Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RALOXIFENE 60 MG TABLET

Facility

$19.94

Service Code	NDC 60687026611
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$17.95
Rate for Payer: Aetna Commercial	$16.95
Rate for Payer: Aetna New Business (MI Preferred)	$12.96
Rate for Payer: Cash Price	$15.95
Rate for Payer: Cofinity Commercial	$13.96
Rate for Payer: Cofinity Commercial	$17.15
Rate for Payer: Cofinity Medicare Advantage	$13.96
Rate for Payer: Encore Health Key Benefits Commercial	$15.95
Rate for Payer: Healthscope Commercial	$17.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.95
Rate for Payer: PHP Commercial	$16.95
Rate for Payer: Priority Health Cigna Priority Health	$12.96
Rate for Payer: Priority Health SBD	$12.56

RALOXIFENE 60 MG TABLET

Facility

$19.94

Service Code	NDC 60687026611
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$7.98
Max. Negotiated Rate	$17.95
Rate for Payer: Aetna Commercial	$16.95
Rate for Payer: Aetna Medicare	$9.97
Rate for Payer: Aetna New Business (MI Preferred)	$12.96
Rate for Payer: BCBS Complete	$7.98
Rate for Payer: Cash Price	$15.95
Rate for Payer: Cofinity Commercial	$13.96
Rate for Payer: Cofinity Commercial	$17.15
Rate for Payer: Cofinity Medicare Advantage	$13.96
Rate for Payer: Encore Health Key Benefits Commercial	$15.95
Rate for Payer: Healthscope Commercial	$17.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.95
Rate for Payer: PHP Commercial	$16.95
Rate for Payer: Priority Health Cigna Priority Health	$12.96
Rate for Payer: Priority Health SBD	$12.56

RALOXIFENE 60 MG TABLET

Facility

$714.29

Service Code	NDC 00002418430
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$285.72
Max. Negotiated Rate	$642.86
Rate for Payer: Aetna Commercial	$607.15
Rate for Payer: Aetna Medicare	$357.14
Rate for Payer: Aetna New Business (MI Preferred)	$464.29
Rate for Payer: BCBS Complete	$285.72
Rate for Payer: Cash Price	$571.43
Rate for Payer: Cofinity Commercial	$500.00
Rate for Payer: Cofinity Commercial	$614.29
Rate for Payer: Cofinity Medicare Advantage	$500.00
Rate for Payer: Encore Health Key Benefits Commercial	$571.43
Rate for Payer: Healthscope Commercial	$642.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$607.15
Rate for Payer: PHP Commercial	$607.15
Rate for Payer: Priority Health Cigna Priority Health	$464.29
Rate for Payer: Priority Health SBD	$450.00

RALOXIFENE 60 MG TABLET

Facility

$597.96

Service Code	NDC 60687026621
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$239.18
Max. Negotiated Rate	$538.16
Rate for Payer: Aetna Commercial	$508.27
Rate for Payer: Aetna Medicare	$298.98
Rate for Payer: Aetna New Business (MI Preferred)	$388.67
Rate for Payer: BCBS Complete	$239.18
Rate for Payer: Cash Price	$478.37
Rate for Payer: Cofinity Commercial	$418.57
Rate for Payer: Cofinity Commercial	$514.25
Rate for Payer: Cofinity Medicare Advantage	$418.57
Rate for Payer: Encore Health Key Benefits Commercial	$478.37
Rate for Payer: Healthscope Commercial	$538.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$508.27
Rate for Payer: PHP Commercial	$508.27
Rate for Payer: Priority Health Cigna Priority Health	$388.67
Rate for Payer: Priority Health SBD	$376.71

