Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

RIFAXIMIN 550 MG TABLET

Facility

$11,242.53

Service Code	NDC 65649030303
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$7,082.79
Max. Negotiated Rate	$10,118.28
Rate for Payer: Aetna Commercial	$9,556.15
Rate for Payer: Aetna New Business (MI Preferred)	$7,307.64
Rate for Payer: Cash Price	$8,994.02
Rate for Payer: Cofinity Commercial	$7,869.77
Rate for Payer: Cofinity Commercial	$9,668.58
Rate for Payer: Cofinity Medicare Advantage	$7,869.77
Rate for Payer: Encore Health Key Benefits Commercial	$8,994.02
Rate for Payer: Healthscope Commercial	$10,118.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,556.15
Rate for Payer: PHP Commercial	$9,556.15
Rate for Payer: Priority Health Cigna Priority Health	$7,307.64
Rate for Payer: Priority Health SBD	$7,082.79

RIFAXIMIN 550 MG TABLET

Facility

$11,242.53

Service Code	NDC 65649030302
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$7,082.79
Max. Negotiated Rate	$10,118.28
Rate for Payer: Aetna Commercial	$9,556.15
Rate for Payer: Aetna New Business (MI Preferred)	$7,307.64
Rate for Payer: Cash Price	$8,994.02
Rate for Payer: Cofinity Commercial	$7,869.77
Rate for Payer: Cofinity Commercial	$9,668.58
Rate for Payer: Cofinity Medicare Advantage	$7,869.77
Rate for Payer: Encore Health Key Benefits Commercial	$8,994.02
Rate for Payer: Healthscope Commercial	$10,118.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,556.15
Rate for Payer: PHP Commercial	$9,556.15
Rate for Payer: Priority Health Cigna Priority Health	$7,307.64
Rate for Payer: Priority Health SBD	$7,082.79

RIFAXIMIN 550 MG TABLET

Facility

$11,242.53

Service Code	NDC 65649030302
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$4,497.01
Max. Negotiated Rate	$10,118.28
Rate for Payer: Aetna Commercial	$9,556.15
Rate for Payer: Aetna Medicare	$5,621.27
Rate for Payer: Aetna New Business (MI Preferred)	$7,307.64
Rate for Payer: BCBS Complete	$4,497.01
Rate for Payer: Cash Price	$8,994.02
Rate for Payer: Cofinity Commercial	$7,869.77
Rate for Payer: Cofinity Commercial	$9,668.58
Rate for Payer: Cofinity Medicare Advantage	$7,869.77
Rate for Payer: Encore Health Key Benefits Commercial	$8,994.02
Rate for Payer: Healthscope Commercial	$10,118.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,556.15
Rate for Payer: PHP Commercial	$9,556.15
Rate for Payer: Priority Health Cigna Priority Health	$7,307.64
Rate for Payer: Priority Health SBD	$7,082.79

RIFAXIMIN 550 MG TABLET

Facility

$11,242.53

Service Code	NDC 65649030303
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$4,497.01
Max. Negotiated Rate	$10,118.28
Rate for Payer: Aetna Commercial	$9,556.15
Rate for Payer: Aetna Medicare	$5,621.27
Rate for Payer: Aetna New Business (MI Preferred)	$7,307.64
Rate for Payer: BCBS Complete	$4,497.01
Rate for Payer: Cash Price	$8,994.02
Rate for Payer: Cofinity Commercial	$7,869.77
Rate for Payer: Cofinity Commercial	$9,668.58
Rate for Payer: Cofinity Medicare Advantage	$7,869.77
Rate for Payer: Encore Health Key Benefits Commercial	$8,994.02
Rate for Payer: Healthscope Commercial	$10,118.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,556.15
Rate for Payer: PHP Commercial	$9,556.15
Rate for Payer: Priority Health Cigna Priority Health	$7,307.64
Rate for Payer: Priority Health SBD	$7,082.79

RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION

Facility

$26,969.02

Service Code	HCPCS J2327
Hospital Charge Code	200582
Hospital Revenue Code	636
Min. Negotiated Rate	$16,990.48
Max. Negotiated Rate	$24,272.12
Rate for Payer: Aetna Commercial	$22,923.67
Rate for Payer: Aetna New Business (MI Preferred)	$17,529.86
Rate for Payer: Cash Price	$21,575.22
Rate for Payer: Cofinity Commercial	$18,878.31
Rate for Payer: Cofinity Commercial	$23,193.36
Rate for Payer: Cofinity Medicare Advantage	$18,878.31
Rate for Payer: Encore Health Key Benefits Commercial	$21,575.22
Rate for Payer: Healthscope Commercial	$24,272.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,923.67
Rate for Payer: PHP Commercial	$22,923.67
Rate for Payer: Priority Health Cigna Priority Health	$17,529.86
Rate for Payer: Priority Health SBD	$16,990.48

