Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TAMSULOSIN 0.4 MG CAPSULE

Facility

$2.52

Service Code	NDC 50268074011
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare	$1.26
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: BCBS Complete	$1.01
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health Cigna Priority Health	$1.64
Rate for Payer: Priority Health SBD	$1.59

TAMSULOSIN 0.4 MG CAPSULE

Facility

$230.85

Service Code	NDC 68084029901
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$92.34
Max. Negotiated Rate	$207.76
Rate for Payer: Aetna Commercial	$196.22
Rate for Payer: Aetna Medicare	$115.42
Rate for Payer: Aetna New Business (MI Preferred)	$150.05
Rate for Payer: BCBS Complete	$92.34
Rate for Payer: Cash Price	$184.68
Rate for Payer: Cofinity Commercial	$161.59
Rate for Payer: Cofinity Commercial	$198.53
Rate for Payer: Cofinity Medicare Advantage	$161.59
Rate for Payer: Encore Health Key Benefits Commercial	$184.68
Rate for Payer: Healthscope Commercial	$207.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$196.22
Rate for Payer: PHP Commercial	$196.22
Rate for Payer: Priority Health Cigna Priority Health	$150.05
Rate for Payer: Priority Health SBD	$145.44

TAMSULOSIN 0.4 MG CAPSULE

Facility

$288.80

Service Code	NDC 51079029420
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$181.94
Max. Negotiated Rate	$259.92
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna New Business (MI Preferred)	$187.72
Rate for Payer: Cash Price	$231.04
Rate for Payer: Cofinity Commercial	$202.16
Rate for Payer: Cofinity Commercial	$248.37
Rate for Payer: Cofinity Medicare Advantage	$202.16
Rate for Payer: Encore Health Key Benefits Commercial	$231.04
Rate for Payer: Healthscope Commercial	$259.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.48
Rate for Payer: PHP Commercial	$245.48
Rate for Payer: Priority Health Cigna Priority Health	$187.72
Rate for Payer: Priority Health SBD	$181.94

TAMSULOSIN 0.4 MG CAPSULE

Facility

$304.00

Service Code	NDC 63739056710
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna New Business (MI Preferred)	$197.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cofinity Commercial	$212.80
Rate for Payer: Cofinity Commercial	$261.44
Rate for Payer: Cofinity Medicare Advantage	$212.80
Rate for Payer: Encore Health Key Benefits Commercial	$243.20
Rate for Payer: Healthscope Commercial	$273.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.40
Rate for Payer: PHP Commercial	$258.40
Rate for Payer: Priority Health Cigna Priority Health	$197.60
Rate for Payer: Priority Health SBD	$191.52

TAMSULOSIN 0.4 MG CAPSULE

Facility

$288.80

Service Code	NDC 51079029420
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$115.52
Max. Negotiated Rate	$259.92
Rate for Payer: Aetna Commercial	$245.48
Rate for Payer: Aetna Medicare	$144.40
Rate for Payer: Aetna New Business (MI Preferred)	$187.72
Rate for Payer: BCBS Complete	$115.52
Rate for Payer: Cash Price	$231.04
Rate for Payer: Cofinity Commercial	$202.16
Rate for Payer: Cofinity Commercial	$248.37
Rate for Payer: Cofinity Medicare Advantage	$202.16
Rate for Payer: Encore Health Key Benefits Commercial	$231.04
Rate for Payer: Healthscope Commercial	$259.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$245.48
Rate for Payer: PHP Commercial	$245.48
Rate for Payer: Priority Health Cigna Priority Health	$187.72
Rate for Payer: Priority Health SBD	$181.94

TAMSULOSIN 0.4 MG CAPSULE

Facility

$192.85

Service Code	NDC 00904640161
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$77.14
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna Medicare	$96.42
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: BCBS Complete	$77.14
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Commercial	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Cofinity Medicare Advantage	$135.00
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$125.35
Rate for Payer: Priority Health SBD	$121.50

TAMSULOSIN 0.4 MG CAPSULE

Facility

$166.85

Service Code	NDC 65862059801
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$105.12
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Commercial	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Cofinity Medicare Advantage	$116.80
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health Cigna Priority Health	$108.45
Rate for Payer: Priority Health SBD	$105.12

