Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH

Facility

$78.61

Service Code	NDC 00078050361
Hospital Charge Code	162142
Hospital Revenue Code	637
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$70.75
Rate for Payer: Aetna Commercial	$66.82
Rate for Payer: Aetna New Business (MI Preferred)	$51.10
Rate for Payer: Cash Price	$62.89
Rate for Payer: Cofinity Advantage	$55.03
Rate for Payer: Cofinity Commercial	$67.60
Rate for Payer: Encore Health Key Benefits Commercial	$62.89
Rate for Payer: Healthscope Commercial	$70.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.96
Rate for Payer: PHP Commercial	$66.82
Rate for Payer: Priority Health SBD	$49.52

RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH

Facility

$281.52

Service Code	NDC 65162074934
Hospital Charge Code	162142
Hospital Revenue Code	637
Min. Negotiated Rate	$177.36
Max. Negotiated Rate	$253.37
Rate for Payer: Aetna Commercial	$239.29
Rate for Payer: Aetna New Business (MI Preferred)	$182.99
Rate for Payer: Cash Price	$225.22
Rate for Payer: Cofinity Advantage	$197.06
Rate for Payer: Cofinity Commercial	$242.11
Rate for Payer: Encore Health Key Benefits Commercial	$225.22
Rate for Payer: Healthscope Commercial	$253.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$211.14
Rate for Payer: PHP Commercial	$239.29
Rate for Payer: Priority Health SBD	$177.36

RIVASTIGMINE 13.3 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,358.20

Service Code	NDC 00078050315
Hospital Charge Code	162142
Hospital Revenue Code	637
Min. Negotiated Rate	$926.77
Max. Negotiated Rate	$2,122.38
Rate for Payer: Aetna Commercial	$2,004.47
Rate for Payer: Aetna Medicare	$1,179.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,532.83
Rate for Payer: BCBS Complete	$943.28
Rate for Payer: Cash Price	$1,886.56
Rate for Payer: Cofinity Advantage	$1,650.74
Rate for Payer: Cofinity Commercial	$2,028.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,886.56
Rate for Payer: Healthscope Commercial	$2,122.38
Rate for Payer: MI Amish Medical Board Commercial	$1,886.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,004.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,768.65
Rate for Payer: PHP Commercial	$2,004.47
Rate for Payer: Priority Health SBD	$1,485.67
Rate for Payer: UHC All Payor (Choice/PPO)	$1,532.83
Rate for Payer: UHC Core	$1,228.62
Rate for Payer: UHC Exchange	$926.77

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$218.55

Service Code	NDC 72241001103
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$85.89
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna Medicare	$109.28
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: BCBS Complete	$87.42
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Advantage	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: MI Amish Medical Board Commercial	$174.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.91
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health SBD	$137.69
Rate for Payer: UHC All Payor (Choice/PPO)	$142.06
Rate for Payer: UHC Core	$113.86
Rate for Payer: UHC Exchange	$85.89

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$218.55

Service Code	NDC 72241001103
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Advantage	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.91
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health SBD	$137.69

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$156.39

Service Code	NDC 55111035260
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$61.46
Max. Negotiated Rate	$140.75
Rate for Payer: Aetna Commercial	$132.93
Rate for Payer: Aetna Medicare	$78.19
Rate for Payer: Aetna New Business (MI Preferred)	$101.65
Rate for Payer: BCBS Complete	$62.56
Rate for Payer: Cash Price	$125.11
Rate for Payer: Cofinity Advantage	$109.47
Rate for Payer: Cofinity Commercial	$134.50
Rate for Payer: Encore Health Key Benefits Commercial	$125.11
Rate for Payer: Healthscope Commercial	$140.75
Rate for Payer: MI Amish Medical Board Commercial	$125.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.29
Rate for Payer: PHP Commercial	$132.93
Rate for Payer: Priority Health SBD	$98.53
Rate for Payer: UHC All Payor (Choice/PPO)	$101.65
Rate for Payer: UHC Core	$81.48
Rate for Payer: UHC Exchange	$61.46

