Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,379.29

Service Code	HCPCS J7503
Hospital Charge Code	175523
Hospital Revenue Code	636
Min. Negotiated Rate	$1,498.95
Max. Negotiated Rate	$2,141.36
Rate for Payer: Aetna Commercial	$2,022.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,546.54
Rate for Payer: Cash Price	$1,903.43
Rate for Payer: Cofinity Commercial	$1,665.50
Rate for Payer: Cofinity Commercial	$2,046.19
Rate for Payer: Healthscope Commercial	$2,141.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,022.40
Rate for Payer: PHP Commercial	$2,022.40
Rate for Payer: Priority Health Cigna Priority Health	$1,665.50
Rate for Payer: Priority Health SBD	$1,498.95

TAMOXIFEN 10 MG TABLET

Facility

$270.72

Service Code	NDC 0378-0144-91
Hospital Charge Code	7711
Hospital Revenue Code	637
Min. Negotiated Rate	$170.55
Max. Negotiated Rate	$243.65
Rate for Payer: Aetna Commercial	$230.11
Rate for Payer: Aetna New Business (MI Preferred)	$175.97
Rate for Payer: Cash Price	$216.58
Rate for Payer: Cofinity Commercial	$189.50
Rate for Payer: Cofinity Commercial	$232.82
Rate for Payer: Healthscope Commercial	$243.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$230.11
Rate for Payer: PHP Commercial	$230.11
Rate for Payer: Priority Health Cigna Priority Health	$189.50
Rate for Payer: Priority Health SBD	$170.55

TAMOXIFEN 10 MG TABLET

Facility

$341.05

Service Code	NDC 63739-269-10
Hospital Charge Code	7711
Hospital Revenue Code	637
Min. Negotiated Rate	$214.86
Max. Negotiated Rate	$306.94
Rate for Payer: Aetna Commercial	$289.89
Rate for Payer: Aetna New Business (MI Preferred)	$221.68
Rate for Payer: Cash Price	$272.84
Rate for Payer: Cofinity Commercial	$238.74
Rate for Payer: Cofinity Commercial	$293.30
Rate for Payer: Healthscope Commercial	$306.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$289.89
Rate for Payer: PHP Commercial	$289.89
Rate for Payer: Priority Health Cigna Priority Health	$238.74
Rate for Payer: Priority Health SBD	$214.86

TAMOXIFEN 10 MG TABLET

Facility

$387.60

Service Code	NDC 63739-143-10
Hospital Charge Code	7711
Hospital Revenue Code	637
Min. Negotiated Rate	$244.19
Max. Negotiated Rate	$348.84
Rate for Payer: Aetna Commercial	$329.46
Rate for Payer: Aetna New Business (MI Preferred)	$251.94
Rate for Payer: Cash Price	$310.08
Rate for Payer: Cofinity Commercial	$333.34
Rate for Payer: Cofinity Commercial	$271.32
Rate for Payer: Healthscope Commercial	$348.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$329.46
Rate for Payer: PHP Commercial	$329.46
Rate for Payer: Priority Health Cigna Priority Health	$271.32
Rate for Payer: Priority Health SBD	$244.19

TAMSULOSIN 0.4 MG CAPSULE

Facility

$232.75

Service Code	NDC 68084-299-01
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$146.63
Max. Negotiated Rate	$209.48
Rate for Payer: Aetna Commercial	$197.84
Rate for Payer: Aetna New Business (MI Preferred)	$151.29
Rate for Payer: Cash Price	$186.20
Rate for Payer: Cofinity Commercial	$162.92
Rate for Payer: Cofinity Commercial	$200.16
Rate for Payer: Healthscope Commercial	$209.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$197.84
Rate for Payer: PHP Commercial	$197.84
Rate for Payer: Priority Health Cigna Priority Health	$162.92
Rate for Payer: Priority Health SBD	$146.63

