Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$3.03

Service Code	NDC 51079-542-01
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$2.73
Rate for Payer: Aetna American Axle	$1.97
Rate for Payer: Aetna Commercial	$2.58
Rate for Payer: Aetna New Business (MI Preferred)	$1.97
Rate for Payer: BCBS Complete	$1.21
Rate for Payer: Cash Price	$2.42
Rate for Payer: Cofinity Commercial	$2.12
Rate for Payer: Cofinity Commercial	$2.61
Rate for Payer: Encore Health Key Benefits Commercial	$2.42
Rate for Payer: Healthscope Commercial	$2.73
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2.12
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.58
Rate for Payer: PHP Commercial	$2.58
Rate for Payer: Priority Health Cigna Priority Health	$2.12
Rate for Payer: Priority Health SBD	$1.91
Rate for Payer: UMR Bronson Commercial	$1.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.27

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$286.56

Service Code	NDC 50268-685-15
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$126.09
Max. Negotiated Rate	$257.90
Rate for Payer: Aetna American Axle	$186.26
Rate for Payer: Aetna Commercial	$243.58
Rate for Payer: Aetna New Business (MI Preferred)	$186.26
Rate for Payer: Cash Price	$229.25
Rate for Payer: Cofinity Commercial	$200.59
Rate for Payer: Cofinity Commercial	$246.44
Rate for Payer: Encore Health Key Benefits Commercial	$229.25
Rate for Payer: Healthscope Commercial	$257.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$200.59
Rate for Payer: Lakeland Regional Health Systems Commercial	$214.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.58
Rate for Payer: PHP Commercial	$243.58
Rate for Payer: Priority Health Cigna Priority Health	$200.59
Rate for Payer: Priority Health SBD	$180.53
Rate for Payer: UMR Bronson Commercial	$126.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$214.92

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$302.88

Service Code	NDC 51079-542-20
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$133.27
Max. Negotiated Rate	$272.59
Rate for Payer: Aetna American Axle	$196.87
Rate for Payer: Aetna Commercial	$257.45
Rate for Payer: Aetna New Business (MI Preferred)	$196.87
Rate for Payer: Cash Price	$242.30
Rate for Payer: Cofinity Commercial	$212.02
Rate for Payer: Cofinity Commercial	$260.48
Rate for Payer: Encore Health Key Benefits Commercial	$242.30
Rate for Payer: Healthscope Commercial	$272.59
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$212.02
Rate for Payer: Lakeland Regional Health Systems Commercial	$227.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$257.45
Rate for Payer: PHP Commercial	$257.45
Rate for Payer: Priority Health Cigna Priority Health	$212.02
Rate for Payer: Priority Health SBD	$190.81
Rate for Payer: UMR Bronson Commercial	$133.27
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$227.16

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$426.55

Service Code	NDC 0378-5110-01
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$187.68
Max. Negotiated Rate	$383.90
Rate for Payer: Aetna American Axle	$277.26
Rate for Payer: Aetna Commercial	$362.57
Rate for Payer: Aetna New Business (MI Preferred)	$277.26
Rate for Payer: Cash Price	$341.24
Rate for Payer: Cofinity Commercial	$298.58
Rate for Payer: Cofinity Commercial	$366.83
Rate for Payer: Encore Health Key Benefits Commercial	$341.24
Rate for Payer: Healthscope Commercial	$383.90
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$298.58
Rate for Payer: Lakeland Regional Health Systems Commercial	$319.91
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$362.57
Rate for Payer: PHP Commercial	$362.57
Rate for Payer: Priority Health Cigna Priority Health	$298.58
Rate for Payer: Priority Health SBD	$268.73
Rate for Payer: UMR Bronson Commercial	$187.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$319.91

