Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

OSTEOMYELITIS WITHOUT CC/MCC

Facility

$11,508.32

Service Code	MSDRG 541
Min. Negotiated Rate	$7,053.48
Max. Negotiated Rate	$11,508.32
Rate for Payer: Aetna Medicare	$7,424.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,280.90
Rate for Payer: Amish Plain Church Group Commercial	$9,280.90
Rate for Payer: BCBS MAPPO	$7,424.72
Rate for Payer: BCN Medicare Advantage	$7,424.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,424.72
Rate for Payer: Humana Choice PPO Medicare	$7,424.72
Rate for Payer: Mclaren Medicare	$7,424.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,795.96
Rate for Payer: MI Amish Medical Board Commercial	$8,538.43
Rate for Payer: Molina Medicare/Medicaid	$8,167.19
Rate for Payer: PACE Medicare	$7,053.48
Rate for Payer: PACE SWMI	$7,424.72
Rate for Payer: PHP Commercial	$8,167.19
Rate for Payer: PHP Medicare Advantage	$7,424.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$10,817.93
Rate for Payer: Priority Health Medicare	$7,424.72
Rate for Payer: Priority Health Narrow Network	$8,654.34
Rate for Payer: Railroad Medicare Medicare	$7,424.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,424.72
Rate for Payer: UHC Exchange	$11,508.32
Rate for Payer: UHCCP DNSP	$7,424.72
Rate for Payer: VA VA	$7,424.72

OTHER AFTERCARE AND CONVALESCENCE

Facility

$7,277.81

Service Code	APR-DRG 8623
Min. Negotiated Rate	$6,580.01
Max. Negotiated Rate	$7,277.81
Rate for Payer: BCBS Complete	$7,277.81
Rate for Payer: Mclaren Medicaid	$6,931.24
Rate for Payer: Meridian Medicaid	$7,277.81
Rate for Payer: PHP Medicaid	$6,580.01
Rate for Payer: Priority Health Choice Medicaid	$6,931.24
Rate for Payer: UHC Medicaid	$6,931.24
Rate for Payer: UHCCP Medicaid	$6,931.24

OTHER AFTERCARE AND CONVALESCENCE

Facility

$5,197.19

Service Code	APR-DRG 8622
Min. Negotiated Rate	$4,698.88
Max. Negotiated Rate	$5,197.19
Rate for Payer: BCBS Complete	$5,197.19
Rate for Payer: Mclaren Medicaid	$4,949.70
Rate for Payer: Meridian Medicaid	$5,197.19
Rate for Payer: PHP Medicaid	$4,698.88
Rate for Payer: Priority Health Choice Medicaid	$4,949.70
Rate for Payer: UHC Medicaid	$4,949.70
Rate for Payer: UHCCP Medicaid	$4,949.70

OTHER AFTERCARE AND CONVALESCENCE

Facility

$3,708.38

Service Code	APR-DRG 8621
Min. Negotiated Rate	$3,352.82
Max. Negotiated Rate	$3,708.38
Rate for Payer: BCBS Complete	$3,708.38
Rate for Payer: Mclaren Medicaid	$3,531.80
Rate for Payer: Meridian Medicaid	$3,708.38
Rate for Payer: PHP Medicaid	$3,352.82
Rate for Payer: Priority Health Choice Medicaid	$3,531.80
Rate for Payer: UHC Medicaid	$3,531.80
Rate for Payer: UHCCP Medicaid	$3,531.80

OTHER AFTERCARE AND CONVALESCENCE

Facility

$7,980.25

Service Code	APR-DRG 8624
Min. Negotiated Rate	$7,215.10
Max. Negotiated Rate	$7,980.25
Rate for Payer: BCBS Complete	$7,980.25
Rate for Payer: Mclaren Medicaid	$7,600.24
Rate for Payer: Meridian Medicaid	$7,980.25
Rate for Payer: PHP Medicaid	$7,215.10
Rate for Payer: Priority Health Choice Medicaid	$7,600.24
Rate for Payer: UHC Medicaid	$7,600.24
Rate for Payer: UHCCP Medicaid	$7,600.24