TAMSULOSIN 0.4 MG CAPSULE

Facility

$288.80

Service Code	NDC 51079-294-20
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: Healthscope Commercial	$259.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$245.48
Rate for Payer: PHP Commercial	$245.48
Rate for Payer: Priority Health Cigna Priority Health	$202.16
Rate for Payer: Priority Health SBD	$181.94

TAMSULOSIN 0.4 MG CAPSULE

Facility

$2.33

Service Code	NDC 68084-299-11
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$2.10
Rate for Payer: Aetna Commercial	$1.98
Rate for Payer: Aetna New Business (MI Preferred)	$1.51
Rate for Payer: Cash Price	$1.86
Rate for Payer: Cofinity Commercial	$1.63
Rate for Payer: Cofinity Commercial	$2.00
Rate for Payer: Healthscope Commercial	$2.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.98
Rate for Payer: PHP Commercial	$1.98
Rate for Payer: Priority Health Cigna Priority Health	$1.63
Rate for Payer: Priority Health SBD	$1.47

TAMSULOSIN 0.4 MG CAPSULE

Facility

$451.25

Service Code	NDC 0228-2996-11
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	$388.08
Rate for Payer: Healthscope Commercial	$406.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$383.56
Rate for Payer: PHP Commercial	$383.56
Rate for Payer: Priority Health Cigna Priority Health	$315.88
Rate for Payer: Priority Health SBD	$284.29

TAMSULOSIN 0.4 MG CAPSULE

Facility

$2.20

Service Code	NDC 50268-740-11
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$1.98
Rate for Payer: Aetna Commercial	$1.87
Rate for Payer: Aetna New Business (MI Preferred)	$1.43
Rate for Payer: Cash Price	$1.76
Rate for Payer: Cofinity Commercial	$1.54
Rate for Payer: Cofinity Commercial	$1.89
Rate for Payer: Healthscope Commercial	$1.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1.87
Rate for Payer: PHP Commercial	$1.87
Rate for Payer: Priority Health Cigna Priority Health	$1.54
Rate for Payer: Priority Health SBD	$1.39

TAMSULOSIN 0.4 MG CAPSULE

Facility

$166.85

Service Code	NDC 65862-598-01
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: Healthscope Commercial	$150.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$141.82
Rate for Payer: PHP Commercial	$141.82
Rate for Payer: Priority Health Cigna Priority Health	$116.80
Rate for Payer: Priority Health SBD	$105.12

TAMSULOSIN 0.4 MG CAPSULE

Facility

$262.26

Service Code	NDC 62756-160-81
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: Healthscope Commercial	$236.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$222.92
Rate for Payer: PHP Commercial	$222.92
Rate for Payer: Priority Health Cigna Priority Health	$183.58
Rate for Payer: Priority Health SBD	$165.22

TAMSULOSIN 0.4 MG CAPSULE

Facility

$304.00

Service Code	NDC 63739-567-10
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: Healthscope Commercial	$273.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$258.40
Rate for Payer: PHP Commercial	$258.40
Rate for Payer: Priority Health Cigna Priority Health	$212.80
Rate for Payer: Priority Health SBD	$191.52

TAMSULOSIN 0.4 MG CAPSULE

Facility

$192.85

Service Code	NDC 0904-6401-61
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: Healthscope Commercial	$173.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$163.92
Rate for Payer: PHP Commercial	$163.92
Rate for Payer: Priority Health Cigna Priority Health	$135.00
Rate for Payer: Priority Health SBD	$121.50

TAMSULOSIN 0.4 MG CAPSULE

Facility

$109.73

Service Code	NDC 50268-740-15
Hospital Charge Code	103890
Hospital Revenue Code	637
Min. Negotiated Rate	$69.13
Max. Negotiated Rate	$98.76
Rate for Payer: Aetna Commercial	$93.27
Rate for Payer: Aetna New Business (MI Preferred)	$71.32
Rate for Payer: Cash Price	$87.78
Rate for Payer: Cofinity Commercial	$76.81
Rate for Payer: Cofinity Commercial	$94.37
Rate for Payer: Healthscope Commercial	$98.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$93.27
Rate for Payer: PHP Commercial	$93.27
Rate for Payer: Priority Health Cigna Priority Health	$76.81
Rate for Payer: Priority Health SBD	$69.13

