Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RALOXIFENE 60 MG TABLET

Facility

$582.09

Service Code	NDC 60687-266-21
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$366.72
Max. Negotiated Rate	$523.88
Rate for Payer: Aetna Commercial	$494.78
Rate for Payer: Aetna New Business (MI Preferred)	$378.36
Rate for Payer: Cash Price	$465.67
Rate for Payer: Cofinity Commercial	$407.46
Rate for Payer: Cofinity Commercial	$500.60
Rate for Payer: Healthscope Commercial	$523.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$494.78
Rate for Payer: PHP Commercial	$494.78
Rate for Payer: Priority Health Cigna Priority Health	$407.46
Rate for Payer: Priority Health SBD	$366.72

RALOXIFENE 60 MG TABLET

Facility

$87.12

Service Code	NDC 65162-057-03
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$54.89
Max. Negotiated Rate	$78.41
Rate for Payer: Aetna Commercial	$74.05
Rate for Payer: Aetna New Business (MI Preferred)	$56.63
Rate for Payer: Cash Price	$69.70
Rate for Payer: Cofinity Commercial	$60.98
Rate for Payer: Cofinity Commercial	$74.92
Rate for Payer: Healthscope Commercial	$78.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$74.05
Rate for Payer: PHP Commercial	$74.05
Rate for Payer: Priority Health Cigna Priority Health	$60.98
Rate for Payer: Priority Health SBD	$54.89

RALOXIFENE 60 MG TABLET

Facility

$681.32

Service Code	NDC 0002-4184-30
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$429.23
Max. Negotiated Rate	$613.19
Rate for Payer: Aetna Commercial	$579.12
Rate for Payer: Aetna New Business (MI Preferred)	$442.86
Rate for Payer: Cash Price	$545.06
Rate for Payer: Cofinity Commercial	$476.92
Rate for Payer: Cofinity Commercial	$585.94
Rate for Payer: Healthscope Commercial	$613.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$579.12
Rate for Payer: PHP Commercial	$579.12
Rate for Payer: Priority Health Cigna Priority Health	$476.92
Rate for Payer: Priority Health SBD	$429.23

RALOXIFENE 60 MG TABLET

Facility

$9.67

Service Code	NDC 50268-694-11
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$8.70
Rate for Payer: Aetna Commercial	$8.22
Rate for Payer: Aetna New Business (MI Preferred)	$6.29
Rate for Payer: Cash Price	$7.74
Rate for Payer: Cofinity Commercial	$6.77
Rate for Payer: Cofinity Commercial	$8.32
Rate for Payer: Healthscope Commercial	$8.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.22
Rate for Payer: PHP Commercial	$8.22
Rate for Payer: Priority Health Cigna Priority Health	$6.77
Rate for Payer: Priority Health SBD	$6.09

RALOXIFENE 60 MG TABLET

Facility

$483.22

Service Code	NDC 50268-694-15
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$304.43
Max. Negotiated Rate	$434.90
Rate for Payer: Aetna Commercial	$410.74
Rate for Payer: Aetna New Business (MI Preferred)	$314.09
Rate for Payer: Cash Price	$386.58
Rate for Payer: Cofinity Commercial	$338.25
Rate for Payer: Cofinity Commercial	$415.57
Rate for Payer: Healthscope Commercial	$434.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$410.74
Rate for Payer: PHP Commercial	$410.74
Rate for Payer: Priority Health Cigna Priority Health	$338.25
Rate for Payer: Priority Health SBD	$304.43

RALTEGRAVIR 400 MG TABLET

Facility

$7,203.46

Service Code	NDC 0006-0227-61
Hospital Charge Code	88608
Hospital Revenue Code	637
Min. Negotiated Rate	$4,538.18
Max. Negotiated Rate	$6,483.11
Rate for Payer: Aetna Commercial	$6,122.94
Rate for Payer: Aetna New Business (MI Preferred)	$4,682.25
Rate for Payer: Cash Price	$5,762.77
Rate for Payer: Cofinity Commercial	$5,042.42
Rate for Payer: Cofinity Commercial	$6,194.98
Rate for Payer: Healthscope Commercial	$6,483.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,122.94
Rate for Payer: PHP Commercial	$6,122.94
Rate for Payer: Priority Health Cigna Priority Health	$5,042.42
Rate for Payer: Priority Health SBD	$4,538.18