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$6,926.86

Service Code	APR-DRG 2533
Min. Negotiated Rate	$6,262.71
Max. Negotiated Rate	$6,926.86
Rate for Payer: BCBS Complete	$6,926.86
Rate for Payer: Mclaren Medicaid	$6,597.01
Rate for Payer: Meridian Medicaid	$6,926.86
Rate for Payer: PHP Medicaid	$6,262.71
Rate for Payer: Priority Health Choice Medicaid	$6,597.01
Rate for Payer: UHC Medicaid	$6,597.01
Rate for Payer: UHCCP Medicaid	$6,597.01

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$9,371.51

Service Code	APR-DRG 2534
Min. Negotiated Rate	$8,472.96
Max. Negotiated Rate	$9,371.51
Rate for Payer: BCBS Complete	$9,371.51
Rate for Payer: Mclaren Medicaid	$8,925.24
Rate for Payer: Meridian Medicaid	$9,371.51
Rate for Payer: PHP Medicaid	$8,472.96
Rate for Payer: Priority Health Choice Medicaid	$8,925.24
Rate for Payer: UHC Medicaid	$8,925.24
Rate for Payer: UHCCP Medicaid	$8,925.24

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$4,808.64

Service Code	APR-DRG 2532
Min. Negotiated Rate	$4,347.58
Max. Negotiated Rate	$4,808.64
Rate for Payer: BCBS Complete	$4,808.64
Rate for Payer: Mclaren Medicaid	$4,579.66
Rate for Payer: Meridian Medicaid	$4,808.64
Rate for Payer: PHP Medicaid	$4,347.58
Rate for Payer: Priority Health Choice Medicaid	$4,579.66
Rate for Payer: UHC Medicaid	$4,579.66
Rate for Payer: UHCCP Medicaid	$4,579.66

OTHER AND UNSPECIFIED GASTROINTESTINAL HEMORRHAGE

Facility

$4,280.58

Service Code	APR-DRG 2531
Min. Negotiated Rate	$3,870.16
Max. Negotiated Rate	$4,280.58
Rate for Payer: BCBS Complete	$4,280.58
Rate for Payer: Mclaren Medicaid	$4,076.74
Rate for Payer: Meridian Medicaid	$4,280.58
Rate for Payer: PHP Medicaid	$3,870.16
Rate for Payer: Priority Health Choice Medicaid	$4,076.74
Rate for Payer: UHC Medicaid	$4,076.74
Rate for Payer: UHCCP Medicaid	$4,076.74

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$6,616.78

Service Code	APR-DRG 6633
Min. Negotiated Rate	$5,982.36
Max. Negotiated Rate	$6,616.78
Rate for Payer: BCBS Complete	$6,616.78
Rate for Payer: Mclaren Medicaid	$6,301.70
Rate for Payer: Meridian Medicaid	$6,616.78
Rate for Payer: PHP Medicaid	$5,982.36
Rate for Payer: Priority Health Choice Medicaid	$6,301.70
Rate for Payer: UHC Medicaid	$6,301.70
Rate for Payer: UHCCP Medicaid	$6,301.70

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$4,506.74

Service Code	APR-DRG 6632
Min. Negotiated Rate	$4,074.63
Max. Negotiated Rate	$4,506.74
Rate for Payer: BCBS Complete	$4,506.74
Rate for Payer: Mclaren Medicaid	$4,292.13
Rate for Payer: Meridian Medicaid	$4,506.74
Rate for Payer: PHP Medicaid	$4,074.63
Rate for Payer: Priority Health Choice Medicaid	$4,292.13
Rate for Payer: UHC Medicaid	$4,292.13
Rate for Payer: UHCCP Medicaid	$4,292.13

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$3,151.99

Service Code	APR-DRG 6631
Min. Negotiated Rate	$2,849.78
Max. Negotiated Rate	$3,151.99
Rate for Payer: BCBS Complete	$3,151.99
Rate for Payer: Mclaren Medicaid	$3,001.90
Rate for Payer: Meridian Medicaid	$3,151.99
Rate for Payer: PHP Medicaid	$2,849.78
Rate for Payer: Priority Health Choice Medicaid	$3,001.90
Rate for Payer: UHC Medicaid	$3,001.90
Rate for Payer: UHCCP Medicaid	$3,001.90

