Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$23,179.71

Service Code	APR-DRG 7944
Min. Negotiated Rate	$22,075.91
Max. Negotiated Rate	$23,179.71
Rate for Payer: BCBS Complete	$23,179.71
Rate for Payer: Mclaren Medicaid	$22,075.91
Rate for Payer: Meridian Medicaid	$23,179.71
Rate for Payer: Priority Health Choice Medicaid	$22,075.91
Rate for Payer: UHC Medicaid	$22,075.91
Rate for Payer: UHCCP Medicaid	$22,075.91

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$11,548.39

Service Code	APR-DRG 7943
Min. Negotiated Rate	$10,998.47
Max. Negotiated Rate	$11,548.39
Rate for Payer: BCBS Complete	$11,548.39
Rate for Payer: Mclaren Medicaid	$10,998.47
Rate for Payer: Meridian Medicaid	$11,548.39
Rate for Payer: Priority Health Choice Medicaid	$10,998.47
Rate for Payer: UHC Medicaid	$10,998.47
Rate for Payer: UHCCP Medicaid	$10,998.47

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$8,118.01

Service Code	APR-DRG 7942
Min. Negotiated Rate	$7,731.44
Max. Negotiated Rate	$8,118.01
Rate for Payer: BCBS Complete	$8,118.01
Rate for Payer: Mclaren Medicaid	$7,731.44
Rate for Payer: Meridian Medicaid	$8,118.01
Rate for Payer: Priority Health Choice Medicaid	$7,731.44
Rate for Payer: UHC Medicaid	$7,731.44
Rate for Payer: UHCCP Medicaid	$7,731.44

NON-EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT

Facility

$6,014.51

Service Code	APR-DRG 7941
Min. Negotiated Rate	$5,728.10
Max. Negotiated Rate	$6,014.51
Rate for Payer: BCBS Complete	$6,014.51
Rate for Payer: Mclaren Medicaid	$5,728.10
Rate for Payer: Meridian Medicaid	$6,014.51
Rate for Payer: Priority Health Choice Medicaid	$5,728.10
Rate for Payer: UHC Medicaid	$5,728.10
Rate for Payer: UHCCP Medicaid	$5,728.10

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

Facility

$35,477.67

Service Code	MSDRG 988
Min. Negotiated Rate	$13,621.00
Max. Negotiated Rate	$35,477.67
Rate for Payer: Aetna Medicare	$14,911.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$17,922.38
Rate for Payer: Amish Plain Church Group Commercial	$17,922.38
Rate for Payer: BCBS MAPPO	$14,337.90
Rate for Payer: BCBS Trust/PPO	$35,477.67
Rate for Payer: BCN Commercial	$35,477.67
Rate for Payer: BCN Medicare Advantage	$14,337.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,337.90
Rate for Payer: Mclaren Medicare	$14,337.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,054.80
Rate for Payer: MI Amish Medical Board Commercial	$16,488.58
Rate for Payer: Molina Medicare/Medicaid	$15,771.69
Rate for Payer: Nomi Health Commercial	$21,202.44
Rate for Payer: PACE Medicare	$13,621.00
Rate for Payer: PACE SWMI	$14,337.90
Rate for Payer: PHP Medicare Advantage	$14,337.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$26,498.35
Rate for Payer: Priority Health Medicare	$14,337.90
Rate for Payer: Priority Health Tiered Network	$21,198.68
Rate for Payer: Railroad Medicare Medicare	$14,337.90
Rate for Payer: UHC All Payor (Choice/PPO)	$26,790.68
Rate for Payer: UHC Core	$22,413.77
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,337.90
Rate for Payer: UHC Exchange	$18,304.77
Rate for Payer: VA VA	$14,337.90