RISANKIZUMAB-RZAA 60 MG/ML INTRAVENOUS SOLUTION

Facility

$26,969.02

Service Code	HCPCS J2327
Hospital Charge Code	200582
Hospital Revenue Code	636
Min. Negotiated Rate	$8.01
Max. Negotiated Rate	$24,272.12
Rate for Payer: Aetna Commercial	$22,923.67
Rate for Payer: Aetna Medicare	$15.54
Rate for Payer: Aetna New Business (MI Preferred)	$17,529.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$18.68
Rate for Payer: Amish Plain Church Group Commercial	$18.68
Rate for Payer: BCBS Complete	$8.41
Rate for Payer: BCBS MAPPO	$14.94
Rate for Payer: BCN Medicare Advantage	$14.94
Rate for Payer: Cash Price	$21,575.22
Rate for Payer: Cash Price	$21,575.22
Rate for Payer: Cofinity Commercial	$23,193.36
Rate for Payer: Cofinity Commercial	$18,878.31
Rate for Payer: Cofinity Medicare Advantage	$18,878.31
Rate for Payer: Encore Health Key Benefits Commercial	$21,575.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$14.94
Rate for Payer: Healthscope Commercial	$24,272.12
Rate for Payer: Mclaren Medicaid	$8.01
Rate for Payer: Mclaren Medicare	$14.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15.69
Rate for Payer: Meridian Medicaid	$8.41
Rate for Payer: MI Amish Medical Board Commercial	$17.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22,923.67
Rate for Payer: PACE Medicare	$14.19
Rate for Payer: PACE SWMI	$14.94
Rate for Payer: PHP Commercial	$22,923.67
Rate for Payer: PHP Medicare Advantage	$14.94
Rate for Payer: Priority Health Choice Medicaid	$8.01
Rate for Payer: Priority Health Cigna Priority Health	$17,529.86
Rate for Payer: Priority Health Medicare	$14.94
Rate for Payer: Priority Health SBD	$16,990.48
Rate for Payer: Railroad Medicare Medicare	$14.94
Rate for Payer: UHC All Payor (Choice/PPO)	$42.05
Rate for Payer: UHC Dual Complete DSNP	$14.94
Rate for Payer: UHC Medicare Advantage	$14.94
Rate for Payer: UHCCP Medicaid	$8.41
Rate for Payer: VA VA	$14.94

RISPERIDONE 0.25 MG TABLET

Facility

$310.20

Service Code	NDC 00904635761
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$124.08
Max. Negotiated Rate	$279.18
Rate for Payer: Aetna Commercial	$263.67
Rate for Payer: Aetna Medicare	$155.10
Rate for Payer: Aetna New Business (MI Preferred)	$201.63
Rate for Payer: BCBS Complete	$124.08
Rate for Payer: Cash Price	$248.16
Rate for Payer: Cofinity Commercial	$217.14
Rate for Payer: Cofinity Commercial	$266.77
Rate for Payer: Cofinity Medicare Advantage	$217.14
Rate for Payer: Encore Health Key Benefits Commercial	$248.16
Rate for Payer: Healthscope Commercial	$279.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.67
Rate for Payer: PHP Commercial	$263.67
Rate for Payer: Priority Health Cigna Priority Health	$201.63
Rate for Payer: Priority Health SBD	$195.43

RISPERIDONE 0.25 MG TABLET

Facility

$249.85

Service Code	NDC 51079046020
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$157.41
Max. Negotiated Rate	$224.87
Rate for Payer: Aetna Commercial	$212.37
Rate for Payer: Aetna New Business (MI Preferred)	$162.40
Rate for Payer: Cash Price	$199.88
Rate for Payer: Cofinity Commercial	$174.90
Rate for Payer: Cofinity Commercial	$214.87
Rate for Payer: Cofinity Medicare Advantage	$174.90
Rate for Payer: Encore Health Key Benefits Commercial	$199.88
Rate for Payer: Healthscope Commercial	$224.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$212.37
Rate for Payer: PHP Commercial	$212.37
Rate for Payer: Priority Health Cigna Priority Health	$162.40
Rate for Payer: Priority Health SBD	$157.41