OTHER ANEMIA AND DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS

Facility

$10,862.49

Service Code	APR-DRG 6634
Min. Negotiated Rate	$9,820.99
Max. Negotiated Rate	$10,862.49
Rate for Payer: BCBS Complete	$10,862.49
Rate for Payer: Mclaren Medicaid	$10,345.23
Rate for Payer: Meridian Medicaid	$10,862.49
Rate for Payer: PHP Medicaid	$9,820.99
Rate for Payer: Priority Health Choice Medicaid	$10,345.23
Rate for Payer: UHC Medicaid	$10,345.23
Rate for Payer: UHCCP Medicaid	$10,345.23

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC

Facility

$15,658.32

Service Code	MSDRG 818
Min. Negotiated Rate	$9,597.03
Max. Negotiated Rate	$15,658.32
Rate for Payer: Aetna Medicare	$10,102.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,627.67
Rate for Payer: Amish Plain Church Group Commercial	$12,627.67
Rate for Payer: BCBS MAPPO	$10,102.14
Rate for Payer: BCN Medicare Advantage	$10,102.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,102.14
Rate for Payer: Humana Choice PPO Medicare	$10,102.14
Rate for Payer: Mclaren Medicare	$10,102.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,607.25
Rate for Payer: MI Amish Medical Board Commercial	$11,617.46
Rate for Payer: Molina Medicare/Medicaid	$11,112.35
Rate for Payer: PACE Medicare	$9,597.03
Rate for Payer: PACE SWMI	$10,102.14
Rate for Payer: PHP Commercial	$11,112.35
Rate for Payer: PHP Medicare Advantage	$10,102.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$12,235.78
Rate for Payer: Priority Health Medicare	$10,102.14
Rate for Payer: Priority Health Narrow Network	$9,788.62
Rate for Payer: Railroad Medicare Medicare	$10,102.14
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,102.14
Rate for Payer: UHC Exchange	$15,658.32
Rate for Payer: UHCCP DNSP	$10,102.14
Rate for Payer: VA VA	$10,102.14

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC

Facility

$28,186.46

Service Code	MSDRG 817
Min. Negotiated Rate	$17,275.57
Max. Negotiated Rate	$28,186.46
Rate for Payer: Aetna Medicare	$18,184.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,731.01
Rate for Payer: Amish Plain Church Group Commercial	$22,731.01
Rate for Payer: BCBS MAPPO	$18,184.81
Rate for Payer: BCN Medicare Advantage	$18,184.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$18,184.81
Rate for Payer: Humana Choice PPO Medicare	$18,184.81
Rate for Payer: Mclaren Medicare	$18,184.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19,094.05
Rate for Payer: MI Amish Medical Board Commercial	$20,912.53
Rate for Payer: Molina Medicare/Medicaid	$20,003.29
Rate for Payer: PACE Medicare	$17,275.57
Rate for Payer: PACE SWMI	$18,184.81
Rate for Payer: PHP Commercial	$20,003.29
Rate for Payer: PHP Medicare Advantage	$18,184.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$22,803.66
Rate for Payer: Priority Health Medicare	$18,184.81
Rate for Payer: Priority Health Narrow Network	$18,242.93
Rate for Payer: Railroad Medicare Medicare	$18,184.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$18,184.81
Rate for Payer: UHC Exchange	$28,186.46
Rate for Payer: UHCCP DNSP	$18,184.81
Rate for Payer: VA VA	$18,184.81

OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC

Facility

$12,317.56

Service Code	MSDRG 819
Min. Negotiated Rate	$6,045.07
Max. Negotiated Rate	$12,317.56
Rate for Payer: Aetna Medicare	$7,946.81
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,933.51
Rate for Payer: Amish Plain Church Group Commercial	$9,933.51
Rate for Payer: BCBS MAPPO	$7,946.81
Rate for Payer: BCN Medicare Advantage	$7,946.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,946.81
Rate for Payer: Humana Choice PPO Medicare	$7,946.81
Rate for Payer: Mclaren Medicare	$7,946.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,344.15
Rate for Payer: MI Amish Medical Board Commercial	$9,138.83
Rate for Payer: Molina Medicare/Medicaid	$8,741.49
Rate for Payer: PACE Medicare	$7,549.47
Rate for Payer: PACE SWMI	$7,946.81
Rate for Payer: PHP Commercial	$8,741.49
Rate for Payer: PHP Medicare Advantage	$7,946.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7,556.34
Rate for Payer: Priority Health Medicare	$7,946.81
Rate for Payer: Priority Health Narrow Network	$6,045.07
Rate for Payer: Railroad Medicare Medicare	$7,946.81
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,946.81
Rate for Payer: UHC Exchange	$12,317.56
Rate for Payer: UHCCP DNSP	$7,946.81
Rate for Payer: VA VA	$7,946.81