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

Facility

$90,958.89

Service Code	MSDRG 987
Min. Negotiated Rate	$27,800.46
Max. Negotiated Rate	$90,958.89
Rate for Payer: Aetna Medicare	$30,434.19
Rate for Payer: Allen County Amish Medical Aid Commercial	$36,579.55
Rate for Payer: Amish Plain Church Group Commercial	$36,579.55
Rate for Payer: BCBS MAPPO	$29,263.64
Rate for Payer: BCBS Trust/PPO	$90,958.89
Rate for Payer: BCN Commercial	$90,958.89
Rate for Payer: BCN Medicare Advantage	$29,263.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$29,263.64
Rate for Payer: Mclaren Medicare	$29,263.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30,726.82
Rate for Payer: MI Amish Medical Board Commercial	$33,653.19
Rate for Payer: Molina Medicare/Medicaid	$32,190.00
Rate for Payer: Nomi Health Commercial	$44,226.36
Rate for Payer: PACE Medicare	$27,800.46
Rate for Payer: PACE SWMI	$29,263.64
Rate for Payer: PHP Medicare Advantage	$29,263.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$55,273.14
Rate for Payer: Priority Health Medicare	$29,263.64
Rate for Payer: Priority Health Tiered Network	$44,218.51
Rate for Payer: Railroad Medicare Medicare	$29,263.64
Rate for Payer: UHC All Payor (Choice/PPO)	$55,882.92
Rate for Payer: UHC Core	$46,753.09
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$29,263.64
Rate for Payer: UHC Exchange	$38,182.09
Rate for Payer: VA VA	$29,263.64

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

Facility

$24,832.17

Service Code	MSDRG 989
Min. Negotiated Rate	$10,090.43
Max. Negotiated Rate	$24,832.17
Rate for Payer: Aetna Medicare	$11,046.37
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,276.89
Rate for Payer: Amish Plain Church Group Commercial	$13,276.89
Rate for Payer: BCBS MAPPO	$10,621.51
Rate for Payer: BCBS Trust/PPO	$24,832.17
Rate for Payer: BCN Commercial	$24,832.17
Rate for Payer: BCN Medicare Advantage	$10,621.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,621.51
Rate for Payer: Mclaren Medicare	$10,621.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11,152.59
Rate for Payer: MI Amish Medical Board Commercial	$12,214.74
Rate for Payer: Molina Medicare/Medicaid	$11,683.66
Rate for Payer: Nomi Health Commercial	$15,469.68
Rate for Payer: PACE Medicare	$10,090.43
Rate for Payer: PACE SWMI	$10,621.51
Rate for Payer: PHP Medicare Advantage	$10,621.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,333.67
Rate for Payer: Priority Health Medicare	$10,621.51
Rate for Payer: Priority Health Tiered Network	$15,466.93
Rate for Payer: Railroad Medicare Medicare	$10,621.51
Rate for Payer: UHC All Payor (Choice/PPO)	$19,546.96
Rate for Payer: UHC Core	$16,353.49
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,621.51
Rate for Payer: UHC Exchange	$13,355.49
Rate for Payer: VA VA	$10,621.51

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$7,068.99

Service Code	APR-DRG 9521
Min. Negotiated Rate	$6,732.37
Max. Negotiated Rate	$7,068.99
Rate for Payer: BCBS Complete	$7,068.99
Rate for Payer: Mclaren Medicaid	$6,732.37
Rate for Payer: Meridian Medicaid	$7,068.99
Rate for Payer: Priority Health Choice Medicaid	$6,732.37
Rate for Payer: UHC Medicaid	$6,732.37
Rate for Payer: UHCCP Medicaid	$6,732.37

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$12,018.12

Service Code	APR-DRG 9523
Min. Negotiated Rate	$11,445.83
Max. Negotiated Rate	$12,018.12
Rate for Payer: BCBS Complete	$12,018.12
Rate for Payer: Mclaren Medicaid	$11,445.83
Rate for Payer: Meridian Medicaid	$12,018.12
Rate for Payer: Priority Health Choice Medicaid	$11,445.83
Rate for Payer: UHC Medicaid	$11,445.83
Rate for Payer: UHCCP Medicaid	$11,445.83

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$21,726.93

Service Code	APR-DRG 9524
Min. Negotiated Rate	$20,692.31
Max. Negotiated Rate	$21,726.93
Rate for Payer: BCBS Complete	$21,726.93
Rate for Payer: Mclaren Medicaid	$20,692.31
Rate for Payer: Meridian Medicaid	$21,726.93
Rate for Payer: Priority Health Choice Medicaid	$20,692.31
Rate for Payer: UHC Medicaid	$20,692.31
Rate for Payer: UHCCP Medicaid	$20,692.31

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$9,210.02

Service Code	APR-DRG 9522
Min. Negotiated Rate	$8,771.45
Max. Negotiated Rate	$9,210.02
Rate for Payer: BCBS Complete	$9,210.02
Rate for Payer: Mclaren Medicaid	$8,771.45
Rate for Payer: Meridian Medicaid	$9,210.02
Rate for Payer: Priority Health Choice Medicaid	$8,771.45
Rate for Payer: UHC Medicaid	$8,771.45
Rate for Payer: UHCCP Medicaid	$8,771.45