RALOXIFENE 60 MG TABLET

Facility

$597.96

Service Code	NDC 60687026621
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$376.71
Max. Negotiated Rate	$538.16
Rate for Payer: Aetna Commercial	$508.27
Rate for Payer: Aetna New Business (MI Preferred)	$388.67
Rate for Payer: Cash Price	$478.37
Rate for Payer: Cofinity Commercial	$418.57
Rate for Payer: Cofinity Commercial	$514.25
Rate for Payer: Cofinity Medicare Advantage	$418.57
Rate for Payer: Encore Health Key Benefits Commercial	$478.37
Rate for Payer: Healthscope Commercial	$538.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$508.27
Rate for Payer: PHP Commercial	$508.27
Rate for Payer: Priority Health Cigna Priority Health	$388.67
Rate for Payer: Priority Health SBD	$376.71

RALOXIFENE 60 MG TABLET

Facility

$9.77

Service Code	NDC 50268069411
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$8.79
Rate for Payer: Aetna Commercial	$8.30
Rate for Payer: Aetna New Business (MI Preferred)	$6.35
Rate for Payer: Cash Price	$7.82
Rate for Payer: Cofinity Commercial	$6.84
Rate for Payer: Cofinity Commercial	$8.40
Rate for Payer: Cofinity Medicare Advantage	$6.84
Rate for Payer: Encore Health Key Benefits Commercial	$7.82
Rate for Payer: Healthscope Commercial	$8.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.30
Rate for Payer: PHP Commercial	$8.30
Rate for Payer: Priority Health Cigna Priority Health	$6.35
Rate for Payer: Priority Health SBD	$6.16

RALOXIFENE 60 MG TABLET

Facility

$714.29

Service Code	NDC 00002418430
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$642.86
Rate for Payer: Aetna Commercial	$607.15
Rate for Payer: Aetna New Business (MI Preferred)	$464.29
Rate for Payer: Cash Price	$571.43
Rate for Payer: Cofinity Commercial	$500.00
Rate for Payer: Cofinity Commercial	$614.29
Rate for Payer: Cofinity Medicare Advantage	$500.00
Rate for Payer: Encore Health Key Benefits Commercial	$571.43
Rate for Payer: Healthscope Commercial	$642.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$607.15
Rate for Payer: PHP Commercial	$607.15
Rate for Payer: Priority Health Cigna Priority Health	$464.29
Rate for Payer: Priority Health SBD	$450.00

RALOXIFENE 60 MG TABLET

Facility

$488.03

Service Code	NDC 50268069415
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$195.21
Max. Negotiated Rate	$439.23
Rate for Payer: Aetna Commercial	$414.83
Rate for Payer: Aetna Medicare	$244.01
Rate for Payer: Aetna New Business (MI Preferred)	$317.22
Rate for Payer: BCBS Complete	$195.21
Rate for Payer: Cash Price	$390.42
Rate for Payer: Cofinity Commercial	$341.62
Rate for Payer: Cofinity Commercial	$419.71
Rate for Payer: Cofinity Medicare Advantage	$341.62
Rate for Payer: Encore Health Key Benefits Commercial	$390.42
Rate for Payer: Healthscope Commercial	$439.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$414.83
Rate for Payer: PHP Commercial	$414.83
Rate for Payer: Priority Health Cigna Priority Health	$317.22
Rate for Payer: Priority Health SBD	$307.46

RALTEGRAVIR 400 MG TABLET

Facility

$7,203.46

Service Code	NDC 00006022761
Hospital Charge Code	88608
Hospital Revenue Code	637
Min. Negotiated Rate	$2,881.38
Max. Negotiated Rate	$6,483.11
Rate for Payer: Aetna Commercial	$6,122.94
Rate for Payer: Aetna Medicare	$3,601.73
Rate for Payer: Aetna New Business (MI Preferred)	$4,682.25
Rate for Payer: BCBS Complete	$2,881.38
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: Cofinity Medicare Advantage	$5,042.42
Rate for Payer: Encore Health Key Benefits Commercial	$5,762.77
Rate for Payer: Healthscope Commercial	$6,483.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,122.94
Rate for Payer: PHP Commercial	$6,122.94
Rate for Payer: Priority Health Cigna Priority Health	$4,682.25
Rate for Payer: Priority Health SBD	$4,538.18