RAMIPRIL 1.25 MG CAPSULE

Facility

$173.90

Service Code	NDC 65862-474-01
Hospital Charge Code	11258
Hospital Revenue Code	637
Min. Negotiated Rate	$109.56
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna New Business (MI Preferred)	$113.04
Rate for Payer: Cash Price	$139.12
Rate for Payer: Cofinity Commercial	$149.55
Rate for Payer: Cofinity Commercial	$121.73
Rate for Payer: Healthscope Commercial	$156.51
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.82
Rate for Payer: PHP Commercial	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$121.73
Rate for Payer: Priority Health SBD	$109.56

RAMIPRIL 5 MG CAPSULE

Facility

$105.75

Service Code	NDC 65862-476-01
Hospital Charge Code	11261
Hospital Revenue Code	637
Min. Negotiated Rate	$66.62
Max. Negotiated Rate	$95.18
Rate for Payer: Aetna Commercial	$89.89
Rate for Payer: Aetna New Business (MI Preferred)	$68.74
Rate for Payer: Cash Price	$84.60
Rate for Payer: Cofinity Commercial	$74.02
Rate for Payer: Cofinity Commercial	$90.94
Rate for Payer: Healthscope Commercial	$95.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$89.89
Rate for Payer: PHP Commercial	$89.89
Rate for Payer: Priority Health Cigna Priority Health	$74.02
Rate for Payer: Priority Health SBD	$66.62

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION

Facility

$32,063.77

Service Code	HCPCS J9308
Hospital Charge Code	170507
Hospital Revenue Code	636
Min. Negotiated Rate	$20,200.18
Max. Negotiated Rate	$28,857.39
Rate for Payer: Aetna Commercial	$27,254.20
Rate for Payer: Aetna Commercial	$5,450.85
Rate for Payer: Aetna New Business (MI Preferred)	$20,841.45
Rate for Payer: Aetna New Business (MI Preferred)	$4,168.29
Rate for Payer: Cash Price	$25,651.02
Rate for Payer: Cash Price	$5,130.21
Rate for Payer: Cofinity Commercial	$27,574.84
Rate for Payer: Cofinity Commercial	$5,514.97
Rate for Payer: Cofinity Commercial	$4,488.93
Rate for Payer: Cofinity Commercial	$22,444.64
Rate for Payer: Healthscope Commercial	$5,771.48
Rate for Payer: Healthscope Commercial	$28,857.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27,254.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,450.85
Rate for Payer: PHP Commercial	$27,254.20
Rate for Payer: PHP Commercial	$5,450.85
Rate for Payer: Priority Health Cigna Priority Health	$4,488.93
Rate for Payer: Priority Health Cigna Priority Health	$22,444.64
Rate for Payer: Priority Health SBD	$20,200.18
Rate for Payer: Priority Health SBD	$4,040.04