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$156.39

Service Code	NDC 55111035260
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$98.53
Max. Negotiated Rate	$140.75
Rate for Payer: Aetna Commercial	$132.93
Rate for Payer: Aetna New Business (MI Preferred)	$101.65
Rate for Payer: Cash Price	$125.11
Rate for Payer: Cofinity Advantage	$109.47
Rate for Payer: Cofinity Commercial	$134.50
Rate for Payer: Encore Health Key Benefits Commercial	$125.11
Rate for Payer: Healthscope Commercial	$140.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.29
Rate for Payer: PHP Commercial	$132.93
Rate for Payer: Priority Health SBD	$98.53

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$967.18

Service Code	NDC 00904710761
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$609.32
Max. Negotiated Rate	$870.46
Rate for Payer: Aetna Commercial	$822.10
Rate for Payer: Aetna New Business (MI Preferred)	$628.67
Rate for Payer: Cash Price	$773.74
Rate for Payer: Cofinity Advantage	$677.03
Rate for Payer: Cofinity Commercial	$831.77
Rate for Payer: Encore Health Key Benefits Commercial	$773.74
Rate for Payer: Healthscope Commercial	$870.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$725.38
Rate for Payer: PHP Commercial	$822.10
Rate for Payer: Priority Health SBD	$609.32

RIVASTIGMINE 1.5 MG CAPSULE

Facility

$967.18

Service Code	NDC 00904710761
Hospital Charge Code	28278
Hospital Revenue Code	637
Min. Negotiated Rate	$380.10
Max. Negotiated Rate	$870.46
Rate for Payer: Aetna Commercial	$822.10
Rate for Payer: Aetna Medicare	$483.59
Rate for Payer: Aetna New Business (MI Preferred)	$628.67
Rate for Payer: BCBS Complete	$386.87
Rate for Payer: Cash Price	$773.74
Rate for Payer: Cofinity Advantage	$677.03
Rate for Payer: Cofinity Commercial	$831.77
Rate for Payer: Encore Health Key Benefits Commercial	$773.74
Rate for Payer: Healthscope Commercial	$870.46
Rate for Payer: MI Amish Medical Board Commercial	$773.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$822.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$725.38
Rate for Payer: PHP Commercial	$822.10
Rate for Payer: Priority Health SBD	$609.32
Rate for Payer: UHC All Payor (Choice/PPO)	$628.67
Rate for Payer: UHC Core	$503.90
Rate for Payer: UHC Exchange	$380.10

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,170.83

Service Code	NDC 47781030403
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$737.62
Max. Negotiated Rate	$1,053.75
Rate for Payer: Aetna Commercial	$995.21
Rate for Payer: Aetna New Business (MI Preferred)	$761.04
Rate for Payer: Cash Price	$936.66
Rate for Payer: Cofinity Advantage	$819.58
Rate for Payer: Cofinity Commercial	$1,006.91
Rate for Payer: Encore Health Key Benefits Commercial	$936.66
Rate for Payer: Healthscope Commercial	$1,053.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$995.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$878.12
Rate for Payer: PHP Commercial	$995.21
Rate for Payer: Priority Health SBD	$737.62

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,170.83

Service Code	NDC 47781030403
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$460.14
Max. Negotiated Rate	$1,053.75
Rate for Payer: Aetna Commercial	$995.21
Rate for Payer: Aetna Medicare	$585.41
Rate for Payer: Aetna New Business (MI Preferred)	$761.04
Rate for Payer: BCBS Complete	$468.33
Rate for Payer: Cash Price	$936.66
Rate for Payer: Cofinity Advantage	$819.58
Rate for Payer: Cofinity Commercial	$1,006.91
Rate for Payer: Encore Health Key Benefits Commercial	$936.66
Rate for Payer: Healthscope Commercial	$1,053.75
Rate for Payer: MI Amish Medical Board Commercial	$936.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$995.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$878.12
Rate for Payer: PHP Commercial	$995.21
Rate for Payer: Priority Health SBD	$737.62
Rate for Payer: UHC All Payor (Choice/PPO)	$761.04
Rate for Payer: UHC Core	$610.00
Rate for Payer: UHC Exchange	$460.14