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	$774.78
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	$729.20
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Commercial	$783.89
Rate for Payer: Cofinity Commercial	$638.05
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Healthscope Commercial	$820.35
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$774.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$774.78
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: PHP Commercial	$774.78
Rate for Payer: Priority Health Cigna Priority Health	$638.05
Rate for Payer: Priority Health Cigna Priority Health	$638.04
Rate for Payer: Priority Health SBD	$574.24
Rate for Payer: Priority Health SBD	$574.24

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	$0.24
Max. Negotiated Rate	$820.35
Rate for Payer: Aetna Commercial	$774.78
Rate for Payer: Aetna Commercial	$774.77
Rate for Payer: Aetna Medicare	$0.46
Rate for Payer: Aetna Medicare	$0.46
Rate for Payer: Aetna New Business (MI Preferred)	$592.47
Rate for Payer: Aetna New Business (MI Preferred)	$592.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.55
Rate for Payer: Amish Plain Church Group Commercial	$0.55
Rate for Payer: Amish Plain Church Group Commercial	$0.55
Rate for Payer: BCBS Complete	$0.25
Rate for Payer: BCBS Complete	$0.25
Rate for Payer: BCBS MAPPO	$0.44
Rate for Payer: BCBS MAPPO	$0.44
Rate for Payer: BCBS Trust/PPO	$1.28
Rate for Payer: BCBS Trust/PPO	$1.28
Rate for Payer: BCN Medicare Advantage	$0.44
Rate for Payer: BCN Medicare Advantage	$0.44
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cash Price	$729.19
Rate for Payer: Cash Price	$729.20
Rate for Payer: Cash Price	$729.20
Rate for Payer: Cofinity Commercial	$638.04
Rate for Payer: Cofinity Commercial	$783.89
Rate for Payer: Cofinity Commercial	$783.88
Rate for Payer: Cofinity Commercial	$638.05
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.44
Rate for Payer: Healthscope Commercial	$820.34
Rate for Payer: Healthscope Commercial	$820.35
Rate for Payer: Mclaren Medicaid	$0.24
Rate for Payer: Mclaren Medicaid	$0.24
Rate for Payer: Mclaren Medicare	$0.44
Rate for Payer: Mclaren Medicare	$0.44
Rate for Payer: Meridian Medicaid	$0.25
Rate for Payer: Meridian Medicaid	$0.25
Rate for Payer: Meridian Wellcare - Medicare Advantage	$0.46
Rate for Payer: Meridian Wellcare - Medicare Advantage	$0.46
Rate for Payer: MI Amish Medical Board Commercial	$0.50
Rate for Payer: MI Amish Medical Board Commercial	$0.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$774.77
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$774.78
Rate for Payer: PACE Medicare	$0.42
Rate for Payer: PACE Medicare	$0.42
Rate for Payer: PACE SWMI	$0.44
Rate for Payer: PACE SWMI	$0.44
Rate for Payer: PHP Commercial	$774.77
Rate for Payer: PHP Commercial	$774.78
Rate for Payer: PHP Medicare Advantage	$0.44
Rate for Payer: PHP Medicare Advantage	$0.44
Rate for Payer: Priority Health Choice Medicaid	$0.24
Rate for Payer: Priority Health Choice Medicaid	$0.24
Rate for Payer: Priority Health Cigna Priority Health	$638.05
Rate for Payer: Priority Health Cigna Priority Health	$638.04
Rate for Payer: Priority Health Medicare	$0.44
Rate for Payer: Priority Health Medicare	$0.44
Rate for Payer: Priority Health SBD	$574.24
Rate for Payer: Priority Health SBD	$574.24
Rate for Payer: Railroad Medicare Medicare	$0.44
Rate for Payer: Railroad Medicare Medicare	$0.44
Rate for Payer: UHC Dual Complete DSNP	$0.44
Rate for Payer: UHC Dual Complete DSNP	$0.44
Rate for Payer: UHC Medicare Advantage	$0.45
Rate for Payer: UHC Medicare Advantage	$0.45
Rate for Payer: VA VA	$0.44
Rate for Payer: VA VA	$0.44