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION

Facility

$32,063.77

Service Code	HCPCS J9308
Hospital Charge Code	170507
Hospital Revenue Code	636
Min. Negotiated Rate	$38.42
Max. Negotiated Rate	$28,857.39
Rate for Payer: Aetna Commercial	$27,254.20
Rate for Payer: Aetna Commercial	$5,450.85
Rate for Payer: Aetna Medicare	$73.05
Rate for Payer: Aetna Medicare	$73.05
Rate for Payer: Aetna New Business (MI Preferred)	$4,168.29
Rate for Payer: Aetna New Business (MI Preferred)	$20,841.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$87.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$87.80
Rate for Payer: Amish Plain Church Group Commercial	$87.80
Rate for Payer: Amish Plain Church Group Commercial	$87.80
Rate for Payer: BCBS Complete	$40.35
Rate for Payer: BCBS Complete	$40.35
Rate for Payer: BCBS MAPPO	$70.24
Rate for Payer: BCBS MAPPO	$70.24
Rate for Payer: BCBS Trust/PPO	$207.93
Rate for Payer: BCBS Trust/PPO	$207.93
Rate for Payer: BCN Medicare Advantage	$70.24
Rate for Payer: BCN Medicare Advantage	$70.24
Rate for Payer: Cash Price	$25,651.02
Rate for Payer: Cash Price	$5,130.21
Rate for Payer: Cash Price	$25,651.02
Rate for Payer: Cash Price	$5,130.21
Rate for Payer: Cofinity Commercial	$27,574.84
Rate for Payer: Cofinity Commercial	$4,488.93
Rate for Payer: Cofinity Commercial	$5,514.97
Rate for Payer: Cofinity Commercial	$22,444.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$70.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$70.24
Rate for Payer: Healthscope Commercial	$28,857.39
Rate for Payer: Healthscope Commercial	$5,771.48
Rate for Payer: Mclaren Medicaid	$38.42
Rate for Payer: Mclaren Medicaid	$38.42
Rate for Payer: Mclaren Medicare	$70.24
Rate for Payer: Mclaren Medicare	$70.24
Rate for Payer: Meridian Medicaid	$40.35
Rate for Payer: Meridian Medicaid	$40.35
Rate for Payer: Meridian Wellcare - Medicare Advantage	$73.76
Rate for Payer: Meridian Wellcare - Medicare Advantage	$73.76
Rate for Payer: MI Amish Medical Board Commercial	$80.78
Rate for Payer: MI Amish Medical Board Commercial	$80.78
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,450.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27,254.20
Rate for Payer: PACE Medicare	$66.73
Rate for Payer: PACE Medicare	$66.73
Rate for Payer: PACE SWMI	$70.24
Rate for Payer: PACE SWMI	$70.24
Rate for Payer: PHP Commercial	$5,450.85
Rate for Payer: PHP Commercial	$27,254.20
Rate for Payer: PHP Medicare Advantage	$70.24
Rate for Payer: PHP Medicare Advantage	$70.24
Rate for Payer: Priority Health Choice Medicaid	$38.42
Rate for Payer: Priority Health Choice Medicaid	$38.42
Rate for Payer: Priority Health Cigna Priority Health	$22,444.64
Rate for Payer: Priority Health Cigna Priority Health	$4,488.93
Rate for Payer: Priority Health Medicare	$70.24
Rate for Payer: Priority Health Medicare	$70.24
Rate for Payer: Priority Health SBD	$20,200.18
Rate for Payer: Priority Health SBD	$4,040.04
Rate for Payer: Railroad Medicare Medicare	$70.24
Rate for Payer: Railroad Medicare Medicare	$70.24
Rate for Payer: UHC Dual Complete DSNP	$70.24
Rate for Payer: UHC Dual Complete DSNP	$70.24
Rate for Payer: UHC Medicare Advantage	$72.35
Rate for Payer: UHC Medicare Advantage	$72.35
Rate for Payer: VA VA	$70.24
Rate for Payer: VA VA	$70.24

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$1,414.81

Service Code	NDC 61958-1003-1
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$891.33
Max. Negotiated Rate	$1,273.33
Rate for Payer: Aetna Commercial	$1,202.59
Rate for Payer: Aetna New Business (MI Preferred)	$919.63
Rate for Payer: Cash Price	$1,131.85
Rate for Payer: Cofinity Commercial	$1,216.74
Rate for Payer: Cofinity Commercial	$990.37
Rate for Payer: Healthscope Commercial	$1,273.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,202.59
Rate for Payer: PHP Commercial	$1,202.59
Rate for Payer: Priority Health Cigna Priority Health	$990.37
Rate for Payer: Priority Health SBD	$891.33

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$381.03

Service Code	NDC 45963-418-06
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$240.05
Max. Negotiated Rate	$342.93
Rate for Payer: Aetna Commercial	$323.88
Rate for Payer: Aetna New Business (MI Preferred)	$247.67
Rate for Payer: Cash Price	$304.82
Rate for Payer: Cofinity Commercial	$266.72
Rate for Payer: Cofinity Commercial	$327.69
Rate for Payer: Healthscope Commercial	$342.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$323.88
Rate for Payer: PHP Commercial	$323.88
Rate for Payer: Priority Health Cigna Priority Health	$266.72
Rate for Payer: Priority Health SBD	$240.05