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$39.03

Service Code	NDC 47781030411
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$35.13
Rate for Payer: Aetna Commercial	$33.18
Rate for Payer: Aetna Medicare	$19.52
Rate for Payer: Aetna New Business (MI Preferred)	$25.37
Rate for Payer: BCBS Complete	$15.61
Rate for Payer: Cash Price	$31.22
Rate for Payer: Cofinity Advantage	$27.32
Rate for Payer: Cofinity Commercial	$33.57
Rate for Payer: Encore Health Key Benefits Commercial	$31.22
Rate for Payer: Healthscope Commercial	$35.13
Rate for Payer: MI Amish Medical Board Commercial	$31.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.27
Rate for Payer: PHP Commercial	$33.18
Rate for Payer: Priority Health SBD	$24.59
Rate for Payer: UHC All Payor (Choice/PPO)	$25.37
Rate for Payer: UHC Core	$20.33
Rate for Payer: UHC Exchange	$15.34

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,358.20

Service Code	NDC 00078050115
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$1,485.67
Max. Negotiated Rate	$2,122.38
Rate for Payer: Aetna Commercial	$2,004.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,532.83
Rate for Payer: Cash Price	$1,886.56
Rate for Payer: Cofinity Advantage	$1,650.74
Rate for Payer: Cofinity Commercial	$2,028.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,886.56
Rate for Payer: Healthscope Commercial	$2,122.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,004.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,768.65
Rate for Payer: PHP Commercial	$2,004.47
Rate for Payer: Priority Health SBD	$1,485.67

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$39.03

Service Code	NDC 47781030411
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$24.59
Max. Negotiated Rate	$35.13
Rate for Payer: Aetna Commercial	$33.18
Rate for Payer: Aetna New Business (MI Preferred)	$25.37
Rate for Payer: Cash Price	$31.22
Rate for Payer: Cofinity Advantage	$27.32
Rate for Payer: Cofinity Commercial	$33.57
Rate for Payer: Encore Health Key Benefits Commercial	$31.22
Rate for Payer: Healthscope Commercial	$35.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.27
Rate for Payer: PHP Commercial	$33.18
Rate for Payer: Priority Health SBD	$24.59

RIVASTIGMINE 4.6 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,358.20

Service Code	NDC 00078050115
Hospital Charge Code	82504
Hospital Revenue Code	637
Min. Negotiated Rate	$926.77
Max. Negotiated Rate	$2,122.38
Rate for Payer: Aetna Commercial	$2,004.47
Rate for Payer: Aetna Medicare	$1,179.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,532.83
Rate for Payer: BCBS Complete	$943.28
Rate for Payer: Cash Price	$1,886.56
Rate for Payer: Cofinity Advantage	$1,650.74
Rate for Payer: Cofinity Commercial	$2,028.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,886.56
Rate for Payer: Healthscope Commercial	$2,122.38
Rate for Payer: MI Amish Medical Board Commercial	$1,886.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,004.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,768.65
Rate for Payer: PHP Commercial	$2,004.47
Rate for Payer: Priority Health SBD	$1,485.67
Rate for Payer: UHC All Payor (Choice/PPO)	$1,532.83
Rate for Payer: UHC Core	$1,228.62
Rate for Payer: UHC Exchange	$926.77

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$78.61

Service Code	NDC 00078050261
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$70.75
Rate for Payer: Aetna Commercial	$66.82
Rate for Payer: Aetna Medicare	$39.30
Rate for Payer: Aetna New Business (MI Preferred)	$51.10
Rate for Payer: BCBS Complete	$31.44
Rate for Payer: Cash Price	$62.89
Rate for Payer: Cofinity Advantage	$55.03
Rate for Payer: Cofinity Commercial	$67.60
Rate for Payer: Encore Health Key Benefits Commercial	$62.89
Rate for Payer: Healthscope Commercial	$70.75
Rate for Payer: MI Amish Medical Board Commercial	$62.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.96
Rate for Payer: PHP Commercial	$66.82
Rate for Payer: Priority Health SBD	$49.52
Rate for Payer: UHC All Payor (Choice/PPO)	$51.10
Rate for Payer: UHC Core	$40.96
Rate for Payer: UHC Exchange	$30.89