TEMAZEPAM 7.5 MG CAPSULE

Facility

$298.59

Service Code	NDC 0904-6436-04
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$188.11
Max. Negotiated Rate	$268.73
Rate for Payer: Aetna Commercial	$253.80
Rate for Payer: Aetna New Business (MI Preferred)	$194.08
Rate for Payer: Cash Price	$238.87
Rate for Payer: Cofinity Commercial	$209.01
Rate for Payer: Cofinity Commercial	$256.79
Rate for Payer: Healthscope Commercial	$268.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$253.80
Rate for Payer: PHP Commercial	$253.80
Rate for Payer: Priority Health Cigna Priority Health	$209.01
Rate for Payer: Priority Health SBD	$188.11

TEMAZEPAM 7.5 MG CAPSULE

Facility

$2,127.84

Service Code	NDC 0378-3110-01
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: Healthscope Commercial	$1,915.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,808.66
Rate for Payer: PHP Commercial	$1,808.66
Rate for Payer: Priority Health Cigna Priority Health	$1,489.49
Rate for Payer: Priority Health SBD	$1,340.54

TEMAZEPAM 7.5 MG CAPSULE

Facility

$409.39

Service Code	NDC 63739-003-33
Hospital Charge Code	11500
Hospital Revenue Code	637
Min. Negotiated Rate	$257.92
Max. Negotiated Rate	$368.45
Rate for Payer: Aetna Commercial	$347.98
Rate for Payer: Aetna New Business (MI Preferred)	$266.10
Rate for Payer: Cash Price	$327.51
Rate for Payer: Cofinity Commercial	$286.57
Rate for Payer: Cofinity Commercial	$352.08
Rate for Payer: Healthscope Commercial	$368.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$347.98
Rate for Payer: PHP Commercial	$347.98
Rate for Payer: Priority Health Cigna Priority Health	$286.57
Rate for Payer: Priority Health SBD	$257.92

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: Healthscope Commercial	$7,007.01
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,617.73
Rate for Payer: PHP Commercial	$6,617.73
Rate for Payer: Priority Health Cigna Priority Health	$5,449.90
Rate for Payer: Priority Health SBD	$4,904.91

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	$16.95
Max. Negotiated Rate	$7,007.01
Rate for Payer: Aetna Commercial	$6,617.73
Rate for Payer: Aetna Medicare	$32.23
Rate for Payer: Aetna New Business (MI Preferred)	$5,060.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$38.74
Rate for Payer: Amish Plain Church Group Commercial	$38.74
Rate for Payer: BCBS Complete	$17.80
Rate for Payer: BCBS MAPPO	$30.99
Rate for Payer: BCBS Trust/PPO	$91.73
Rate for Payer: BCN Medicare Advantage	$30.99
Rate for Payer: Cash Price	$6,228.46
Rate for Payer: Cash Price	$6,228.46
Rate for Payer: Cofinity Commercial	$6,695.59
Rate for Payer: Cofinity Commercial	$5,449.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$30.99
Rate for Payer: Healthscope Commercial	$7,007.01
Rate for Payer: Mclaren Medicaid	$16.95
Rate for Payer: Mclaren Medicare	$30.99
Rate for Payer: Meridian Medicaid	$17.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$32.54
Rate for Payer: MI Amish Medical Board Commercial	$35.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6,617.73
Rate for Payer: PACE Medicare	$29.44
Rate for Payer: PACE SWMI	$30.99
Rate for Payer: PHP Commercial	$6,617.73
Rate for Payer: PHP Medicare Advantage	$30.99
Rate for Payer: Priority Health Choice Medicaid	$16.95
Rate for Payer: Priority Health Cigna Priority Health	$5,449.90
Rate for Payer: Priority Health Medicare	$30.99
Rate for Payer: Priority Health SBD	$4,904.91
Rate for Payer: Railroad Medicare Medicare	$30.99
Rate for Payer: UHC Dual Complete DSNP	$30.99
Rate for Payer: UHC Medicare Advantage	$31.92
Rate for Payer: VA VA	$30.99