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$12,108.32

Service Code	APR-DRG 4264
Min. Negotiated Rate	$11,531.73
Max. Negotiated Rate	$12,108.32
Rate for Payer: BCBS Complete	$12,108.32
Rate for Payer: Mclaren Medicaid	$11,531.73
Rate for Payer: Meridian Medicaid	$12,108.32
Rate for Payer: Priority Health Choice Medicaid	$11,531.73
Rate for Payer: UHC Medicaid	$11,531.73
Rate for Payer: UHCCP Medicaid	$11,531.73

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$4,403.13

Service Code	APR-DRG 4262
Min. Negotiated Rate	$4,193.46
Max. Negotiated Rate	$4,403.13
Rate for Payer: BCBS Complete	$4,403.13
Rate for Payer: Mclaren Medicaid	$4,193.46
Rate for Payer: Meridian Medicaid	$4,403.13
Rate for Payer: Priority Health Choice Medicaid	$4,193.46
Rate for Payer: UHC Medicaid	$4,193.46
Rate for Payer: UHCCP Medicaid	$4,193.46

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$6,887.99

Service Code	APR-DRG 4263
Min. Negotiated Rate	$6,559.99
Max. Negotiated Rate	$6,887.99
Rate for Payer: BCBS Complete	$6,887.99
Rate for Payer: Mclaren Medicaid	$6,559.99
Rate for Payer: Meridian Medicaid	$6,887.99
Rate for Payer: Priority Health Choice Medicaid	$6,559.99
Rate for Payer: UHC Medicaid	$6,559.99
Rate for Payer: UHCCP Medicaid	$6,559.99

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$3,274.20

Service Code	APR-DRG 4261
Min. Negotiated Rate	$3,118.29
Max. Negotiated Rate	$3,274.20
Rate for Payer: BCBS Complete	$3,274.20
Rate for Payer: Mclaren Medicaid	$3,118.29
Rate for Payer: Meridian Medicaid	$3,274.20
Rate for Payer: Priority Health Choice Medicaid	$3,118.29
Rate for Payer: UHC Medicaid	$3,118.29
Rate for Payer: UHCCP Medicaid	$3,118.29

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$16,978.08

Service Code	MSDRG 600
Min. Negotiated Rate	$8,838.37
Max. Negotiated Rate	$16,978.08
Rate for Payer: Aetna Medicare	$9,675.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,629.44
Rate for Payer: Amish Plain Church Group Commercial	$11,629.44
Rate for Payer: BCBS MAPPO	$9,303.55
Rate for Payer: BCBS Trust/PPO	$15,968.25
Rate for Payer: BCN Commercial	$15,968.25
Rate for Payer: BCN Medicare Advantage	$9,303.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,303.55
Rate for Payer: Mclaren Medicare	$9,303.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,768.73
Rate for Payer: MI Amish Medical Board Commercial	$10,699.08
Rate for Payer: Molina Medicare/Medicaid	$10,233.91
Rate for Payer: Nomi Health Commercial	$13,436.64
Rate for Payer: PACE Medicare	$8,838.37
Rate for Payer: PACE SWMI	$9,303.55
Rate for Payer: PHP Medicare Advantage	$9,303.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$16,792.82
Rate for Payer: Priority Health Medicare	$9,303.55
Rate for Payer: Priority Health Tiered Network	$13,434.25
Rate for Payer: Railroad Medicare Medicare	$9,303.55
Rate for Payer: UHC All Payor (Choice/PPO)	$16,978.08
Rate for Payer: UHC Core	$14,204.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,303.55
Rate for Payer: UHC Exchange	$11,600.30
Rate for Payer: VA VA	$9,303.55