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$2,358.20

Service Code	NDC 00078050215
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$926.77
Max. Negotiated Rate	$2,122.38
Rate for Payer: Aetna Commercial	$2,004.47
Rate for Payer: Aetna Medicare	$1,179.10
Rate for Payer: Aetna New Business (MI Preferred)	$1,532.83
Rate for Payer: BCBS Complete	$943.28
Rate for Payer: Cash Price	$1,886.56
Rate for Payer: Cofinity Advantage	$1,650.74
Rate for Payer: Cofinity Commercial	$2,028.05
Rate for Payer: Encore Health Key Benefits Commercial	$1,886.56
Rate for Payer: Healthscope Commercial	$2,122.38
Rate for Payer: MI Amish Medical Board Commercial	$1,886.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,004.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,768.65
Rate for Payer: PHP Commercial	$2,004.47
Rate for Payer: Priority Health SBD	$1,485.67
Rate for Payer: UHC All Payor (Choice/PPO)	$1,532.83
Rate for Payer: UHC Core	$1,228.62
Rate for Payer: UHC Exchange	$926.77

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$223.20

Service Code	NDC 00378907193
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$140.62
Max. Negotiated Rate	$200.88
Rate for Payer: Aetna Commercial	$189.72
Rate for Payer: Aetna New Business (MI Preferred)	$145.08
Rate for Payer: Cash Price	$178.56
Rate for Payer: Cofinity Advantage	$156.24
Rate for Payer: Cofinity Commercial	$191.95
Rate for Payer: Encore Health Key Benefits Commercial	$178.56
Rate for Payer: Healthscope Commercial	$200.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$167.40
Rate for Payer: PHP Commercial	$189.72
Rate for Payer: Priority Health SBD	$140.62

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,395.39

Service Code	NDC 00781730931
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$879.10
Max. Negotiated Rate	$1,255.85
Rate for Payer: Aetna Commercial	$1,186.08
Rate for Payer: Aetna New Business (MI Preferred)	$907.00
Rate for Payer: Cash Price	$1,116.31
Rate for Payer: Cofinity Advantage	$976.77
Rate for Payer: Cofinity Commercial	$1,200.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,116.31
Rate for Payer: Healthscope Commercial	$1,255.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,186.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,046.54
Rate for Payer: PHP Commercial	$1,186.08
Rate for Payer: Priority Health SBD	$879.10

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$223.20

Service Code	NDC 00378907193
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$87.72
Max. Negotiated Rate	$200.88
Rate for Payer: Aetna Commercial	$189.72
Rate for Payer: Aetna Medicare	$111.60
Rate for Payer: Aetna New Business (MI Preferred)	$145.08
Rate for Payer: BCBS Complete	$89.28
Rate for Payer: Cash Price	$178.56
Rate for Payer: Cofinity Advantage	$156.24
Rate for Payer: Cofinity Commercial	$191.95
Rate for Payer: Encore Health Key Benefits Commercial	$178.56
Rate for Payer: Healthscope Commercial	$200.88
Rate for Payer: MI Amish Medical Board Commercial	$178.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$167.40
Rate for Payer: PHP Commercial	$189.72
Rate for Payer: Priority Health SBD	$140.62
Rate for Payer: UHC All Payor (Choice/PPO)	$145.08
Rate for Payer: UHC Core	$116.29
Rate for Payer: UHC Exchange	$87.72