TAMSULOSIN 0.4 MG CAPSULE

Facility

$304.00

Service Code	NDC 63739056710
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$121.60
Max. Negotiated Rate	$273.60
Rate for Payer: Aetna Commercial	$258.40
Rate for Payer: Aetna Medicare	$152.00
Rate for Payer: Aetna New Business (MI Preferred)	$197.60
Rate for Payer: BCBS Complete	$121.60
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cofinity Commercial	$212.80
Rate for Payer: Cofinity Commercial	$261.44
Rate for Payer: Cofinity Medicare Advantage	$212.80
Rate for Payer: Encore Health Key Benefits Commercial	$243.20
Rate for Payer: Healthscope Commercial	$273.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$258.40
Rate for Payer: PHP Commercial	$258.40
Rate for Payer: Priority Health Cigna Priority Health	$197.60
Rate for Payer: Priority Health SBD	$191.52

TAMSULOSIN 0.4 MG CAPSULE

Facility

$262.26

Service Code	NDC 62756016081
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$165.22
Max. Negotiated Rate	$236.03
Rate for Payer: Aetna Commercial	$222.92
Rate for Payer: Aetna New Business (MI Preferred)	$170.47
Rate for Payer: Cash Price	$209.81
Rate for Payer: Cofinity Commercial	$183.58
Rate for Payer: Cofinity Commercial	$225.54
Rate for Payer: Cofinity Medicare Advantage	$183.58
Rate for Payer: Encore Health Key Benefits Commercial	$209.81
Rate for Payer: Healthscope Commercial	$236.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.92
Rate for Payer: PHP Commercial	$222.92
Rate for Payer: Priority Health Cigna Priority Health	$170.47
Rate for Payer: Priority Health SBD	$165.22

TAMSULOSIN 0.4 MG CAPSULE

Facility

$125.88

Service Code	NDC 50268074015
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$113.29
Rate for Payer: Aetna Commercial	$107.00
Rate for Payer: Aetna New Business (MI Preferred)	$81.82
Rate for Payer: Cash Price	$100.70
Rate for Payer: Cofinity Commercial	$108.26
Rate for Payer: Cofinity Commercial	$88.12
Rate for Payer: Cofinity Medicare Advantage	$88.12
Rate for Payer: Encore Health Key Benefits Commercial	$100.70
Rate for Payer: Healthscope Commercial	$113.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.00
Rate for Payer: PHP Commercial	$107.00
Rate for Payer: Priority Health Cigna Priority Health	$81.82
Rate for Payer: Priority Health SBD	$79.30

TAMSULOSIN 0.4 MG CAPSULE

Facility

$2.52

Service Code	NDC 50268074011
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$2.27
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna New Business (MI Preferred)	$1.64
Rate for Payer: Cash Price	$2.02
Rate for Payer: Cofinity Commercial	$1.76
Rate for Payer: Cofinity Commercial	$2.17
Rate for Payer: Cofinity Medicare Advantage	$1.76
Rate for Payer: Encore Health Key Benefits Commercial	$2.02
Rate for Payer: Healthscope Commercial	$2.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.14
Rate for Payer: PHP Commercial	$2.14
Rate for Payer: Priority Health Cigna Priority Health	$1.64
Rate for Payer: Priority Health SBD	$1.59

TAMSULOSIN 0.4 MG CAPSULE

Facility

$451.25

Service Code	NDC 00228299611
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$284.29
Max. Negotiated Rate	$406.12
Rate for Payer: Aetna Commercial	$383.56
Rate for Payer: Aetna New Business (MI Preferred)	$293.31
Rate for Payer: Cash Price	$361.00
Rate for Payer: Cofinity Commercial	$315.88
Rate for Payer: Cofinity Commercial	$388.07
Rate for Payer: Cofinity Medicare Advantage	$315.88
Rate for Payer: Encore Health Key Benefits Commercial	$361.00
Rate for Payer: Healthscope Commercial	$406.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.56
Rate for Payer: PHP Commercial	$383.56
Rate for Payer: Priority Health Cigna Priority Health	$293.31
Rate for Payer: Priority Health SBD	$284.29

TAMSULOSIN 0.4 MG CAPSULE

Facility

$192.85

Service Code	NDC 00904640161
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$121.50
Max. Negotiated Rate	$173.56
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna New Business (MI Preferred)	$125.35
Rate for Payer: Cash Price	$154.28
Rate for Payer: Cofinity Commercial	$135.00
Rate for Payer: Cofinity Commercial	$165.85
Rate for Payer: Cofinity Medicare Advantage	$135.00
Rate for Payer: Encore Health Key Benefits Commercial	$154.28
Rate for Payer: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$125.35
Rate for Payer: Priority Health SBD	$121.50