RALTEGRAVIR 400 MG TABLET

Facility

$7,203.46

Service Code	NDC 00006022761
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: Cofinity Medicare Advantage	$5,042.42
Rate for Payer: Encore Health Key Benefits Commercial	$5,762.77
Rate for Payer: Healthscope Commercial	$6,483.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6,122.94
Rate for Payer: PHP Commercial	$6,122.94
Rate for Payer: Priority Health Cigna Priority Health	$4,682.25
Rate for Payer: Priority Health SBD	$4,538.18

RAMIPRIL 1.25 MG CAPSULE

Facility

$173.90

Service Code	NDC 65862047401
Hospital Charge Code	11258
Hospital Revenue Code	637
Min. Negotiated Rate	$109.56
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$147.81
Rate for Payer: Aetna New Business (MI Preferred)	$113.03
Rate for Payer: Cash Price	$139.12
Rate for Payer: Cofinity Commercial	$121.73
Rate for Payer: Cofinity Commercial	$149.55
Rate for Payer: Cofinity Medicare Advantage	$121.73
Rate for Payer: Encore Health Key Benefits Commercial	$139.12
Rate for Payer: Healthscope Commercial	$156.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.81
Rate for Payer: PHP Commercial	$147.81
Rate for Payer: Priority Health Cigna Priority Health	$113.03
Rate for Payer: Priority Health SBD	$109.56

RAMIPRIL 1.25 MG CAPSULE

Facility

$173.90

Service Code	NDC 65862047401
Hospital Charge Code	11258
Hospital Revenue Code	637
Min. Negotiated Rate	$69.56
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$147.81
Rate for Payer: Aetna Medicare	$86.95
Rate for Payer: Aetna New Business (MI Preferred)	$113.03
Rate for Payer: BCBS Complete	$69.56
Rate for Payer: Cash Price	$139.12
Rate for Payer: Cofinity Commercial	$121.73
Rate for Payer: Cofinity Commercial	$149.55
Rate for Payer: Cofinity Medicare Advantage	$121.73
Rate for Payer: Encore Health Key Benefits Commercial	$139.12
Rate for Payer: Healthscope Commercial	$156.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.81
Rate for Payer: PHP Commercial	$147.81
Rate for Payer: Priority Health Cigna Priority Health	$113.03
Rate for Payer: Priority Health SBD	$109.56

RAMIPRIL 5 MG CAPSULE

Facility

$141.00

Service Code	NDC 65862047601
Hospital Charge Code	11261
Hospital Revenue Code	637
Min. Negotiated Rate	$88.83
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna Commercial	$119.85
Rate for Payer: Aetna New Business (MI Preferred)	$91.65
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$121.26
Rate for Payer: Cofinity Commercial	$98.70
Rate for Payer: Cofinity Medicare Advantage	$98.70
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: PHP Commercial	$119.85
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health SBD	$88.83

RAMIPRIL 5 MG CAPSULE

Facility

$141.00

Service Code	NDC 65862047601
Hospital Charge Code	11261
Hospital Revenue Code	637
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$126.90
Rate for Payer: Aetna Commercial	$119.85
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: Aetna New Business (MI Preferred)	$91.65
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$121.26
Rate for Payer: Cofinity Commercial	$98.70
Rate for Payer: Cofinity Medicare Advantage	$98.70
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: PHP Commercial	$119.85
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health SBD	$88.83

