	$14,998.80
Max. Negotiated Rate	$15,748.74
Rate for Payer: BCBS Complete	$15,748.74
Rate for Payer: Mclaren Medicaid	$14,998.80
Rate for Payer: Meridian Medicaid	$15,748.74
Rate for Payer: Priority Health Choice Medicaid	$14,998.80
Rate for Payer: UHC Medicaid	$14,998.80
Rate for Payer: UHCCP Medicaid	$14,998.80

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$6,370.44

Service Code	APR-DRG 9302
Min. Negotiated Rate	$6,067.09
Max. Negotiated Rate	$6,370.44
Rate for Payer: BCBS Complete	$6,370.44
Rate for Payer: Mclaren Medicaid	$6,067.09
Rate for Payer: Meridian Medicaid	$6,370.44
Rate for Payer: Priority Health Choice Medicaid	$6,067.09
Rate for Payer: UHC Medicaid	$6,067.09
Rate for Payer: UHCCP Medicaid	$6,067.09

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$301.60

Service Code	NDC 40985022368
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$132.70
Max. Negotiated Rate	$271.44
Rate for Payer: Aetna American Axle	$196.04
Rate for Payer: Aetna Commercial	$256.36
Rate for Payer: Aetna New Business (MI Preferred)	$196.04
Rate for Payer: Cash Price	$241.28
Rate for Payer: Cofinity Advantage	$211.12
Rate for Payer: Cofinity Commercial	$259.38
Rate for Payer: Encore Health Key Benefits Commercial	$241.28
Rate for Payer: Healthscope Commercial	$271.44
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$211.12
Rate for Payer: Lakeland Regional Health Systems Commercial	$226.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$226.20
Rate for Payer: PHP Commercial	$256.36
Rate for Payer: Priority Health SBD	$190.01
Rate for Payer: UMR Bronson Commercial	$132.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$226.20

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$1,240.00

Service Code	NDC 00536466110
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$545.60
Max. Negotiated Rate	$1,116.00
Rate for Payer: Aetna American Axle	$806.00
Rate for Payer: Aetna Commercial	$1,054.00
Rate for Payer: Aetna New Business (MI Preferred)	$806.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: Cofinity Advantage	$868.00
Rate for Payer: Cofinity Commercial	$1,066.40
Rate for Payer: Encore Health Key Benefits Commercial	$992.00
Rate for Payer: Healthscope Commercial	$1,116.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$868.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$930.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,054.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$930.00
Rate for Payer: PHP Commercial	$1,054.00
Rate for Payer: Priority Health SBD	$781.20
Rate for Payer: UMR Bronson Commercial	$545.60
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$930.00

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$301.60

Service Code	NDC 40985022368
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$111.59
Max. Negotiated Rate	$271.44
Rate for Payer: Aetna American Axle	$196.04
Rate for Payer: Aetna Commercial	$256.36
Rate for Payer: Aetna Medicare	$150.80
Rate for Payer: Aetna New Business (MI Preferred)	$196.04
Rate for Payer: BCBS Complete	$120.64
Rate for Payer: Cash Price	$241.28
Rate for Payer: Cofinity Advantage	$211.12
Rate for Payer: Cofinity Commercial	$259.38
Rate for Payer: Encore Health Key Benefits Commercial	$241.28
Rate for Payer: Healthscope Commercial	$271.44
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$211.12
Rate for Payer: Lakeland Regional Health Systems Commercial	$226.20
Rate for Payer: MI Amish Medical Board Commercial	$241.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$256.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$226.20
Rate for Payer: PHP Commercial	$256.36
Rate for Payer: Priority Health SBD	$190.01
Rate for Payer: UHC All Payor (Choice/PPO)	$196.04
Rate for Payer: UHC Core	$157.13
Rate for Payer: UHC Exchange	$118.53
Rate for Payer: UMR Bronson Commercial	$111.59
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$226.20

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$180.00

Service Code	NDC 00904549261
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna American Axle	$117.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Advantage	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$126.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$135.00
Rate for Payer: MI Amish Medical Board Commercial	$144.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health SBD	$113.40
Rate for Payer: UHC All Payor (Choice/PPO)	$117.00
Rate for Payer: UHC Core	$93.78
Rate for Payer: UHC Exchange	$70.74
Rate for Payer: UMR Bronson Commercial	$66.60
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$135.00

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$1,240.00

Service Code	NDC 00536466110
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$458.80
Max. Negotiated Rate	$1,116.00
Rate for Payer: Aetna American Axle	$806.00
Rate for Payer: Aetna Commercial	$1,054.00
Rate for Payer: Aetna Medicare	$620.00
Rate for Payer: Aetna New Business (MI Preferred)	$806.00
Rate for Payer: BCBS Complete	$496.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: Cofinity Advantage	$868.00
Rate for Payer: Cofinity Commercial	$1,066.40
Rate for Payer: Encore Health Key Benefits Commercial	$992.00
Rate for Payer: Healthscope Commercial	$1,116.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$868.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$930.00
Rate for Payer: MI Amish Medical Board Commercial	$992.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,054.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$930.00
Rate for Payer: PHP Commercial	$1,054.00
Rate for Payer: Priority Health SBD	$781.20
Rate for Payer: UHC All Payor (Choice/PPO)	$806.00
Rate for Payer: UHC Core	$646.04
Rate for Payer: UHC Exchange	$487.32
Rate for Payer: UMR Bronson Commercial	$458.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$930.00

MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET

Facility

$180.00

Service Code	NDC 00904549261
Hospital Charge Code	118929
Hospital Revenue Code	637
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna American Axle	$117.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: Aetna New Business (MI Preferred)	$117.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Advantage	$126.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$126.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health SBD	$113.40
Rate for Payer: UMR Bronson Commercial	$79.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$135.00

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$160.00

Service Code	NDC 57896062101
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna American Axle	$104.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$112.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$120.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UMR Bronson Commercial	$70.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$120.00

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$208.00

Service Code	NDC 96295012782
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$76.96
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna American Axle	$135.20
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: BCBS Complete	$83.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Advantage	$145.60
Rate for Payer: Cofinity Commercial	$178.88
Rate for Payer: Encore Health Key Benefits Commercial	$166.40
Rate for Payer: Healthscope Commercial	$187.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$145.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$156.00
Rate for Payer: MI Amish Medical Board Commercial	$166.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00
Rate for Payer: PHP Commercial	$176.80
Rate for Payer: Priority Health SBD	$131.04
Rate for Payer: UHC All Payor (Choice/PPO)	$135.20
Rate for Payer: UHC Core	$108.37
Rate for Payer: UHC Exchange	$81.74
Rate for Payer: UMR Bronson Commercial	$76.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$156.00

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$160.00

Service Code	NDC 57896062101
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna American Axle	$104.00
Rate for Payer: Aetna Commercial	$136.00
Rate for Payer: Aetna Medicare	$80.00
Rate for Payer: Aetna New Business (MI Preferred)	$104.00
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Advantage	$112.00
Rate for Payer: Cofinity Commercial	$137.60
Rate for Payer: Encore Health Key Benefits Commercial	$128.00
Rate for Payer: Healthscope Commercial	$144.00
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$112.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$120.00
Rate for Payer: MI Amish Medical Board Commercial	$128.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$136.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.00
Rate for Payer: PHP Commercial	$136.00
Rate for Payer: Priority Health SBD	$100.80
Rate for Payer: UHC All Payor (Choice/PPO)	$104.00
Rate for Payer: UHC Core	$83.36
Rate for Payer: UHC Exchange	$62.88
Rate for Payer: UMR Bronson Commercial	$59.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$120.00

MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET

Facility

$208.00

Service Code	NDC 96295012782
Hospital Charge Code	196928
Hospital Revenue Code	637
Min. Negotiated Rate	$91.52
Max. Negotiated Rate	$187.20
Rate for Payer: Aetna American Axle	$135.20
Rate for Payer: Aetna Commercial	$176.80
Rate for Payer: Aetna New Business (MI Preferred)	$135.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cofinity Advantage	$145.60
Rate for Payer: Cofinity Commercial	$178.88
Rate for Payer: Encore Health Key Benefits Commercial	$166.40
Rate for Payer: Healthscope Commercial	$187.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$145.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$156.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$176.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00
Rate for Payer: PHP Commercial	$176.80
Rate for Payer: Priority Health SBD	$131.04
Rate for Payer: UMR Bronson Commercial	$91.52
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$156.00

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET

Facility

$204.75

Service Code	NDC 80681000300
Hospital Charge Code	159994
Hospital Revenue Code	637
Min. Negotiated Rate	$90.09
Max. Negotiated Rate	$184.28
Rate for Payer: Aetna American Axle	$133.09
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna New Business (MI Preferred)	$133.09
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cofinity Advantage	$143.32
Rate for Payer: Cofinity Commercial	$176.09
Rate for Payer: Encore Health Key Benefits Commercial	$163.80
Rate for Payer: Healthscope Commercial	$184.28
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$143.32
Rate for Payer: Lakeland Regional Health Systems Commercial	$153.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.56
Rate for Payer: PHP Commercial	$174.04
Rate for Payer: Priority Health SBD	$128.99
Rate for Payer: UMR Bronson Commercial	$90.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$153.56

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET

Facility

$132.00

Service Code	NDC 00904053061
Hospital Charge Code	159994
Hospital Revenue Code	637
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna American Axle	$85.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Advantage	$92.40
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$92.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$99.00
Rate for Payer: MI Amish Medical Board Commercial	$105.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health SBD	$83.16
Rate for Payer: UHC All Payor (Choice/PPO)	$85.80
Rate for Payer: UHC Core	$68.77
Rate for Payer: UHC Exchange	$51.88
Rate for Payer: UMR Bronson Commercial	$48.84
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$99.00