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC

Facility

$10,773.86

Service Code	MSDRG 832
Min. Negotiated Rate	$5,178.98
Max. Negotiated Rate	$10,773.86
Rate for Payer: Aetna Medicare	$6,950.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,688.60
Rate for Payer: Amish Plain Church Group Commercial	$8,688.60
Rate for Payer: BCBS MAPPO	$6,950.88
Rate for Payer: BCN Medicare Advantage	$6,950.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,950.88
Rate for Payer: Humana Choice PPO Medicare	$6,950.88
Rate for Payer: Mclaren Medicare	$6,950.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,298.42
Rate for Payer: MI Amish Medical Board Commercial	$7,993.51
Rate for Payer: Molina Medicare/Medicaid	$7,645.97
Rate for Payer: PACE Medicare	$6,603.34
Rate for Payer: PACE SWMI	$6,950.88
Rate for Payer: PHP Commercial	$7,645.97
Rate for Payer: PHP Medicare Advantage	$6,950.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$6,473.72
Rate for Payer: Priority Health Medicare	$6,950.88
Rate for Payer: Priority Health Narrow Network	$5,178.98
Rate for Payer: Railroad Medicare Medicare	$6,950.88
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,950.88
Rate for Payer: UHC Exchange	$10,773.86
Rate for Payer: UHCCP DNSP	$6,950.88
Rate for Payer: VA VA	$6,950.88

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC

Facility

$16,141.64

Service Code	MSDRG 831
Min. Negotiated Rate	$7,407.96
Max. Negotiated Rate	$16,141.64
Rate for Payer: Aetna Medicare	$10,413.96
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,017.45
Rate for Payer: Amish Plain Church Group Commercial	$13,017.45
Rate for Payer: BCBS MAPPO	$10,413.96
Rate for Payer: BCN Medicare Advantage	$10,413.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$10,413.96
Rate for Payer: Humana Choice PPO Medicare	$10,413.96
Rate for Payer: Mclaren Medicare	$10,413.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10,934.66
Rate for Payer: MI Amish Medical Board Commercial	$11,976.05
Rate for Payer: Molina Medicare/Medicaid	$11,455.36
Rate for Payer: PACE Medicare	$9,893.26
Rate for Payer: PACE SWMI	$10,413.96
Rate for Payer: PHP Commercial	$11,455.36
Rate for Payer: PHP Medicare Advantage	$10,413.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$9,259.95
Rate for Payer: Priority Health Medicare	$10,413.96
Rate for Payer: Priority Health Narrow Network	$7,407.96
Rate for Payer: Railroad Medicare Medicare	$10,413.96
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$10,413.96
Rate for Payer: UHC Exchange	$16,141.64
Rate for Payer: UHCCP DNSP	$10,413.96
Rate for Payer: VA VA	$10,413.96

OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$8,555.98

Service Code	MSDRG 833
Min. Negotiated Rate	$3,461.08
Max. Negotiated Rate	$8,555.98
Rate for Payer: Aetna Medicare	$5,519.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,899.99
Rate for Payer: Amish Plain Church Group Commercial	$6,899.99
Rate for Payer: BCBS MAPPO	$5,519.99
Rate for Payer: BCN Medicare Advantage	$5,519.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,519.99
Rate for Payer: Humana Choice PPO Medicare	$5,519.99
Rate for Payer: Mclaren Medicare	$5,519.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,795.99
Rate for Payer: MI Amish Medical Board Commercial	$6,347.99
Rate for Payer: Molina Medicare/Medicaid	$6,071.99
Rate for Payer: PACE Medicare	$5,243.99
Rate for Payer: PACE SWMI	$5,519.99
Rate for Payer: PHP Commercial	$6,071.99
Rate for Payer: PHP Medicare Advantage	$5,519.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$4,326.35
Rate for Payer: Priority Health Medicare	$5,519.99
Rate for Payer: Priority Health Narrow Network	$3,461.08
Rate for Payer: Railroad Medicare Medicare	$5,519.99
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,519.99
Rate for Payer: UHC Exchange	$8,555.98
Rate for Payer: UHCCP DNSP	$5,519.99
Rate for Payer: VA VA	$5,519.99