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$7.44

Service Code	NDC 00378907116
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Aetna Medicare	$3.72
Rate for Payer: Aetna New Business (MI Preferred)	$4.84
Rate for Payer: BCBS Complete	$2.98
Rate for Payer: Cash Price	$5.95
Rate for Payer: Cofinity Advantage	$5.21
Rate for Payer: Cofinity Commercial	$6.40
Rate for Payer: Encore Health Key Benefits Commercial	$5.95
Rate for Payer: Healthscope Commercial	$6.70
Rate for Payer: MI Amish Medical Board Commercial	$5.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.58
Rate for Payer: PHP Commercial	$6.32
Rate for Payer: Priority Health SBD	$4.69
Rate for Payer: UHC All Payor (Choice/PPO)	$4.84
Rate for Payer: UHC Core	$3.88
Rate for Payer: UHC Exchange	$2.92

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$7.44

Service Code	NDC 00378907116
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.69
Max. Negotiated Rate	$6.70
Rate for Payer: Aetna Commercial	$6.32
Rate for Payer: Aetna New Business (MI Preferred)	$4.84
Rate for Payer: Cash Price	$5.95
Rate for Payer: Cofinity Advantage	$5.21
Rate for Payer: Cofinity Commercial	$6.40
Rate for Payer: Encore Health Key Benefits Commercial	$5.95
Rate for Payer: Healthscope Commercial	$6.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.58
Rate for Payer: PHP Commercial	$6.32
Rate for Payer: Priority Health SBD	$4.69

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$1,395.39

Service Code	NDC 00781730931
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$548.39
Max. Negotiated Rate	$1,255.85
Rate for Payer: Aetna Commercial	$1,186.08
Rate for Payer: Aetna Medicare	$697.70
Rate for Payer: Aetna New Business (MI Preferred)	$907.00
Rate for Payer: BCBS Complete	$558.16
Rate for Payer: Cash Price	$1,116.31
Rate for Payer: Cofinity Advantage	$976.77
Rate for Payer: Cofinity Commercial	$1,200.04
Rate for Payer: Encore Health Key Benefits Commercial	$1,116.31
Rate for Payer: Healthscope Commercial	$1,255.85
Rate for Payer: MI Amish Medical Board Commercial	$1,116.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,186.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,046.54
Rate for Payer: PHP Commercial	$1,186.08
Rate for Payer: Priority Health SBD	$879.10
Rate for Payer: UHC All Payor (Choice/PPO)	$907.00
Rate for Payer: UHC Core	$727.00
Rate for Payer: UHC Exchange	$548.39

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$78.61

Service Code	NDC 00078050261
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$49.52
Max. Negotiated Rate	$70.75
Rate for Payer: Aetna Commercial	$66.82
Rate for Payer: Aetna New Business (MI Preferred)	$51.10
Rate for Payer: Cash Price	$62.89
Rate for Payer: Cofinity Advantage	$55.03
Rate for Payer: Cofinity Commercial	$67.60
Rate for Payer: Encore Health Key Benefits Commercial	$62.89
Rate for Payer: Healthscope Commercial	$70.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.96
Rate for Payer: PHP Commercial	$66.82
Rate for Payer: Priority Health SBD	$49.52

RIVASTIGMINE 9.5 MG/24 HOUR TRANSDERMAL PATCH

Facility

$46.52

Service Code	NDC 00781730958
Hospital Charge Code	82505
Hospital Revenue Code	637
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$41.87
Rate for Payer: Aetna Commercial	$39.54
Rate for Payer: Aetna Medicare	$23.26
Rate for Payer: Aetna New Business (MI Preferred)	$30.24
Rate for Payer: BCBS Complete	$18.61
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cofinity Advantage	$32.56
Rate for Payer: Cofinity Commercial	$40.01
Rate for Payer: Encore Health Key Benefits Commercial	$37.22
Rate for Payer: Healthscope Commercial	$41.87
Rate for Payer: MI Amish Medical Board Commercial	$37.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.89
Rate for Payer: PHP Commercial	$39.54
Rate for Payer: Priority Health SBD	$29.31
Rate for Payer: UHC All Payor (Choice/PPO)	$30.24
Rate for Payer: UHC Core	$24.24
Rate for Payer: UHC Exchange	$18.28

Know your out-of-pocket cost for care.

All Charges