TAMSULOSIN 0.4 MG CAPSULE

Facility

$166.85

Service Code	NDC 65862059801
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$66.74
Max. Negotiated Rate	$150.16
Rate for Payer: Aetna Commercial	$141.82
Rate for Payer: Aetna Medicare	$83.42
Rate for Payer: Aetna New Business (MI Preferred)	$108.45
Rate for Payer: BCBS Complete	$66.74
Rate for Payer: Cash Price	$133.48
Rate for Payer: Cofinity Commercial	$116.80
Rate for Payer: Cofinity Commercial	$143.49
Rate for Payer: Cofinity Medicare Advantage	$116.80
Rate for Payer: Encore Health Key Benefits Commercial	$133.48
Rate for Payer: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$141.82
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health Cigna Priority Health	$108.45
Rate for Payer: Priority Health SBD	$105.12

TAMSULOSIN 0.4 MG CAPSULE

Facility

$230.85

Service Code	NDC 68084029901
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$145.44
Max. Negotiated Rate	$207.76
Rate for Payer: Aetna Commercial	$196.22
Rate for Payer: Aetna New Business (MI Preferred)	$150.05
Rate for Payer: Cash Price	$184.68
Rate for Payer: Cofinity Commercial	$161.59
Rate for Payer: Cofinity Commercial	$198.53
Rate for Payer: Cofinity Medicare Advantage	$161.59
Rate for Payer: Encore Health Key Benefits Commercial	$184.68
Rate for Payer: Healthscope Commercial	$207.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$196.22
Rate for Payer: PHP Commercial	$196.22
Rate for Payer: Priority Health Cigna Priority Health	$150.05
Rate for Payer: Priority Health SBD	$145.44

TAMSULOSIN 0.4 MG CAPSULE

Facility

$2.31

Service Code	NDC 68084029911
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$2.08
Rate for Payer: Aetna Commercial	$1.96
Rate for Payer: Aetna New Business (MI Preferred)	$1.50
Rate for Payer: Cash Price	$1.85
Rate for Payer: Cofinity Commercial	$1.62
Rate for Payer: Cofinity Commercial	$1.99
Rate for Payer: Cofinity Medicare Advantage	$1.62
Rate for Payer: Encore Health Key Benefits Commercial	$1.85
Rate for Payer: Healthscope Commercial	$2.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.96
Rate for Payer: PHP Commercial	$1.96
Rate for Payer: Priority Health Cigna Priority Health	$1.50
Rate for Payer: Priority Health SBD	$1.46

TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE

Facility

$911.49

Service Code	HCPCS J1447
Hospital Charge Code	168856
Hospital Revenue Code	636
Min. Negotiated Rate	$574.24
Max. Negotiated Rate	$820.34
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna New Business (MI Preferred)	$592.47
Rate for Payer: Aetna New Business (MI Preferred)	$592.48
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cash Price	$729.20
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Commercial	$638.05
Rate for Payer: Cofinity Commercial	$783.89
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Cofinity Medicare Advantage	$638.05
Rate for Payer: Cofinity Medicare Advantage	$638.04
Rate for Payer: Encore Health Key Benefits Commercial	$729.19
Rate for Payer: Encore Health Key Benefits Commercial	$729.20
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Healthscope Commercial	$820.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: Priority Health Cigna Priority Health	$592.48
Rate for Payer: Priority Health Cigna Priority Health	$592.47
Rate for Payer: Priority Health SBD	$574.24
Rate for Payer: Priority Health SBD	$574.25