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$7,628.21

Service Code	APR-DRG 3473
Min. Negotiated Rate	$6,896.81
Max. Negotiated Rate	$7,628.21
Rate for Payer: BCBS Complete	$7,628.21
Rate for Payer: Mclaren Medicaid	$7,264.96
Rate for Payer: Meridian Medicaid	$7,628.21
Rate for Payer: PHP Medicaid	$6,896.81
Rate for Payer: Priority Health Choice Medicaid	$7,264.96
Rate for Payer: UHC Medicaid	$7,264.96
Rate for Payer: UHCCP Medicaid	$7,264.96

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$5,054.41

Service Code	APR-DRG 3471
Min. Negotiated Rate	$4,569.79
Max. Negotiated Rate	$5,054.41
Rate for Payer: BCBS Complete	$5,054.41
Rate for Payer: Mclaren Medicaid	$4,813.73
Rate for Payer: Meridian Medicaid	$5,054.41
Rate for Payer: PHP Medicaid	$4,569.79
Rate for Payer: Priority Health Choice Medicaid	$4,813.73
Rate for Payer: UHC Medicaid	$4,813.73
Rate for Payer: UHCCP Medicaid	$4,813.73

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$5,895.81

Service Code	APR-DRG 3472
Min. Negotiated Rate	$5,330.52
Max. Negotiated Rate	$5,895.81
Rate for Payer: BCBS Complete	$5,895.81
Rate for Payer: Mclaren Medicaid	$5,615.06
Rate for Payer: Meridian Medicaid	$5,895.81
Rate for Payer: PHP Medicaid	$5,330.52
Rate for Payer: Priority Health Choice Medicaid	$5,615.06
Rate for Payer: UHC Medicaid	$5,615.06
Rate for Payer: UHCCP Medicaid	$5,615.06

OTHER BACK AND NECK DISORDERS, FRACTURES AND INJURIES

Facility

$9,764.96

Service Code	APR-DRG 3474
Min. Negotiated Rate	$8,828.69
Max. Negotiated Rate	$9,764.96
Rate for Payer: BCBS Complete	$9,764.96
Rate for Payer: Mclaren Medicaid	$9,299.96
Rate for Payer: Meridian Medicaid	$9,764.96
Rate for Payer: PHP Medicaid	$8,828.69
Rate for Payer: Priority Health Choice Medicaid	$9,299.96
Rate for Payer: UHC Medicaid	$9,299.96
Rate for Payer: UHCCP Medicaid	$9,299.96

OTHER BLADDER PROCEDURES

Facility

$7,987.88

Service Code	APR-DRG 4451
Min. Negotiated Rate	$7,222.00
Max. Negotiated Rate	$7,987.88
Rate for Payer: BCBS Complete	$7,987.88
Rate for Payer: Mclaren Medicaid	$7,607.50
Rate for Payer: Meridian Medicaid	$7,987.88
Rate for Payer: PHP Medicaid	$7,222.00
Rate for Payer: Priority Health Choice Medicaid	$7,607.50
Rate for Payer: UHC Medicaid	$7,607.50
Rate for Payer: UHCCP Medicaid	$7,607.50

OTHER BLADDER PROCEDURES

Facility

$11,178.56

Service Code	APR-DRG 4453
Min. Negotiated Rate	$10,106.76
Max. Negotiated Rate	$11,178.56
Rate for Payer: BCBS Complete	$11,178.56
Rate for Payer: Mclaren Medicaid	$10,646.25
Rate for Payer: Meridian Medicaid	$11,178.56
Rate for Payer: PHP Medicaid	$10,106.76
Rate for Payer: Priority Health Choice Medicaid	$10,646.25
Rate for Payer: UHC Medicaid	$10,646.25
Rate for Payer: UHCCP Medicaid	$10,646.25

Know your out-of-pocket cost for care.

All Charges