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION

Facility

$6,606.41

Service Code	HCPCS J9308
Hospital Charge Code	170507
Hospital Revenue Code	636
Min. Negotiated Rate	$39.86
Max. Negotiated Rate	$5,945.77
Rate for Payer: Aetna Commercial	$5,615.45
Rate for Payer: Aetna Commercial	$28,077.23
Rate for Payer: Aetna Medicare	$77.33
Rate for Payer: Aetna Medicare	$77.33
Rate for Payer: Aetna New Business (MI Preferred)	$4,294.17
Rate for Payer: Aetna New Business (MI Preferred)	$21,470.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$92.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$92.95
Rate for Payer: Amish Plain Church Group Commercial	$92.95
Rate for Payer: Amish Plain Church Group Commercial	$92.95
Rate for Payer: BCBS Complete	$41.85
Rate for Payer: BCBS Complete	$41.85
Rate for Payer: BCBS MAPPO	$74.36
Rate for Payer: BCBS MAPPO	$74.36
Rate for Payer: BCN Medicare Advantage	$74.36
Rate for Payer: BCN Medicare Advantage	$74.36
Rate for Payer: Cash Price	$26,425.63
Rate for Payer: Cash Price	$5,285.13
Rate for Payer: Cash Price	$5,285.13
Rate for Payer: Cash Price	$26,425.63
Rate for Payer: Cofinity Commercial	$28,407.55
Rate for Payer: Cofinity Commercial	$5,681.51
Rate for Payer: Cofinity Commercial	$4,624.49
Rate for Payer: Cofinity Commercial	$23,122.43
Rate for Payer: Cofinity Medicare Advantage	$23,122.43
Rate for Payer: Cofinity Medicare Advantage	$4,624.49
Rate for Payer: Encore Health Key Benefits Commercial	$26,425.63
Rate for Payer: Encore Health Key Benefits Commercial	$5,285.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$74.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$74.36
Rate for Payer: Healthscope Commercial	$5,945.77
Rate for Payer: Healthscope Commercial	$29,728.84
Rate for Payer: Mclaren Medicaid	$39.86
Rate for Payer: Mclaren Medicaid	$39.86
Rate for Payer: Mclaren Medicare	$74.36
Rate for Payer: Mclaren Medicare	$74.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$78.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$78.08
Rate for Payer: Meridian Medicaid	$41.85
Rate for Payer: Meridian Medicaid	$41.85
Rate for Payer: MI Amish Medical Board Commercial	$85.51
Rate for Payer: MI Amish Medical Board Commercial	$85.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,615.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28,077.23
Rate for Payer: PACE Medicare	$70.64
Rate for Payer: PACE Medicare	$70.64
Rate for Payer: PACE SWMI	$74.36
Rate for Payer: PACE SWMI	$74.36
Rate for Payer: PHP Commercial	$5,615.45
Rate for Payer: PHP Commercial	$28,077.23
Rate for Payer: PHP Medicare Advantage	$74.36
Rate for Payer: PHP Medicare Advantage	$74.36
Rate for Payer: Priority Health Choice Medicaid	$39.86
Rate for Payer: Priority Health Choice Medicaid	$39.86
Rate for Payer: Priority Health Cigna Priority Health	$4,294.17
Rate for Payer: Priority Health Cigna Priority Health	$21,470.83
Rate for Payer: Priority Health Medicare	$74.36
Rate for Payer: Priority Health Medicare	$74.36
Rate for Payer: Priority Health SBD	$20,810.19
Rate for Payer: Priority Health SBD	$4,162.04
Rate for Payer: Railroad Medicare Medicare	$74.36
Rate for Payer: Railroad Medicare Medicare	$74.36
Rate for Payer: UHC All Payor (Choice/PPO)	$209.32
Rate for Payer: UHC All Payor (Choice/PPO)	$209.32
Rate for Payer: UHC Dual Complete DSNP	$74.36
Rate for Payer: UHC Dual Complete DSNP	$74.36
Rate for Payer: UHC Medicare Advantage	$74.36
Rate for Payer: UHC Medicare Advantage	$74.36
Rate for Payer: UHCCP Medicaid	$41.86
Rate for Payer: UHCCP Medicaid	$41.86
Rate for Payer: VA VA	$74.36
Rate for Payer: VA VA	$74.36