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$5.78

Service Code	NDC 60687-549-11
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$3.64
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Commercial	$4.91
Rate for Payer: Aetna New Business (MI Preferred)	$3.76
Rate for Payer: Cash Price	$4.62
Rate for Payer: Cofinity Commercial	$4.05
Rate for Payer: Cofinity Commercial	$4.97
Rate for Payer: Healthscope Commercial	$5.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$4.91
Rate for Payer: PHP Commercial	$4.91
Rate for Payer: Priority Health Cigna Priority Health	$4.05
Rate for Payer: Priority Health SBD	$3.64

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$173.38

Service Code	NDC 60687-549-21
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$109.23
Max. Negotiated Rate	$156.04
Rate for Payer: Aetna Commercial	$147.37
Rate for Payer: Aetna New Business (MI Preferred)	$112.70
Rate for Payer: Cash Price	$138.70
Rate for Payer: Cofinity Commercial	$121.37
Rate for Payer: Cofinity Commercial	$149.11
Rate for Payer: Healthscope Commercial	$156.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$147.37
Rate for Payer: PHP Commercial	$147.37
Rate for Payer: Priority Health Cigna Priority Health	$121.37
Rate for Payer: Priority Health SBD	$109.23

RASAGILINE 0.5 MG TABLET

Facility

$335.56

Service Code	NDC 67877-259-30
Hospital Charge Code	76480
Hospital Revenue Code	637
Min. Negotiated Rate	$211.40
Max. Negotiated Rate	$302.00
Rate for Payer: Aetna Commercial	$285.23
Rate for Payer: Aetna New Business (MI Preferred)	$218.11
Rate for Payer: Cash Price	$268.45
Rate for Payer: Cofinity Commercial	$234.89
Rate for Payer: Cofinity Commercial	$288.58
Rate for Payer: Healthscope Commercial	$302.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$285.23
Rate for Payer: PHP Commercial	$285.23
Rate for Payer: Priority Health Cigna Priority Health	$234.89
Rate for Payer: Priority Health SBD	$211.40

RASAGILINE 1 MG TABLET

Facility

$3,935.18

Service Code	NDC 68546-229-56
Hospital Charge Code	76481
Hospital Revenue Code	637
Min. Negotiated Rate	$2,479.16
Max. Negotiated Rate	$3,541.66
Rate for Payer: Aetna Commercial	$3,344.90
Rate for Payer: Aetna New Business (MI Preferred)	$2,557.87
Rate for Payer: Cash Price	$3,148.14
Rate for Payer: Cofinity Commercial	$2,754.63
Rate for Payer: Cofinity Commercial	$3,384.25
Rate for Payer: Healthscope Commercial	$3,541.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3,344.90
Rate for Payer: PHP Commercial	$3,344.90
Rate for Payer: Priority Health Cigna Priority Health	$2,754.63
Rate for Payer: Priority Health SBD	$2,479.16

RASAGILINE 1 MG TABLET

Facility

$737.04

Service Code	NDC 0093-3061-56
Hospital Charge Code	76481
Hospital Revenue Code	637
Min. Negotiated Rate	$464.34
Max. Negotiated Rate	$663.34
Rate for Payer: Aetna Commercial	$626.48
Rate for Payer: Aetna New Business (MI Preferred)	$479.08
Rate for Payer: Cash Price	$589.63
Rate for Payer: Cofinity Commercial	$515.93
Rate for Payer: Cofinity Commercial	$633.85
Rate for Payer: Healthscope Commercial	$663.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$626.48
Rate for Payer: PHP Commercial	$626.48
Rate for Payer: Priority Health Cigna Priority Health	$515.93
Rate for Payer: Priority Health SBD	$464.34