RISPERIDONE 0.25 MG TABLET

Facility

$1.99

Service Code	NDC 68084027011
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Commercial	$1.71
Rate for Payer: Cofinity Medicare Advantage	$1.39
Rate for Payer: Encore Health Key Benefits Commercial	$1.59
Rate for Payer: Healthscope Commercial	$1.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.69
Rate for Payer: PHP Commercial	$1.69
Rate for Payer: Priority Health Cigna Priority Health	$1.29
Rate for Payer: Priority Health SBD	$1.25

RISPERIDONE 0.25 MG TABLET

Facility

$1.99

Service Code	NDC 68084027011
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.79
Rate for Payer: Aetna Commercial	$1.69
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: Aetna New Business (MI Preferred)	$1.29
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.59
Rate for Payer: Cofinity Commercial	$1.39
Rate for Payer: Cofinity Commercial	$1.71
Rate for Payer: Cofinity Medicare Advantage	$1.39
Rate for Payer: Encore Health Key Benefits Commercial	$1.59
Rate for Payer: Healthscope Commercial	$1.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.69
Rate for Payer: PHP Commercial	$1.69
Rate for Payer: Priority Health Cigna Priority Health	$1.29
Rate for Payer: Priority Health SBD	$1.25

RISPERIDONE 0.25 MG TABLET

Facility

$198.55

Service Code	NDC 68084027001
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$79.42
Max. Negotiated Rate	$178.69
Rate for Payer: Aetna Commercial	$168.77
Rate for Payer: Aetna Medicare	$99.28
Rate for Payer: Aetna New Business (MI Preferred)	$129.06
Rate for Payer: BCBS Complete	$79.42
Rate for Payer: Cash Price	$158.84
Rate for Payer: Cofinity Commercial	$138.99
Rate for Payer: Cofinity Commercial	$170.75
Rate for Payer: Cofinity Medicare Advantage	$138.99
Rate for Payer: Encore Health Key Benefits Commercial	$158.84
Rate for Payer: Healthscope Commercial	$178.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$168.77
Rate for Payer: PHP Commercial	$168.77
Rate for Payer: Priority Health Cigna Priority Health	$129.06
Rate for Payer: Priority Health SBD	$125.09

RISPERIDONE 0.25 MG TABLET

Facility

$198.55

Service Code	NDC 68084027001
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$125.09
Max. Negotiated Rate	$178.69
Rate for Payer: Aetna Commercial	$168.77
Rate for Payer: Aetna New Business (MI Preferred)	$129.06
Rate for Payer: Cash Price	$158.84
Rate for Payer: Cofinity Commercial	$138.99
Rate for Payer: Cofinity Commercial	$170.75
Rate for Payer: Cofinity Medicare Advantage	$138.99
Rate for Payer: Encore Health Key Benefits Commercial	$158.84
Rate for Payer: Healthscope Commercial	$178.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$168.77
Rate for Payer: PHP Commercial	$168.77
Rate for Payer: Priority Health Cigna Priority Health	$129.06
Rate for Payer: Priority Health SBD	$125.09

RISPERIDONE 0.25 MG TABLET

Facility

$310.20

Service Code	NDC 00904635761
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$195.43
Max. Negotiated Rate	$279.18
Rate for Payer: Aetna Commercial	$263.67
Rate for Payer: Aetna New Business (MI Preferred)	$201.63
Rate for Payer: Cash Price	$248.16
Rate for Payer: Cofinity Commercial	$217.14
Rate for Payer: Cofinity Commercial	$266.77
Rate for Payer: Cofinity Medicare Advantage	$217.14
Rate for Payer: Encore Health Key Benefits Commercial	$248.16
Rate for Payer: Healthscope Commercial	$279.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$263.67
Rate for Payer: PHP Commercial	$263.67
Rate for Payer: Priority Health Cigna Priority Health	$201.63
Rate for Payer: Priority Health SBD	$195.43

RISPERIDONE 0.25 MG TABLET

Facility

$249.85

Service Code	NDC 51079046020
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$99.94
Max. Negotiated Rate	$224.87
Rate for Payer: Aetna Commercial	$212.37
Rate for Payer: Aetna Medicare	$124.92
Rate for Payer: Aetna New Business (MI Preferred)	$162.40
Rate for Payer: BCBS Complete	$99.94
Rate for Payer: Cash Price	$199.88
Rate for Payer: Cofinity Commercial	$174.90
Rate for Payer: Cofinity Commercial	$214.87
Rate for Payer: Cofinity Medicare Advantage	$174.90
Rate for Payer: Encore Health Key Benefits Commercial	$199.88
Rate for Payer: Healthscope Commercial	$224.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$212.37
Rate for Payer: PHP Commercial	$212.37
Rate for Payer: Priority Health Cigna Priority Health	$162.40
Rate for Payer: Priority Health SBD	$157.41