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$9,861.50

Service Code	MSDRG 601
Min. Negotiated Rate	$5,369.77
Max. Negotiated Rate	$9,861.50
Rate for Payer: Aetna Medicare	$5,878.49
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,065.49
Rate for Payer: Amish Plain Church Group Commercial	$7,065.49
Rate for Payer: BCBS MAPPO	$5,652.39
Rate for Payer: BCBS Trust/PPO	$8,880.40
Rate for Payer: BCN Commercial	$8,880.40
Rate for Payer: BCN Medicare Advantage	$5,652.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,652.39
Rate for Payer: Mclaren Medicare	$5,652.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,935.01
Rate for Payer: MI Amish Medical Board Commercial	$6,500.25
Rate for Payer: Molina Medicare/Medicaid	$6,217.63
Rate for Payer: Nomi Health Commercial	$7,804.50
Rate for Payer: PACE Medicare	$5,369.77
Rate for Payer: PACE SWMI	$5,652.39
Rate for Payer: PHP Medicare Advantage	$5,652.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$9,753.89
Rate for Payer: Priority Health Medicare	$5,652.39
Rate for Payer: Priority Health Tiered Network	$7,803.11
Rate for Payer: Railroad Medicare Medicare	$5,652.39
Rate for Payer: UHC All Payor (Choice/PPO)	$9,861.50
Rate for Payer: UHC Core	$8,250.39
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,652.39
Rate for Payer: UHC Exchange	$6,737.89
Rate for Payer: VA VA	$5,652.39

NON-SELECTIVE CATHETER PLACEMENT, THORACIC AORTA, WITH ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID, VERTEBRAL, AND/OR INTRACRANIAL VESSELS, UNILATERAL OR BILATERAL, AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAPHY OF THE CERVICOCEREBRAL ARCH, WHEN PERFORMED

Facility

$10,174.29

Service Code	CPT 36221
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.43
Max. Negotiated Rate	$10,174.29
Rate for Payer: Aetna Medicare	$3,271.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,932.66
Rate for Payer: Amish Plain Church Group Commercial	$3,932.66
Rate for Payer: BCBS Complete	$1,727.85
Rate for Payer: BCBS MAPPO	$3,146.13
Rate for Payer: BCBS Trust/PPO	$2,663.55
Rate for Payer: BCN Commercial	$2,663.55
Rate for Payer: BCN Medicare Advantage	$3,146.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,146.13
Rate for Payer: Mclaren Medicaid	$3,146.13
Rate for Payer: Mclaren Medicare	$3,146.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,303.44
Rate for Payer: Meridian Medicaid	$3,303.44
Rate for Payer: MI Amish Medical Board Commercial	$3,618.05
Rate for Payer: Molina Medicare/Medicaid	$3,460.74
Rate for Payer: Nomi Health Commercial	$9,438.39
Rate for Payer: PACE Medicare	$2,988.82
Rate for Payer: PACE SWMI	$3,146.13
Rate for Payer: PHP Medicare Advantage	$3,146.13
Rate for Payer: Priority Health Choice Medicaid	$1,645.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$10,174.29
Rate for Payer: Priority Health Medicare	$3,146.13
Rate for Payer: Priority Health Tiered Network	$8,139.43
Rate for Payer: Railroad Medicare Medicare	$3,146.13
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,146.13
Rate for Payer: UHC Medicaid	$1,645.43
Rate for Payer: UHCCP Medicaid	$1,645.43
Rate for Payer: VA VA	$3,146.13

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$9,457.60

Service Code	APR-DRG 0463
Min. Negotiated Rate	$9,007.24
Max. Negotiated Rate	$9,457.60
Rate for Payer: BCBS Complete	$9,457.60
Rate for Payer: Mclaren Medicaid	$9,007.24
Rate for Payer: Meridian Medicaid	$9,457.60
Rate for Payer: Priority Health Choice Medicaid	$9,007.24
Rate for Payer: UHC Medicaid	$9,007.24
Rate for Payer: UHCCP Medicaid	$9,007.24

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$7,297.80

Service Code	APR-DRG 0462
Min. Negotiated Rate	$6,950.28
Max. Negotiated Rate	$7,297.80
Rate for Payer: BCBS Complete	$7,297.80
Rate for Payer: Mclaren Medicaid	$6,950.28
Rate for Payer: Meridian Medicaid	$7,297.80
Rate for Payer: Priority Health Choice Medicaid	$6,950.28
Rate for Payer: UHC Medicaid	$6,950.28
Rate for Payer: UHCCP Medicaid	$6,950.28

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$16,287.48

Service Code	APR-DRG 0464
Min. Negotiated Rate	$15,511.89
Max. Negotiated Rate	$16,287.48
Rate for Payer: BCBS Complete	$16,287.48
Rate for Payer: Mclaren Medicaid	$15,511.89
Rate for Payer: Meridian Medicaid	$16,287.48
Rate for Payer: Priority Health Choice Medicaid	$15,511.89
Rate for Payer: UHC Medicaid	$15,511.89
Rate for Payer: UHCCP Medicaid	$15,511.89