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET

Facility

$204.75

Service Code	NDC 80681000300
Hospital Charge Code	159994
Hospital Revenue Code	637
Min. Negotiated Rate	$75.76
Max. Negotiated Rate	$184.28
Rate for Payer: Aetna American Axle	$133.09
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: Aetna Medicare	$102.38
Rate for Payer: Aetna New Business (MI Preferred)	$133.09
Rate for Payer: BCBS Complete	$81.90
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cofinity Advantage	$143.32
Rate for Payer: Cofinity Commercial	$176.09
Rate for Payer: Encore Health Key Benefits Commercial	$163.80
Rate for Payer: Healthscope Commercial	$184.28
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$143.32
Rate for Payer: Lakeland Regional Health Systems Commercial	$153.56
Rate for Payer: MI Amish Medical Board Commercial	$163.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$174.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.56
Rate for Payer: PHP Commercial	$174.04
Rate for Payer: Priority Health SBD	$128.99
Rate for Payer: UHC All Payor (Choice/PPO)	$133.09
Rate for Payer: UHC Core	$106.67
Rate for Payer: UHC Exchange	$80.47
Rate for Payer: UMR Bronson Commercial	$75.76
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$153.56

MULTIVITAMIN WITH FOLIC ACID 400 MCG TABLET

Facility

$132.00

Service Code	NDC 00904053061
Hospital Charge Code	159994
Hospital Revenue Code	637
Min. Negotiated Rate	$58.08
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna American Axle	$85.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Advantage	$92.40
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$92.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$99.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health SBD	$83.16
Rate for Payer: UMR Bronson Commercial	$58.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$99.00

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$21.95

Service Code	NDC 09900000800
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$9.66
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna American Axle	$14.27
Rate for Payer: Aetna Commercial	$18.66
Rate for Payer: Aetna New Business (MI Preferred)	$14.27
Rate for Payer: Cash Price	$17.56
Rate for Payer: Cofinity Advantage	$15.37
Rate for Payer: Cofinity Commercial	$18.88
Rate for Payer: Encore Health Key Benefits Commercial	$17.56
Rate for Payer: Healthscope Commercial	$19.75
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$15.37
Rate for Payer: Lakeland Regional Health Systems Commercial	$16.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.46
Rate for Payer: PHP Commercial	$18.66
Rate for Payer: Priority Health SBD	$13.83
Rate for Payer: UMR Bronson Commercial	$9.66
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$16.46

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$387.04

Service Code	NDC 00573051330
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$170.30
Max. Negotiated Rate	$348.34
Rate for Payer: Aetna American Axle	$251.58
Rate for Payer: Aetna Commercial	$328.98
Rate for Payer: Aetna New Business (MI Preferred)	$251.58
Rate for Payer: Cash Price	$309.63
Rate for Payer: Cofinity Advantage	$270.93
Rate for Payer: Cofinity Commercial	$332.85
Rate for Payer: Encore Health Key Benefits Commercial	$309.63
Rate for Payer: Healthscope Commercial	$348.34
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$270.93
Rate for Payer: Lakeland Regional Health Systems Commercial	$290.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$328.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$290.28
Rate for Payer: PHP Commercial	$328.98
Rate for Payer: Priority Health SBD	$243.84
Rate for Payer: UMR Bronson Commercial	$170.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$290.28

MULTIVIT AND MINERALS-FERROUS GLUCONATE 9 MG IRON/15 ML ORAL LIQUID

Facility

$387.04

Service Code	NDC 00573051330
Hospital Charge Code	119617
Hospital Revenue Code	637
Min. Negotiated Rate	$143.20
Max. Negotiated Rate	$348.34
Rate for Payer: Aetna American Axle	$251.58
Rate for Payer: Aetna Commercial	$328.98
Rate for Payer: Aetna Medicare	$193.52
Rate for Payer: Aetna New Business (MI Preferred)	$251.58
Rate for Payer: BCBS Complete	$154.82
Rate for Payer: Cash Price	$309.63
Rate for Payer: Cofinity Advantage	$270.93
Rate for Payer: Cofinity Commercial	$332.85
Rate for Payer: Encore Health Key Benefits Commercial	$309.63
Rate for Payer: Healthscope Commercial	$348.34
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$270.93
Rate for Payer: Lakeland Regional Health Systems Commercial	$290.28
Rate for Payer: MI Amish Medical Board Commercial	$309.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$328.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$290.28
Rate for Payer: PHP Commercial	$328.98
Rate for Payer: Priority Health SBD	$243.84
Rate for Payer: UHC All Payor (Choice/PPO)	$251.58
Rate for Payer: UHC Core	$201.65
Rate for Payer: UHC Exchange	$152.11
Rate for Payer: UMR Bronson Commercial	$143.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$290.28

Know your out-of-pocket cost for care.

All Charges