TBO-FILGRASTIM 480 MCG/0.8 ML SUBCUTANEOUS SYRINGE

Facility

$911.50

Service Code	HCPCS J1447
Hospital Charge Code	168856
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$820.35
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna Medicare	$0.29
Rate for Payer: Aetna Medicare	$0.29
Rate for Payer: Aetna New Business (MI Preferred)	$592.48
Rate for Payer: Aetna New Business (MI Preferred)	$592.47
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.35
Rate for Payer: Amish Plain Church Group Commercial	$0.35
Rate for Payer: Amish Plain Church Group Commercial	$0.35
Rate for Payer: BCBS Complete	$0.16
Rate for Payer: BCBS Complete	$0.16
Rate for Payer: BCBS MAPPO	$0.28
Rate for Payer: BCBS MAPPO	$0.28
Rate for Payer: BCN Medicare Advantage	$0.28
Rate for Payer: BCN Medicare Advantage	$0.28
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cash Price	$729.20
Rate for Payer: Cash Price	$729.20
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Cofinity Commercial	$783.89
Rate for Payer: Cofinity Commercial	$638.05
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Medicare Advantage	$638.04
Rate for Payer: Cofinity Medicare Advantage	$638.05
Rate for Payer: Encore Health Key Benefits Commercial	$729.19
Rate for Payer: Encore Health Key Benefits Commercial	$729.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.28
Rate for Payer: Healthscope Commercial	$820.35
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Mclaren Medicaid	$0.15
Rate for Payer: Mclaren Medicaid	$0.15
Rate for Payer: Mclaren Medicare	$0.28
Rate for Payer: Mclaren Medicare	$0.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.29
Rate for Payer: Meridian Medicaid	$0.16
Rate for Payer: Meridian Medicaid	$0.16
Rate for Payer: MI Amish Medical Board Commercial	$0.32
Rate for Payer: MI Amish Medical Board Commercial	$0.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$774.77
Rate for Payer: PACE Medicare	$0.27
Rate for Payer: PACE Medicare	$0.27
Rate for Payer: PACE SWMI	$0.28
Rate for Payer: PACE SWMI	$0.28
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: PHP Medicare Advantage	$0.28
Rate for Payer: PHP Medicare Advantage	$0.28
Rate for Payer: Priority Health Choice Medicaid	$0.15
Rate for Payer: Priority Health Choice Medicaid	$0.15
Rate for Payer: Priority Health Cigna Priority Health	$592.48
Rate for Payer: Priority Health Cigna Priority Health	$592.47
Rate for Payer: Priority Health Medicare	$0.28
Rate for Payer: Priority Health Medicare	$0.28
Rate for Payer: Priority Health SBD	$574.24
Rate for Payer: Priority Health SBD	$574.25
Rate for Payer: Railroad Medicare Medicare	$0.28
Rate for Payer: Railroad Medicare Medicare	$0.28
Rate for Payer: UHC All Payor (Choice/PPO)	$0.79
Rate for Payer: UHC All Payor (Choice/PPO)	$0.79
Rate for Payer: UHC Dual Complete DSNP	$0.28
Rate for Payer: UHC Dual Complete DSNP	$0.28
Rate for Payer: UHC Medicare Advantage	$0.28
Rate for Payer: UHC Medicare Advantage	$0.28
Rate for Payer: UHCCP Medicaid	$0.16
Rate for Payer: UHCCP Medicaid	$0.16
Rate for Payer: VA VA	$0.28
Rate for Payer: VA VA	$0.28

TEMAZEPAM 7.5 MG CAPSULE

Facility

$2,127.84

Service Code	NDC 00378311001
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$1,340.54
Max. Negotiated Rate	$1,915.06
Rate for Payer: Aetna Commercial	$1,808.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,383.10
Rate for Payer: Cash Price	$1,702.27
Rate for Payer: Cofinity Commercial	$1,489.49
Rate for Payer: Cofinity Commercial	$1,829.94
Rate for Payer: Cofinity Medicare Advantage	$1,489.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,702.27
Rate for Payer: Healthscope Commercial	$1,915.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,808.66
Rate for Payer: PHP Commercial	$1,808.66
Rate for Payer: Priority Health Cigna Priority Health	$1,383.10
Rate for Payer: Priority Health SBD	$1,340.54

TEMAZEPAM 7.5 MG CAPSULE

Facility

$384.93

Service Code	NDC 63739000333
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$346.44
Rate for Payer: Aetna Commercial	$327.19
Rate for Payer: Aetna Medicare	$192.47
Rate for Payer: Aetna New Business (MI Preferred)	$250.20
Rate for Payer: BCBS Complete	$153.97
Rate for Payer: Cash Price	$307.94
Rate for Payer: Cofinity Commercial	$269.45
Rate for Payer: Cofinity Commercial	$331.04
Rate for Payer: Cofinity Medicare Advantage	$269.45
Rate for Payer: Encore Health Key Benefits Commercial	$307.94
Rate for Payer: Healthscope Commercial	$346.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.19
Rate for Payer: PHP Commercial	$327.19
Rate for Payer: Priority Health Cigna Priority Health	$250.20
Rate for Payer: Priority Health SBD	$242.51