RASBURICASE 1.5 MG INTRAVENOUS SOLUTION

Facility

$3,438.46

Service Code	HCPCS J2783
Hospital Charge Code	33591
Hospital Revenue Code	636
Min. Negotiated Rate	$2,166.23
Max. Negotiated Rate	$3,094.61
Rate for Payer: Aetna Commercial	$2,922.69
Rate for Payer: Aetna New Business (MI Preferred)	$2,235.00
Rate for Payer: Cash Price	$2,750.77
Rate for Payer: Cofinity Commercial	$2,406.92
Rate for Payer: Cofinity Commercial	$2,957.08
Rate for Payer: Healthscope Commercial	$3,094.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,922.69
Rate for Payer: PHP Commercial	$2,922.69
Rate for Payer: Priority Health Cigna Priority Health	$2,406.92
Rate for Payer: Priority Health SBD	$2,166.23

RASBURICASE 7.5 MG INTRAVENOUS SOLUTION

Facility

$13,968.69

Service Code	HCPCS J2783
Hospital Charge Code	76868
Hospital Revenue Code	636
Min. Negotiated Rate	$8,800.27
Max. Negotiated Rate	$12,571.82
Rate for Payer: Aetna Commercial	$11,873.39
Rate for Payer: Aetna New Business (MI Preferred)	$9,079.65
Rate for Payer: Cash Price	$11,174.95
Rate for Payer: Cofinity Commercial	$12,013.07
Rate for Payer: Cofinity Commercial	$9,778.08
Rate for Payer: Healthscope Commercial	$12,571.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11,873.39
Rate for Payer: PHP Commercial	$11,873.39
Rate for Payer: Priority Health Cigna Priority Health	$9,778.08
Rate for Payer: Priority Health SBD	$8,800.27

RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)

Facility

$7,957.04

Service Code	CPT 28238
Hospital Revenue Code	360
Min. Negotiated Rate	$484.29
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$2,451.57
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$532.72
Rate for Payer: UHC Core	$7,632.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$484.29
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)

Facility

$4,155.00

Service Code	CPT 28313
Hospital Revenue Code	360
Min. Negotiated Rate	$359.53
Max. Negotiated Rate	$4,155.00
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,058.03
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$395.48
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$359.53
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)

Facility

$7,957.04

Service Code	CPT 27422
Hospital Revenue Code	360
Min. Negotiated Rate	$738.71
Max. Negotiated Rate	$7,957.04
Rate for Payer: Aetna Medicare	$6,620.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,957.04
Rate for Payer: Amish Plain Church Group Commercial	$7,957.04
Rate for Payer: BCBS Complete	$3,656.42
Rate for Payer: BCBS MAPPO	$6,365.63
Rate for Payer: BCBS Trust/PPO	$2,299.99
Rate for Payer: BCN Medicare Advantage	$6,365.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,365.63
Rate for Payer: Mclaren Medicaid	$3,482.00
Rate for Payer: Mclaren Medicare	$6,365.63
Rate for Payer: Meridian Medicaid	$3,656.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,683.91
Rate for Payer: MI Amish Medical Board Commercial	$7,320.47
Rate for Payer: PACE Medicare	$6,047.35
Rate for Payer: PACE SWMI	$6,365.63
Rate for Payer: PHP Medicare Advantage	$6,365.63
Rate for Payer: Priority Health Choice Medicaid	$3,482.00
Rate for Payer: Priority Health Medicare	$6,365.63
Rate for Payer: Railroad Medicare Medicare	$6,365.63
Rate for Payer: UHC All Payor (Choice/PPO)	$812.58
Rate for Payer: UHC Core	$6,837.00
Rate for Payer: UHC Dual Complete DSNP	$6,365.63
Rate for Payer: UHC Exchange	$738.71
Rate for Payer: UHC Medicare Advantage	$6,556.60
Rate for Payer: VA VA	$6,365.63

