Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RALOXIFENE 60 MG TABLET

Facility

$488.03

Service Code	NDC 50268069415
Hospital Charge Code	22143
Hospital Revenue Code	637
Min. Negotiated Rate	$307.46
Max. Negotiated Rate	$439.23
Rate for Payer: Aetna Commercial	$414.83
Rate for Payer: Aetna New Business (MI Preferred)	$317.22
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

RALOXIFENE 60 MG TABLET

Facility

$87.12

Service Code	NDC 65162005703
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: Cofinity Medicare Advantage	$60.98
Rate for Payer: Encore Health Key Benefits Commercial	$69.70
Rate for Payer: Healthscope Commercial	$78.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.05
Rate for Payer: PHP Commercial	$74.05
Rate for Payer: Priority Health Cigna Priority Health	$56.63
Rate for Payer: Priority Health SBD	$54.89

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

$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

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	$69.56
Max. Negotiated Rate	$156.51
Rate for Payer: Aetna Commercial	$147.82
Rate for Payer: Aetna Medicare	$86.95
Rate for Payer: Aetna New Business (MI Preferred)	$113.04
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	$147.82
Rate for Payer: PHP Commercial	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$113.04
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	$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	$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	$147.82
Rate for Payer: PHP Commercial	$147.82
Rate for Payer: Priority Health Cigna Priority Health	$113.04
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	$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

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

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	$28,077.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,615.45
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	$4,162.04
Rate for Payer: Priority Health SBD	$20,810.19

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	$39.08
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 Medicare	$75.83
Rate for Payer: Aetna Medicare	$75.83
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	$91.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$91.14
Rate for Payer: Amish Plain Church Group Commercial	$91.14
Rate for Payer: Amish Plain Church Group Commercial	$91.14
Rate for Payer: BCBS Complete	$41.03
Rate for Payer: BCBS Complete	$41.03
Rate for Payer: BCBS MAPPO	$72.91
Rate for Payer: BCBS MAPPO	$72.91
Rate for Payer: BCBS Trust/PPO	$197.04
Rate for Payer: BCBS Trust/PPO	$197.04
Rate for Payer: BCN Commercial	$197.04
Rate for Payer: BCN Commercial	$197.04
Rate for Payer: BCN Medicare Advantage	$72.91
Rate for Payer: BCN Medicare Advantage	$72.91
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: Cash Price	$26,425.63
Rate for Payer: Cofinity Commercial	$23,122.43
Rate for Payer: Cofinity Commercial	$5,681.51
Rate for Payer: Cofinity Commercial	$4,624.49
Rate for Payer: Cofinity Commercial	$28,407.55
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	$72.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$72.91
Rate for Payer: Healthscope Commercial	$5,945.77
Rate for Payer: Healthscope Commercial	$29,728.84
Rate for Payer: Mclaren Medicaid	$39.08
Rate for Payer: Mclaren Medicaid	$39.08
Rate for Payer: Mclaren Medicare	$72.91
Rate for Payer: Mclaren Medicare	$72.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$76.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$76.56
Rate for Payer: Meridian Medicaid	$41.03
Rate for Payer: Meridian Medicaid	$41.03
Rate for Payer: MI Amish Medical Board Commercial	$83.85
Rate for Payer: MI Amish Medical Board Commercial	$83.85
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: Nomi Health Commercial	$218.73
Rate for Payer: Nomi Health Commercial	$218.73
Rate for Payer: PACE Medicare	$69.26
Rate for Payer: PACE Medicare	$69.26
Rate for Payer: PACE SWMI	$72.91
Rate for Payer: PACE SWMI	$72.91
Rate for Payer: PHP Commercial	$28,077.23
Rate for Payer: PHP Commercial	$5,615.45
Rate for Payer: PHP Medicare Advantage	$72.91
Rate for Payer: PHP Medicare Advantage	$72.91
Rate for Payer: Priority Health Choice Medicaid	$39.08
Rate for Payer: Priority Health Choice Medicaid	$39.08
Rate for Payer: Priority Health Cigna Priority Health	$21,470.83
Rate for Payer: Priority Health Cigna Priority Health	$4,294.17
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$204.53
Rate for Payer: Priority Health Medicare	$72.91
Rate for Payer: Priority Health Medicare	$72.91
Rate for Payer: Priority Health Narrow Network	$163.62
Rate for Payer: Priority Health Narrow Network	$163.62
Rate for Payer: Priority Health SBD	$4,162.04
Rate for Payer: Priority Health SBD	$20,810.19
Rate for Payer: Railroad Medicare Medicare	$72.91
Rate for Payer: Railroad Medicare Medicare	$72.91
Rate for Payer: UHC All Payor (Choice/PPO)	$205.23
Rate for Payer: UHC All Payor (Choice/PPO)	$205.23
Rate for Payer: UHC Dual Complete DSNP	$72.91
Rate for Payer: UHC Dual Complete DSNP	$72.91
Rate for Payer: UHC Medicare Advantage	$72.91
Rate for Payer: UHC Medicare Advantage	$72.91
Rate for Payer: UHCCP Medicaid	$41.05
Rate for Payer: UHCCP Medicaid	$41.05
Rate for Payer: VA VA	$72.91
Rate for Payer: VA VA	$72.91