RAMUCIRUMAB 10 MG/ML INTRAVENOUS SOLUTION

Facility

$33,032.04

Service Code	HCPCS J9308
Hospital Charge Code	170507
Hospital Revenue Code	636
Min. Negotiated Rate	$20,810.19
Max. Negotiated Rate	$29,728.84
Rate for Payer: Aetna Commercial	$28,077.23
Rate for Payer: Aetna Commercial	$5,615.45
Rate for Payer: Aetna New Business (MI Preferred)	$21,470.83
Rate for Payer: Aetna New Business (MI Preferred)	$4,294.17
Rate for Payer: Cash Price	$26,425.63
Rate for Payer: Cash Price	$5,285.13
Rate for Payer: Cofinity Commercial	$23,122.43
Rate for Payer: Cofinity Commercial	$4,624.49
Rate for Payer: Cofinity Commercial	$5,681.51
Rate for Payer: Cofinity Commercial	$28,407.55
Rate for Payer: Cofinity Medicare Advantage	$4,624.49
Rate for Payer: Cofinity Medicare Advantage	$23,122.43
Rate for Payer: Encore Health Key Benefits Commercial	$26,425.63
Rate for Payer: Encore Health Key Benefits Commercial	$5,285.13
Rate for Payer: Healthscope Commercial	$29,728.84
Rate for Payer: Healthscope Commercial	$5,945.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,615.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$28,077.23
Rate for Payer: PHP Commercial	$28,077.23
Rate for Payer: PHP Commercial	$5,615.45
Rate for Payer: Priority Health Cigna Priority Health	$4,294.17
Rate for Payer: Priority Health Cigna Priority Health	$21,470.83
Rate for Payer: Priority Health SBD	$20,810.19
Rate for Payer: Priority Health SBD	$4,162.04

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$5.91

Service Code	NDC 60687054911
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$5.32
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna Medicare	$2.96
Rate for Payer: Aetna New Business (MI Preferred)	$3.84
Rate for Payer: BCBS Complete	$2.36
Rate for Payer: Cash Price	$4.73
Rate for Payer: Cofinity Commercial	$4.14
Rate for Payer: Cofinity Commercial	$5.08
Rate for Payer: Cofinity Medicare Advantage	$4.14
Rate for Payer: Encore Health Key Benefits Commercial	$4.73
Rate for Payer: Healthscope Commercial	$5.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.02
Rate for Payer: PHP Commercial	$5.02
Rate for Payer: Priority Health Cigna Priority Health	$3.84
Rate for Payer: Priority Health SBD	$3.72

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$1,414.81

Service Code	NDC 61958100301
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: Cofinity Medicare Advantage	$990.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,131.85
Rate for Payer: Healthscope Commercial	$1,273.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,202.59
Rate for Payer: PHP Commercial	$1,202.59
Rate for Payer: Priority Health Cigna Priority Health	$919.63
Rate for Payer: Priority Health SBD	$891.33

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$1,414.81

Service Code	NDC 61958100301
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$565.92
Max. Negotiated Rate	$1,273.33
Rate for Payer: Aetna Commercial	$1,202.59
Rate for Payer: Aetna Medicare	$707.40
Rate for Payer: Aetna New Business (MI Preferred)	$919.63
Rate for Payer: BCBS Complete	$565.92
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: Cofinity Medicare Advantage	$990.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,131.85
Rate for Payer: Healthscope Commercial	$1,273.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,202.59
Rate for Payer: PHP Commercial	$1,202.59
Rate for Payer: Priority Health Cigna Priority Health	$919.63
Rate for Payer: Priority Health SBD	$891.33

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$381.03

Service Code	NDC 45963041806
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$152.41
Max. Negotiated Rate	$342.93
Rate for Payer: Aetna Commercial	$323.88
Rate for Payer: Aetna Medicare	$190.51
Rate for Payer: Aetna New Business (MI Preferred)	$247.67
Rate for Payer: BCBS Complete	$152.41
Rate for Payer: Cash Price	$304.82
Rate for Payer: Cofinity Commercial	$266.72
Rate for Payer: Cofinity Commercial	$327.69
Rate for Payer: Cofinity Medicare Advantage	$266.72
Rate for Payer: Encore Health Key Benefits Commercial	$304.82
Rate for Payer: Healthscope Commercial	$342.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.88
Rate for Payer: PHP Commercial	$323.88
Rate for Payer: Priority Health Cigna Priority Health	$247.67
Rate for Payer: Priority Health SBD	$240.05