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$28,500.59

Service Code	MS-DRG 557
Min. Negotiated Rate	$11,119.25
Max. Negotiated Rate	$28,500.59
Rate for Payer: Aetna Medicare	$12,172.65
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,630.59
Rate for Payer: Amish Plain Church Group Commercial	$14,630.59
Rate for Payer: BCBS MAPPO	$11,704.47
Rate for Payer: BCBS Trust/PPO	$28,500.59
Rate for Payer: BCN Medicare Advantage	$11,704.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,704.47
Rate for Payer: Mclaren Medicare	$11,704.47
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,289.69
Rate for Payer: MI Amish Medical Board Commercial	$13,460.14
Rate for Payer: PACE Medicare	$11,119.25
Rate for Payer: PACE SWMI	$11,704.47
Rate for Payer: PHP Medicare Advantage	$11,704.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,339.96
Rate for Payer: Priority Health Medicare	$11,704.47
Rate for Payer: Priority Health Narrow Network	$17,871.97
Rate for Payer: Railroad Medicare Medicare	$11,704.47
Rate for Payer: UHC All Payor (Choice/PPO)	$23,747.43
Rate for Payer: UHC Core	$14,571.65
Rate for Payer: UHC Dual Complete DSNP	$11,704.47
Rate for Payer: UHC Exchange	$15,606.92
Rate for Payer: UHC Medicare Advantage	$12,055.60
Rate for Payer: VA VA	$11,704.47

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$13,399.11

Service Code	MS-DRG 558
Min. Negotiated Rate	$6,477.84
Max. Negotiated Rate	$13,399.11
Rate for Payer: Aetna Medicare	$7,091.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,523.48
Rate for Payer: Amish Plain Church Group Commercial	$8,523.48
Rate for Payer: BCBS MAPPO	$6,818.78
Rate for Payer: BCBS Trust/PPO	$9,319.40
Rate for Payer: BCN Medicare Advantage	$6,818.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,818.78
Rate for Payer: Mclaren Medicare	$6,818.78
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,159.72
Rate for Payer: MI Amish Medical Board Commercial	$7,841.60
Rate for Payer: PACE Medicare	$6,477.84
Rate for Payer: PACE SWMI	$6,818.78
Rate for Payer: PHP Medicare Advantage	$6,818.78
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12,604.97
Rate for Payer: Priority Health Medicare	$6,818.78
Rate for Payer: Priority Health Narrow Network	$10,083.98
Rate for Payer: Railroad Medicare Medicare	$6,818.78
Rate for Payer: UHC All Payor (Choice/PPO)	$13,399.11
Rate for Payer: UHC Core	$8,221.82
Rate for Payer: UHC Dual Complete DSNP	$6,818.78
Rate for Payer: UHC Exchange	$8,805.96
Rate for Payer: UHC Medicare Advantage	$7,023.34
Rate for Payer: VA VA	$6,818.78

TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)

Facility

$3,138.00

Service Code	CPT 26055
Hospital Revenue Code	360
Min. Negotiated Rate	$294.04
Max. Negotiated Rate	$3,138.00
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$857.09
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$323.44
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$294.04
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR, FOREARM AND/OR WRIST, SINGLE; EACH TENDON

Facility

$8,817.68

Service Code	CPT 25310
Hospital Revenue Code	360
Min. Negotiated Rate	$621.81
Max. Negotiated Rate	$8,817.68
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	$1,472.07
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 HMO/PPO/Tiered Network	$8,817.68
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health Narrow Network	$7,054.14
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$683.99
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$621.81
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

Know your out-of-pocket cost for care.

All Charges