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$462.65

Service Code	NDC 59746-115-06
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$203.57
Max. Negotiated Rate	$416.38
Rate for Payer: Aetna American Axle	$300.72
Rate for Payer: Aetna Commercial	$393.25
Rate for Payer: Aetna New Business (MI Preferred)	$300.72
Rate for Payer: Cash Price	$370.12
Rate for Payer: Cofinity Commercial	$323.86
Rate for Payer: Cofinity Commercial	$397.88
Rate for Payer: Encore Health Key Benefits Commercial	$370.12
Rate for Payer: Healthscope Commercial	$416.38
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$323.86
Rate for Payer: Lakeland Regional Health Systems Commercial	$346.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$393.25
Rate for Payer: PHP Commercial	$393.25
Rate for Payer: Priority Health Cigna Priority Health	$323.86
Rate for Payer: Priority Health SBD	$291.47
Rate for Payer: UMR Bronson Commercial	$203.57
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$346.99

PROCHLORPERAZINE MALEATE 10 MG TABLET

Facility

$217.55

Service Code	NDC 70710-1668-1
Hospital Charge Code	6582
Hospital Revenue Code	637
Min. Negotiated Rate	$95.72
Max. Negotiated Rate	$195.80
Rate for Payer: Aetna American Axle	$141.41
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna New Business (MI Preferred)	$141.41
Rate for Payer: Cash Price	$174.04
Rate for Payer: Cofinity Commercial	$152.28
Rate for Payer: Cofinity Commercial	$187.09
Rate for Payer: Encore Health Key Benefits Commercial	$174.04
Rate for Payer: Healthscope Commercial	$195.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$152.28
Rate for Payer: Lakeland Regional Health Systems Commercial	$163.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$184.92
Rate for Payer: PHP Commercial	$184.92
Rate for Payer: Priority Health Cigna Priority Health	$152.28
Rate for Payer: Priority Health SBD	$137.06
Rate for Payer: UMR Bronson Commercial	$95.72
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$163.16

PROCHLORPERAZINE MALEATE 5 MG TABLET

Facility

$307.80

Service Code	NDC 59746-113-06
Hospital Charge Code	6583
Hospital Revenue Code	637
Min. Negotiated Rate	$135.43
Max. Negotiated Rate	$277.02
Rate for Payer: Aetna American Axle	$200.07
Rate for Payer: Aetna Commercial	$261.63
Rate for Payer: Aetna New Business (MI Preferred)	$200.07
Rate for Payer: Cash Price	$246.24
Rate for Payer: Cofinity Commercial	$215.46
Rate for Payer: Cofinity Commercial	$264.71
Rate for Payer: Encore Health Key Benefits Commercial	$246.24
Rate for Payer: Healthscope Commercial	$277.02
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$215.46
Rate for Payer: Lakeland Regional Health Systems Commercial	$230.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$261.63
Rate for Payer: PHP Commercial	$261.63
Rate for Payer: Priority Health Cigna Priority Health	$215.46
Rate for Payer: Priority Health SBD	$193.91
Rate for Payer: UMR Bronson Commercial	$135.43
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$230.85

PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Facility

$2,557.47

Service Code	CPT 45300
Hospital Revenue Code	360
Min. Negotiated Rate	$47.15
Max. Negotiated Rate	$2,557.47
Rate for Payer: Aetna Medicare	$844.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,015.50
Rate for Payer: Amish Plain Church Group Commercial	$1,015.50
Rate for Payer: BCBS Complete	$466.64
Rate for Payer: BCBS MAPPO	$812.40
Rate for Payer: BCBS Trust/PPO	$116.80
Rate for Payer: BCN Medicare Advantage	$812.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$812.40
Rate for Payer: Mclaren Medicaid	$444.38
Rate for Payer: Mclaren Medicare	$812.40
Rate for Payer: Meridian Medicaid	$466.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$853.02
Rate for Payer: MI Amish Medical Board Commercial	$934.26
Rate for Payer: PACE Medicare	$771.78
Rate for Payer: PACE SWMI	$812.40
Rate for Payer: PHP Medicare Advantage	$812.40
Rate for Payer: Priority Health Choice Medicaid	$444.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,557.47
Rate for Payer: Priority Health Medicare	$812.40
Rate for Payer: Priority Health Narrow Network	$2,045.98
Rate for Payer: Railroad Medicare Medicare	$812.40
Rate for Payer: UHC All Payor (Choice/PPO)	$51.86
Rate for Payer: UHC Core	$981.00
Rate for Payer: UHC Dual Complete DSNP	$812.40
Rate for Payer: UHC Exchange	$47.15
Rate for Payer: UHC Medicare Advantage	$836.77
Rate for Payer: VA VA	$812.40

PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN

Professional

Both

$111.00

Service Code	HCPCS 99241
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$77.70
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: Cash Price	$88.80
Rate for Payer: Priority Health Cigna Priority Health	$77.70
Rate for Payer: UMR Bronson Commercial	$51.06

PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES

Professional

Both

$364.00

Service Code	HCPCS 99245
Min. Negotiated Rate	$114.17
Max. Negotiated Rate	$254.80
Rate for Payer: Aetna Commercial	$196.80
Rate for Payer: BCBS Complete	$119.88
Rate for Payer: BCBS Trust/PPO	$202.34
Rate for Payer: Cash Price	$291.20
Rate for Payer: Cash Price	$291.20
Rate for Payer: Meridian Medicaid	$119.88
Rate for Payer: Priority Health Choice Medicaid	$114.17
Rate for Payer: Priority Health Cigna Priority Health	$254.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$229.16
Rate for Payer: Priority Health Narrow Network	$229.16
Rate for Payer: Priority Health SBD	$229.16
Rate for Payer: UMR Bronson Commercial	$167.44

PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES

Professional

Both

$200.00

Service Code	HCPCS 99243
Min. Negotiated Rate	$55.81
Max. Negotiated Rate	$1,523.62
Rate for Payer: Aetna Commercial	$98.89
Rate for Payer: BCBS Complete	$58.60
Rate for Payer: BCBS Trust/PPO	$1,523.62
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Meridian Medicaid	$58.60
Rate for Payer: Priority Health Choice Medicaid	$55.81
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$112.21
Rate for Payer: Priority Health Narrow Network	$112.21
Rate for Payer: Priority Health SBD	$112.21
Rate for Payer: UMR Bronson Commercial	$92.00

PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES

Professional

Both

$293.00

Service Code	HCPCS 99244
Min. Negotiated Rate	$84.99
Max. Negotiated Rate	$722.19
Rate for Payer: Aetna Commercial	$159.16
Rate for Payer: BCBS Complete	$89.24
Rate for Payer: BCBS Trust/PPO	$722.19
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Meridian Medicaid	$89.24
Rate for Payer: Priority Health Choice Medicaid	$84.99
Rate for Payer: Priority Health Cigna Priority Health	$205.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$171.33
Rate for Payer: Priority Health Narrow Network	$171.33
Rate for Payer: Priority Health SBD	$171.33
Rate for Payer: UMR Bronson Commercial	$134.78

PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES

Professional

Both

$148.00

Service Code	HCPCS 99242
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$158.49
Rate for Payer: Aetna Commercial	$70.73
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCBS Trust/PPO	$158.49
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Meridian Medicaid	$37.13
Rate for Payer: Priority Health Choice Medicaid	$35.36
Rate for Payer: Priority Health Cigna Priority Health	$103.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.10
Rate for Payer: Priority Health Narrow Network	$71.10
Rate for Payer: Priority Health SBD	$71.10
Rate for Payer: UMR Bronson Commercial	$68.08

PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN

Professional

Both

$212.00

Service Code	HCPCS 99215
Min. Negotiated Rate	$97.52
Max. Negotiated Rate	$1,816.82
Rate for Payer: Aetna Commercial	$145.41
Rate for Payer: BCBS Complete	$129.80
Rate for Payer: BCBS Trust/PPO	$1,816.82
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Meridian Medicaid	$129.80
Rate for Payer: Priority Health Choice Medicaid	$123.62
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$147.20
Rate for Payer: Priority Health Narrow Network	$147.20
Rate for Payer: Priority Health SBD	$147.20
Rate for Payer: UMR Bronson Commercial	$97.52

PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN

Professional

Both

$110.00

Service Code	HCPCS 99213
Min. Negotiated Rate	$50.60
Max. Negotiated Rate	$1,305.96
Rate for Payer: Aetna Commercial	$66.92
Rate for Payer: BCBS Complete	$59.30
Rate for Payer: BCBS Trust/PPO	$1,305.96
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Meridian Medicaid	$59.30
Rate for Payer: Priority Health Choice Medicaid	$56.48
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.86
Rate for Payer: Priority Health Narrow Network	$67.86
Rate for Payer: Priority Health SBD	$67.86
Rate for Payer: UMR Bronson Commercial	$50.60

PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN

Professional

Both

$160.00

Service Code	HCPCS 99214
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$1,340.83
Rate for Payer: Aetna Commercial	$98.82
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,340.83
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$100.23
Rate for Payer: Priority Health Narrow Network	$100.23
Rate for Payer: Priority Health SBD	$100.23
Rate for Payer: UMR Bronson Commercial	$73.60

PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN

Professional

Both

$62.00

Service Code	HCPCS 99212
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$2,731.31
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: BCBS Complete	$31.77
Rate for Payer: BCBS Trust/PPO	$2,731.31
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Meridian Medicaid	$31.77
Rate for Payer: Priority Health Choice Medicaid	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$43.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$36.54
Rate for Payer: Priority Health Narrow Network	$36.54
Rate for Payer: Priority Health SBD	$36.54
Rate for Payer: UMR Bronson Commercial	$28.52

PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP

Professional

Both

$40.00

Service Code	HCPCS 99211
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$2,495.16
Rate for Payer: Aetna Commercial	$8.94
Rate for Payer: BCBS Complete	$7.86
Rate for Payer: BCBS Trust/PPO	$2,495.16
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Meridian Medicaid	$7.86
Rate for Payer: Priority Health Choice Medicaid	$7.49
Rate for Payer: Priority Health Cigna Priority Health	$28.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9.05
Rate for Payer: Priority Health Narrow Network	$9.05
Rate for Payer: Priority Health SBD	$9.05
Rate for Payer: UMR Bronson Commercial	$18.40

PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES

Professional

Both

$310.00

Service Code	HCPCS 99205
Min. Negotiated Rate	$142.60
Max. Negotiated Rate	$2,028.67
Rate for Payer: Aetna Commercial	$183.49
Rate for Payer: BCBS Complete	$163.38
Rate for Payer: BCBS Trust/PPO	$2,028.67
Rate for Payer: Cash Price	$248.00
Rate for Payer: Cash Price	$248.00
Rate for Payer: Meridian Medicaid	$163.38
Rate for Payer: Priority Health Choice Medicaid	$155.60
Rate for Payer: Priority Health Cigna Priority Health	$217.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$186.19
Rate for Payer: Priority Health Narrow Network	$186.19
Rate for Payer: Priority Health SBD	$186.19
Rate for Payer: UMR Bronson Commercial	$142.60

PR OFFICE OUTPATIENT NEW LEVL I

Professional

Both

$70.00

Service Code	HCPCS 99201
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$49.00
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Priority Health Cigna Priority Health	$49.00
Rate for Payer: UMR Bronson Commercial	$32.20

PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES

Professional

Both

$160.00

Service Code	HCPCS 99203
Min. Negotiated Rate	$70.31
Max. Negotiated Rate	$931.39
Rate for Payer: Aetna Commercial	$83.07
Rate for Payer: BCBS Complete	$73.83
Rate for Payer: BCBS Trust/PPO	$931.39
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Meridian Medicaid	$73.83
Rate for Payer: Priority Health Choice Medicaid	$70.31
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$85.26
Rate for Payer: Priority Health Narrow Network	$85.26
Rate for Payer: Priority Health SBD	$85.26
Rate for Payer: UMR Bronson Commercial	$73.60

PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES

Professional

Both

$250.00

Service Code	HCPCS 99204
Min. Negotiated Rate	$114.40
Max. Negotiated Rate	$1,704.30
Rate for Payer: Aetna Commercial	$135.20
Rate for Payer: BCBS Complete	$120.12
Rate for Payer: BCBS Trust/PPO	$1,704.30
Rate for Payer: Cash Price	$200.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Meridian Medicaid	$120.12
Rate for Payer: Priority Health Choice Medicaid	$114.40
Rate for Payer: Priority Health Cigna Priority Health	$175.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.12
Rate for Payer: Priority Health Narrow Network	$137.12
Rate for Payer: Priority Health SBD	$137.12
Rate for Payer: UMR Bronson Commercial	$115.00

PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES

Professional

Both

$110.00

Service Code	HCPCS 99202
Min. Negotiated Rate	$40.63
Max. Negotiated Rate	$706.34
Rate for Payer: Aetna Commercial	$49.04
Rate for Payer: BCBS Complete	$42.66
Rate for Payer: BCBS Trust/PPO	$706.34
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Meridian Medicaid	$42.66
Rate for Payer: Priority Health Choice Medicaid	$40.63
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$49.42
Rate for Payer: Priority Health Narrow Network	$49.42
Rate for Payer: Priority Health SBD	$49.42
Rate for Payer: UMR Bronson Commercial	$50.60

PROGESTERONE MICRONIZED 100 MG CAPSULE

Facility

$256.80

Service Code	NDC 17478-766-10
Hospital Charge Code	23122
Hospital Revenue Code	637
Min. Negotiated Rate	$112.99
Max. Negotiated Rate	$231.12
Rate for Payer: Aetna American Axle	$166.92
Rate for Payer: Aetna Commercial	$218.28
Rate for Payer: Aetna New Business (MI Preferred)	$166.92
Rate for Payer: Cash Price	$205.44
Rate for Payer: Cofinity Commercial	$179.76
Rate for Payer: Cofinity Commercial	$220.85
Rate for Payer: Encore Health Key Benefits Commercial	$205.44
Rate for Payer: Healthscope Commercial	$231.12
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$179.76
Rate for Payer: Lakeland Regional Health Systems Commercial	$192.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$218.28
Rate for Payer: PHP Commercial	$218.28
Rate for Payer: Priority Health Cigna Priority Health	$179.76
Rate for Payer: Priority Health SBD	$161.78
Rate for Payer: UMR Bronson Commercial	$112.99
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$192.60

PROGESTERONE MICRONIZED 100 MG CAPSULE

Facility

$437.10

Service Code	NDC 59651-152-01
Hospital Charge Code	23122
Hospital Revenue Code	637
Min. Negotiated Rate	$192.32
Max. Negotiated Rate	$393.39
Rate for Payer: Aetna American Axle	$284.12
Rate for Payer: Aetna Commercial	$371.54
Rate for Payer: Aetna New Business (MI Preferred)	$284.12
Rate for Payer: Cash Price	$349.68
Rate for Payer: Cofinity Commercial	$305.97
Rate for Payer: Cofinity Commercial	$375.91
Rate for Payer: Encore Health Key Benefits Commercial	$349.68
Rate for Payer: Healthscope Commercial	$393.39
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$305.97
Rate for Payer: Lakeland Regional Health Systems Commercial	$327.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$371.54
Rate for Payer: PHP Commercial	$371.54
Rate for Payer: Priority Health Cigna Priority Health	$305.97
Rate for Payer: Priority Health SBD	$275.37
Rate for Payer: UMR Bronson Commercial	$192.32
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$327.82

Know your out-of-pocket cost for care.

All Charges