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$5.91

Service Code	NDC 60687054911
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$5.32
Rate for Payer: Aetna Commercial	$5.02
Rate for Payer: Aetna New Business (MI Preferred)	$3.84
Rate for Payer: Cash Price	$4.73
Rate for Payer: Cofinity Commercial	$4.14
Rate for Payer: Cofinity Commercial	$5.08
Rate for Payer: Cofinity Medicare Advantage	$4.14
Rate for Payer: Encore Health Key Benefits Commercial	$4.73
Rate for Payer: Healthscope Commercial	$5.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.02
Rate for Payer: PHP Commercial	$5.02
Rate for Payer: Priority Health Cigna Priority Health	$3.84
Rate for Payer: Priority Health SBD	$3.72

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$177.12

Service Code	NDC 60687054921
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$159.41
Rate for Payer: Aetna Commercial	$150.55
Rate for Payer: Aetna Medicare	$88.56
Rate for Payer: Aetna New Business (MI Preferred)	$115.13
Rate for Payer: BCBS Complete	$70.85
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Cofinity Commercial	$152.32
Rate for Payer: Cofinity Medicare Advantage	$123.98
Rate for Payer: Encore Health Key Benefits Commercial	$141.70
Rate for Payer: Healthscope Commercial	$159.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.55
Rate for Payer: PHP Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$115.13
Rate for Payer: Priority Health SBD	$111.59

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$177.12

Service Code	NDC 60687054921
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$111.59
Max. Negotiated Rate	$159.41
Rate for Payer: Aetna Commercial	$150.55
Rate for Payer: Aetna New Business (MI Preferred)	$115.13
Rate for Payer: Cash Price	$141.70
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Cofinity Commercial	$152.32
Rate for Payer: Cofinity Medicare Advantage	$123.98
Rate for Payer: Encore Health Key Benefits Commercial	$141.70
Rate for Payer: Healthscope Commercial	$159.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$150.55
Rate for Payer: PHP Commercial	$150.55
Rate for Payer: Priority Health Cigna Priority Health	$115.13
Rate for Payer: Priority Health SBD	$111.59

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility

$381.03

Service Code	NDC 45963041806
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: Cofinity Medicare Advantage	$266.72
Rate for Payer: Encore Health Key Benefits Commercial	$304.82
Rate for Payer: Healthscope Commercial	$342.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.88
Rate for Payer: PHP Commercial	$323.88
Rate for Payer: Priority Health Cigna Priority Health	$247.67
Rate for Payer: Priority Health SBD	$240.05

RASAGILINE 0.5 MG TABLET

Facility

$342.44

Service Code	NDC 67877025930
Hospital Charge Code	76480
Hospital Revenue Code	637
Min. Negotiated Rate	$215.74
Max. Negotiated Rate	$308.20
Rate for Payer: Aetna Commercial	$291.07
Rate for Payer: Aetna New Business (MI Preferred)	$222.59
Rate for Payer: Cash Price	$273.95
Rate for Payer: Cofinity Commercial	$239.71
Rate for Payer: Cofinity Commercial	$294.50
Rate for Payer: Cofinity Medicare Advantage	$239.71
Rate for Payer: Encore Health Key Benefits Commercial	$273.95
Rate for Payer: Healthscope Commercial	$308.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$291.07
Rate for Payer: PHP Commercial	$291.07
Rate for Payer: Priority Health Cigna Priority Health	$222.59
Rate for Payer: Priority Health SBD	$215.74

Know your out-of-pocket cost for care.

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