RISPERIDONE 0.5 MG TABLET

Facility

$4.54

Service Code	NDC 68084027111
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$4.09
Rate for Payer: Aetna Commercial	$3.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.95
Rate for Payer: Cash Price	$3.63
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Commercial	$3.90
Rate for Payer: Cofinity Medicare Advantage	$3.18
Rate for Payer: Encore Health Key Benefits Commercial	$3.63
Rate for Payer: Healthscope Commercial	$4.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.86
Rate for Payer: PHP Commercial	$3.86
Rate for Payer: Priority Health Cigna Priority Health	$2.95
Rate for Payer: Priority Health SBD	$2.86

RISPERIDONE 0.5 MG TABLET

Facility

$453.55

Service Code	NDC 68084027101
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$181.42
Max. Negotiated Rate	$408.19
Rate for Payer: Aetna Commercial	$385.52
Rate for Payer: Aetna Medicare	$226.78
Rate for Payer: Aetna New Business (MI Preferred)	$294.81
Rate for Payer: BCBS Complete	$181.42
Rate for Payer: Cash Price	$362.84
Rate for Payer: Cofinity Commercial	$317.49
Rate for Payer: Cofinity Commercial	$390.05
Rate for Payer: Cofinity Medicare Advantage	$317.49
Rate for Payer: Encore Health Key Benefits Commercial	$362.84
Rate for Payer: Healthscope Commercial	$408.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.52
Rate for Payer: PHP Commercial	$385.52
Rate for Payer: Priority Health Cigna Priority Health	$294.81
Rate for Payer: Priority Health SBD	$285.74

RISPERIDONE 0.5 MG TABLET

Facility

$399.50

Service Code	NDC 00904635861
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$251.69
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.57
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.57
Rate for Payer: PHP Commercial	$339.57
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.69

RISPERIDONE 0.5 MG TABLET

Facility

$226.10

Service Code	NDC 00904736161
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$142.44
Max. Negotiated Rate	$203.49
Rate for Payer: Aetna Commercial	$192.19
Rate for Payer: Aetna New Business (MI Preferred)	$146.97
Rate for Payer: Cash Price	$180.88
Rate for Payer: Cofinity Commercial	$158.27
Rate for Payer: Cofinity Commercial	$194.45
Rate for Payer: Cofinity Medicare Advantage	$158.27
Rate for Payer: Encore Health Key Benefits Commercial	$180.88
Rate for Payer: Healthscope Commercial	$203.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.19
Rate for Payer: PHP Commercial	$192.19
Rate for Payer: Priority Health Cigna Priority Health	$146.97
Rate for Payer: Priority Health SBD	$142.44

RISPERIDONE 0.5 MG TABLET

Facility

$226.10

Service Code	NDC 00904736161
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$90.44
Max. Negotiated Rate	$203.49
Rate for Payer: Aetna Commercial	$192.19
Rate for Payer: Aetna Medicare	$113.05
Rate for Payer: Aetna New Business (MI Preferred)	$146.97
Rate for Payer: BCBS Complete	$90.44
Rate for Payer: Cash Price	$180.88
Rate for Payer: Cofinity Commercial	$158.27
Rate for Payer: Cofinity Commercial	$194.45
Rate for Payer: Cofinity Medicare Advantage	$158.27
Rate for Payer: Encore Health Key Benefits Commercial	$180.88
Rate for Payer: Healthscope Commercial	$203.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$192.19
Rate for Payer: PHP Commercial	$192.19
Rate for Payer: Priority Health Cigna Priority Health	$146.97
Rate for Payer: Priority Health SBD	$142.44

RISPERIDONE 0.5 MG TABLET

Facility

$453.55

Service Code	NDC 68084027101
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$285.74
Max. Negotiated Rate	$408.19
Rate for Payer: Aetna Commercial	$385.52
Rate for Payer: Aetna New Business (MI Preferred)	$294.81
Rate for Payer: Cash Price	$362.84
Rate for Payer: Cofinity Commercial	$317.49
Rate for Payer: Cofinity Commercial	$390.05
Rate for Payer: Cofinity Medicare Advantage	$317.49
Rate for Payer: Encore Health Key Benefits Commercial	$362.84
Rate for Payer: Healthscope Commercial	$408.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$385.52
Rate for Payer: PHP Commercial	$385.52
Rate for Payer: Priority Health Cigna Priority Health	$294.81
Rate for Payer: Priority Health SBD	$285.74