RECTAL RESECTION WITH CC

Facility

$42,091.01

Service Code	MS-DRG 333
Min. Negotiated Rate	$14,695.42
Max. Negotiated Rate	$42,091.01
Rate for Payer: Aetna Medicare	$16,087.61
Rate for Payer: Allen County Amish Medical Aid Commercial	$19,336.08
Rate for Payer: Amish Plain Church Group Commercial	$19,336.08
Rate for Payer: BCBS MAPPO	$15,468.86
Rate for Payer: BCBS Trust/PPO	$42,091.01
Rate for Payer: BCN Medicare Advantage	$15,468.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$15,468.86
Rate for Payer: Mclaren Medicare	$15,468.86
Rate for Payer: Meridian Wellcare - Medicare Advantage	$16,242.30
Rate for Payer: MI Amish Medical Board Commercial	$17,789.19
Rate for Payer: PACE Medicare	$14,695.42
Rate for Payer: PACE SWMI	$15,468.86
Rate for Payer: PHP Medicare Advantage	$15,468.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$29,840.66
Rate for Payer: Priority Health Medicare	$15,468.86
Rate for Payer: Priority Health Narrow Network	$23,872.53
Rate for Payer: Railroad Medicare Medicare	$15,468.86
Rate for Payer: UHC All Payor (Choice/PPO)	$31,720.69
Rate for Payer: UHC Core	$19,464.12
Rate for Payer: UHC Dual Complete DSNP	$15,468.86
Rate for Payer: UHC Exchange	$20,846.99
Rate for Payer: UHC Medicare Advantage	$15,932.93
Rate for Payer: VA VA	$15,468.86

RECTAL RESECTION WITH MCC

Facility

$59,908.54

Service Code	MS-DRG 332
Min. Negotiated Rate	$25,469.73
Max. Negotiated Rate	$59,908.54
Rate for Payer: Aetna Medicare	$27,882.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$33,512.80
Rate for Payer: Amish Plain Church Group Commercial	$33,512.80
Rate for Payer: BCBS MAPPO	$26,810.24
Rate for Payer: BCBS Trust/PPO	$59,908.54
Rate for Payer: BCN Medicare Advantage	$26,810.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$26,810.24
Rate for Payer: Mclaren Medicare	$26,810.24
Rate for Payer: Meridian Wellcare - Medicare Advantage	$28,150.75
Rate for Payer: MI Amish Medical Board Commercial	$30,831.78
Rate for Payer: PACE Medicare	$25,469.73
Rate for Payer: PACE SWMI	$26,810.24
Rate for Payer: PHP Medicare Advantage	$26,810.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$52,055.77
Rate for Payer: Priority Health Medicare	$26,810.24
Rate for Payer: Priority Health Narrow Network	$41,644.62
Rate for Payer: Railroad Medicare Medicare	$26,810.24
Rate for Payer: UHC All Payor (Choice/PPO)	$55,335.41
Rate for Payer: UHC Core	$33,954.34
Rate for Payer: UHC Dual Complete DSNP	$26,810.24
Rate for Payer: UHC Exchange	$36,366.69
Rate for Payer: UHC Medicare Advantage	$27,614.55
Rate for Payer: VA VA	$26,810.24

RECTAL RESECTION WITHOUT CC/MCC

Facility

$33,289.84

Service Code	MS-DRG 334
Min. Negotiated Rate	$11,449.70
Max. Negotiated Rate	$33,289.84
Rate for Payer: Aetna Medicare	$12,534.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,065.40
Rate for Payer: Amish Plain Church Group Commercial	$15,065.40
Rate for Payer: BCBS MAPPO	$12,052.32
Rate for Payer: BCBS Trust/PPO	$33,289.84
Rate for Payer: BCN Medicare Advantage	$12,052.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,052.32
Rate for Payer: Mclaren Medicare	$12,052.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,654.94
Rate for Payer: MI Amish Medical Board Commercial	$13,860.17
Rate for Payer: PACE Medicare	$11,449.70
Rate for Payer: PACE SWMI	$12,052.32
Rate for Payer: PHP Medicare Advantage	$12,052.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23,033.06
Rate for Payer: Priority Health Medicare	$12,052.32
Rate for Payer: Priority Health Narrow Network	$18,426.45
Rate for Payer: Railroad Medicare Medicare	$12,052.32
Rate for Payer: UHC All Payor (Choice/PPO)	$24,484.20
Rate for Payer: UHC Core	$15,023.74
Rate for Payer: UHC Dual Complete DSNP	$12,052.32
Rate for Payer: UHC Exchange	$16,091.13
Rate for Payer: UHC Medicare Advantage	$12,413.89
Rate for Payer: VA VA	$12,052.32

Know your out-of-pocket cost for care.

All Charges