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$5,914.03

Service Code	APR-DRG 0461
Min. Negotiated Rate	$5,632.40
Max. Negotiated Rate	$5,914.03
Rate for Payer: BCBS Complete	$5,914.03
Rate for Payer: Mclaren Medicaid	$5,632.40
Rate for Payer: Meridian Medicaid	$5,914.03
Rate for Payer: Priority Health Choice Medicaid	$5,632.40
Rate for Payer: UHC Medicaid	$5,632.40
Rate for Payer: UHCCP Medicaid	$5,632.40

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$29,869.43

Service Code	MSDRG 080
Min. Negotiated Rate	$14,942.98
Max. Negotiated Rate	$29,869.43
Rate for Payer: Aetna Medicare	$16,358.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,661.81
Rate for Payer: Amish Plain Church Group Commercial	$19,661.81
Rate for Payer: BCBS MAPPO	$15,729.45
Rate for Payer: BCBS Trust/PPO	$29,869.43
Rate for Payer: BCN Commercial	$29,869.43
Rate for Payer: BCN Medicare Advantage	$15,729.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,729.45
Rate for Payer: Mclaren Medicare	$15,729.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16,515.92
Rate for Payer: MI Amish Medical Board Commercial	$18,088.87
Rate for Payer: Molina Medicare/Medicaid	$17,302.40
Rate for Payer: Nomi Health Commercial	$23,349.00
Rate for Payer: PACE Medicare	$14,942.98
Rate for Payer: PACE SWMI	$15,729.45
Rate for Payer: PHP Medicare Advantage	$15,729.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$29,181.07
Rate for Payer: Priority Health Medicare	$15,729.45
Rate for Payer: Priority Health Tiered Network	$23,344.86
Rate for Payer: Railroad Medicare Medicare	$15,729.45
Rate for Payer: UHC All Payor (Choice/PPO)	$29,503.00
Rate for Payer: UHC Core	$24,682.97
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$15,729.45
Rate for Payer: UHC Exchange	$20,157.97
Rate for Payer: VA VA	$15,729.45

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$25,035.31

Service Code	MSDRG 081
Min. Negotiated Rate	$7,678.46
Max. Negotiated Rate	$25,035.31
Rate for Payer: Aetna Medicare	$8,405.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,103.24
Rate for Payer: Amish Plain Church Group Commercial	$10,103.24
Rate for Payer: BCBS MAPPO	$8,082.59
Rate for Payer: BCBS Trust/PPO	$25,035.31
Rate for Payer: BCN Commercial	$25,035.31
Rate for Payer: BCN Medicare Advantage	$8,082.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,082.59
Rate for Payer: Mclaren Medicare	$8,082.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,486.72
Rate for Payer: MI Amish Medical Board Commercial	$9,294.98
Rate for Payer: Molina Medicare/Medicaid	$8,890.85
Rate for Payer: Nomi Health Commercial	$11,553.24
Rate for Payer: PACE Medicare	$7,678.46
Rate for Payer: PACE SWMI	$8,082.59
Rate for Payer: PHP Medicare Advantage	$8,082.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$14,438.99
Rate for Payer: Priority Health Medicare	$8,082.59
Rate for Payer: Priority Health Tiered Network	$11,551.19
Rate for Payer: Railroad Medicare Medicare	$8,082.59
Rate for Payer: UHC All Payor (Choice/PPO)	$14,598.28
Rate for Payer: UHC Core	$12,213.30
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,082.59
Rate for Payer: UHC Exchange	$9,974.30
Rate for Payer: VA VA	$8,082.59

NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH

Facility

$143.65

Service Code	NDC 00378334016
Hospital Charge Code	32248
Hospital Revenue Code	637
Min. Negotiated Rate	$63.21
Max. Negotiated Rate	$129.28
Rate for Payer: Aetna American Axle	$93.37
Rate for Payer: Aetna Commercial	$122.10
Rate for Payer: Aetna New Business (MI Preferred)	$93.37
Rate for Payer: Cash Price	$114.92
Rate for Payer: Cofinity Advantage	$100.56
Rate for Payer: Cofinity Commercial	$123.54
Rate for Payer: Encore Health Key Benefits Commercial	$114.92
Rate for Payer: Healthscope Commercial	$129.28
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$100.56
Rate for Payer: Lakeland Regional Health Systems Commercial	$107.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$107.74
Rate for Payer: PHP Commercial	$122.10
Rate for Payer: Priority Health SBD	$90.50
Rate for Payer: UMR Bronson Commercial	$63.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$107.74

Know your out-of-pocket cost for care.

All Charges