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

$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	$190.52
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

$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

$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

$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	$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	$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	$136.98
Max. Negotiated Rate	$308.20
Rate for Payer: Aetna Commercial	$291.07
Rate for Payer: Aetna Medicare	$171.22
Rate for Payer: Aetna New Business (MI Preferred)	$222.59
Rate for Payer: BCBS Complete	$136.98
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

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

RASAGILINE 1 MG TABLET

Facility

$737.04

Service Code	NDC 00093306156
Hospital Charge Code	76481
Hospital Revenue Code	637
Min. Negotiated Rate	$294.82
Max. Negotiated Rate	$663.34
Rate for Payer: Aetna Commercial	$626.48
Rate for Payer: Aetna Medicare	$368.52
Rate for Payer: Aetna New Business (MI Preferred)	$479.08
Rate for Payer: BCBS Complete	$294.82
Rate for Payer: Cash Price	$589.63
Rate for Payer: Cofinity Commercial	$515.93
Rate for Payer: Cofinity Commercial	$633.85
Rate for Payer: Cofinity Medicare Advantage	$515.93
Rate for Payer: Encore Health Key Benefits Commercial	$589.63
Rate for Payer: Healthscope Commercial	$663.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.48
Rate for Payer: PHP Commercial	$626.48
Rate for Payer: Priority Health Cigna Priority Health	$479.08
Rate for Payer: Priority Health SBD	$464.34

RASAGILINE 1 MG TABLET

Facility

$737.04

Service Code	NDC 00093306156
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: Cofinity Medicare Advantage	$515.93
Rate for Payer: Encore Health Key Benefits Commercial	$589.63
Rate for Payer: Healthscope Commercial	$663.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$626.48
Rate for Payer: PHP Commercial	$626.48
Rate for Payer: Priority Health Cigna Priority Health	$479.08
Rate for Payer: Priority Health SBD	$464.34

RASAGILINE 1 MG TABLET

Facility

$4,305.03

Service Code	NDC 68546022956
Hospital Charge Code	76481
Hospital Revenue Code	637
Min. Negotiated Rate	$2,712.17
Max. Negotiated Rate	$3,874.53
Rate for Payer: Aetna Commercial	$3,659.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,798.27
Rate for Payer: Cash Price	$3,444.02
Rate for Payer: Cofinity Commercial	$3,013.52
Rate for Payer: Cofinity Commercial	$3,702.33
Rate for Payer: Cofinity Medicare Advantage	$3,013.52
Rate for Payer: Encore Health Key Benefits Commercial	$3,444.02
Rate for Payer: Healthscope Commercial	$3,874.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,659.28
Rate for Payer: PHP Commercial	$3,659.28
Rate for Payer: Priority Health Cigna Priority Health	$2,798.27
Rate for Payer: Priority Health SBD	$2,712.17

Know your out-of-pocket cost for care.

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