TEMAZEPAM 7.5 MG CAPSULE

Facility

$308.18

Service Code	NDC 00904643604
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$194.15
Max. Negotiated Rate	$277.36
Rate for Payer: Aetna Commercial	$261.95
Rate for Payer: Aetna New Business (MI Preferred)	$200.32
Rate for Payer: Cash Price	$246.54
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Cofinity Commercial	$265.03
Rate for Payer: Cofinity Medicare Advantage	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$246.54
Rate for Payer: Healthscope Commercial	$277.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.95
Rate for Payer: PHP Commercial	$261.95
Rate for Payer: Priority Health Cigna Priority Health	$200.32
Rate for Payer: Priority Health SBD	$194.15

TEMAZEPAM 7.5 MG CAPSULE

Facility

$308.18

Service Code	NDC 00904643604
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$123.27
Max. Negotiated Rate	$277.36
Rate for Payer: Aetna Commercial	$261.95
Rate for Payer: Aetna Medicare	$154.09
Rate for Payer: Aetna New Business (MI Preferred)	$200.32
Rate for Payer: BCBS Complete	$123.27
Rate for Payer: Cash Price	$246.54
Rate for Payer: Cofinity Commercial	$215.73
Rate for Payer: Cofinity Commercial	$265.03
Rate for Payer: Cofinity Medicare Advantage	$215.73
Rate for Payer: Encore Health Key Benefits Commercial	$246.54
Rate for Payer: Healthscope Commercial	$277.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$261.95
Rate for Payer: PHP Commercial	$261.95
Rate for Payer: Priority Health Cigna Priority Health	$200.32
Rate for Payer: Priority Health SBD	$194.15

TEMAZEPAM 7.5 MG CAPSULE

Facility

$2,127.84

Service Code	NDC 00378311001
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$851.14
Max. Negotiated Rate	$1,915.06
Rate for Payer: Aetna Commercial	$1,808.66
Rate for Payer: Aetna Medicare	$1,063.92
Rate for Payer: Aetna New Business (MI Preferred)	$1,383.10
Rate for Payer: BCBS Complete	$851.14
Rate for Payer: Cash Price	$1,702.27
Rate for Payer: Cofinity Commercial	$1,489.49
Rate for Payer: Cofinity Commercial	$1,829.94
Rate for Payer: Cofinity Medicare Advantage	$1,489.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,702.27
Rate for Payer: Healthscope Commercial	$1,915.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,808.66
Rate for Payer: PHP Commercial	$1,808.66
Rate for Payer: Priority Health Cigna Priority Health	$1,383.10
Rate for Payer: Priority Health SBD	$1,340.54

TEMAZEPAM 7.5 MG CAPSULE

Facility

$384.93

Service Code	NDC 63739000333
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$242.51
Max. Negotiated Rate	$346.44
Rate for Payer: Aetna Commercial	$327.19
Rate for Payer: Aetna New Business (MI Preferred)	$250.20
Rate for Payer: Cash Price	$307.94
Rate for Payer: Cofinity Commercial	$269.45
Rate for Payer: Cofinity Commercial	$331.04
Rate for Payer: Cofinity Medicare Advantage	$269.45
Rate for Payer: Encore Health Key Benefits Commercial	$307.94
Rate for Payer: Healthscope Commercial	$346.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.19
Rate for Payer: PHP Commercial	$327.19
Rate for Payer: Priority Health Cigna Priority Health	$250.20
Rate for Payer: Priority Health SBD	$242.51

TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST DILUTION) INTRAVENOUS SOLN

Facility

$7,785.57

Service Code	HCPCS J9330
Hospital Charge Code	82228
Hospital Revenue Code	636
Min. Negotiated Rate	$4,904.91
Max. Negotiated Rate	$7,007.01
Rate for Payer: Aetna Commercial	$6,617.73
Rate for Payer: Aetna New Business (MI Preferred)	$5,060.62
Rate for Payer: Cash Price	$6,228.46
Rate for Payer: Cofinity Commercial	$5,449.90
Rate for Payer: Cofinity Commercial	$6,695.59
Rate for Payer: Cofinity Medicare Advantage	$5,449.90
Rate for Payer: Encore Health Key Benefits Commercial	$6,228.46
Rate for Payer: Healthscope Commercial	$7,007.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,617.73
Rate for Payer: PHP Commercial	$6,617.73
Rate for Payer: Priority Health Cigna Priority Health	$5,060.62
Rate for Payer: Priority Health SBD	$4,904.91

Know your out-of-pocket cost for care.

All Charges