RISPERIDONE 0.5 MG TABLET

Facility

$399.50

Service Code	NDC 00904635861
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.57
Rate for Payer: Aetna Medicare	$199.75
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: BCBS Complete	$159.80
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.57
Rate for Payer: PHP Commercial	$339.57
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.69

RISPERIDONE 0.5 MG TABLET

Facility

$4.54

Service Code	NDC 68084027111
Hospital Charge Code	25520
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.09
Rate for Payer: Aetna Commercial	$3.86
Rate for Payer: Aetna Medicare	$2.27
Rate for Payer: Aetna New Business (MI Preferred)	$2.95
Rate for Payer: BCBS Complete	$1.82
Rate for Payer: Cash Price	$3.63
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Commercial	$3.90
Rate for Payer: Cofinity Medicare Advantage	$3.18
Rate for Payer: Encore Health Key Benefits Commercial	$3.63
Rate for Payer: Healthscope Commercial	$4.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.86
Rate for Payer: PHP Commercial	$3.86
Rate for Payer: Priority Health Cigna Priority Health	$2.95
Rate for Payer: Priority Health SBD	$2.86

RISPERIDONE 1 MG DISINTEGRATING TABLET

Facility

$389.33

Service Code	NDC 49884031591
Hospital Charge Code	35687
Hospital Revenue Code	637
Min. Negotiated Rate	$155.73
Max. Negotiated Rate	$350.40
Rate for Payer: Aetna Commercial	$330.93
Rate for Payer: Aetna Medicare	$194.66
Rate for Payer: Aetna New Business (MI Preferred)	$253.06
Rate for Payer: BCBS Complete	$155.73
Rate for Payer: Cash Price	$311.46
Rate for Payer: Cofinity Commercial	$272.53
Rate for Payer: Cofinity Commercial	$334.82
Rate for Payer: Cofinity Medicare Advantage	$272.53
Rate for Payer: Encore Health Key Benefits Commercial	$311.46
Rate for Payer: Healthscope Commercial	$350.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.93
Rate for Payer: PHP Commercial	$330.93
Rate for Payer: Priority Health Cigna Priority Health	$253.06
Rate for Payer: Priority Health SBD	$245.28

RISPERIDONE 1 MG DISINTEGRATING TABLET

Facility

$14.06

Service Code	NDC 49884031552
Hospital Charge Code	35687
Hospital Revenue Code	637
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$12.65
Rate for Payer: Aetna Commercial	$11.95
Rate for Payer: Aetna New Business (MI Preferred)	$9.14
Rate for Payer: Cash Price	$11.25
Rate for Payer: Cofinity Commercial	$12.09
Rate for Payer: Cofinity Commercial	$9.84
Rate for Payer: Cofinity Medicare Advantage	$9.84
Rate for Payer: Encore Health Key Benefits Commercial	$11.25
Rate for Payer: Healthscope Commercial	$12.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.95
Rate for Payer: PHP Commercial	$11.95
Rate for Payer: Priority Health Cigna Priority Health	$9.14
Rate for Payer: Priority Health SBD	$8.86

RISPERIDONE 1 MG DISINTEGRATING TABLET

Facility

$389.33

Service Code	NDC 49884031591
Hospital Charge Code	35687
Hospital Revenue Code	637
Min. Negotiated Rate	$245.28
Max. Negotiated Rate	$350.40
Rate for Payer: Aetna Commercial	$330.93
Rate for Payer: Aetna New Business (MI Preferred)	$253.06
Rate for Payer: Cash Price	$311.46
Rate for Payer: Cofinity Commercial	$272.53
Rate for Payer: Cofinity Commercial	$334.82
Rate for Payer: Cofinity Medicare Advantage	$272.53
Rate for Payer: Encore Health Key Benefits Commercial	$311.46
Rate for Payer: Healthscope Commercial	$350.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$330.93
Rate for Payer: PHP Commercial	$330.93
Rate for Payer: Priority Health Cigna Priority Health	$253.06
Rate for Payer: Priority Health SBD	$245.28

Know your out-of-pocket cost for care.

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