Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$134.64

Service Code	NDC 23155031751
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$133.92

Service Code	NDC 00054006344
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$84.37
Max. Negotiated Rate	$120.53
Rate for Payer: Aetna Commercial	$113.83
Rate for Payer: Aetna New Business (MI Preferred)	$87.05
Rate for Payer: Cash Price	$107.14
Rate for Payer: Cofinity Commercial	$115.17
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Medicare Advantage	$93.74
Rate for Payer: Encore Health Key Benefits Commercial	$107.14
Rate for Payer: Healthscope Commercial	$120.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.83
Rate for Payer: PHP Commercial	$113.83
Rate for Payer: Priority Health Cigna Priority Health	$87.05
Rate for Payer: Priority Health SBD	$84.37

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$133.92

Service Code	NDC 00054006344
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$120.53
Rate for Payer: Aetna Commercial	$113.83
Rate for Payer: Aetna Medicare	$66.96
Rate for Payer: Aetna New Business (MI Preferred)	$87.05
Rate for Payer: BCBS Complete	$53.57
Rate for Payer: Cash Price	$107.14
Rate for Payer: Cofinity Commercial	$115.17
Rate for Payer: Cofinity Commercial	$93.74
Rate for Payer: Cofinity Medicare Advantage	$93.74
Rate for Payer: Encore Health Key Benefits Commercial	$107.14
Rate for Payer: Healthscope Commercial	$120.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$113.83
Rate for Payer: PHP Commercial	$113.83
Rate for Payer: Priority Health Cigna Priority Health	$87.05
Rate for Payer: Priority Health SBD	$84.37

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$74.45

Service Code	NDC 50458059601
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$29.78
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: Aetna Medicare	$37.23
Rate for Payer: Aetna New Business (MI Preferred)	$48.39
Rate for Payer: BCBS Complete	$29.78
Rate for Payer: Cash Price	$59.56
Rate for Payer: Cofinity Commercial	$52.12
Rate for Payer: Cofinity Commercial	$64.03
Rate for Payer: Cofinity Medicare Advantage	$52.12
Rate for Payer: Encore Health Key Benefits Commercial	$59.56
Rate for Payer: Healthscope Commercial	$67.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.28
Rate for Payer: PHP Commercial	$63.28
Rate for Payer: Priority Health Cigna Priority Health	$48.39
Rate for Payer: Priority Health SBD	$46.90

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$134.64

Service Code	NDC 23155031751
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$53.86
Max. Negotiated Rate	$121.18
Rate for Payer: Aetna Commercial	$114.44
Rate for Payer: Aetna Medicare	$67.32
Rate for Payer: Aetna New Business (MI Preferred)	$87.52
Rate for Payer: BCBS Complete	$53.86
Rate for Payer: Cash Price	$107.71
Rate for Payer: Cofinity Commercial	$115.79
Rate for Payer: Cofinity Commercial	$94.25
Rate for Payer: Cofinity Medicare Advantage	$94.25
Rate for Payer: Encore Health Key Benefits Commercial	$107.71
Rate for Payer: Healthscope Commercial	$121.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$114.44
Rate for Payer: PHP Commercial	$114.44
Rate for Payer: Priority Health Cigna Priority Health	$87.52
Rate for Payer: Priority Health SBD	$84.82

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$93.75

Service Code	NDC 65162067384
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$59.06
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Commercial	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Cofinity Medicare Advantage	$65.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$60.94
Rate for Payer: Priority Health SBD	$59.06

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$74.45

Service Code	NDC 50458059601
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$67.00
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: Aetna New Business (MI Preferred)	$48.39
Rate for Payer: Cash Price	$59.56
Rate for Payer: Cofinity Commercial	$52.12
Rate for Payer: Cofinity Commercial	$64.03
Rate for Payer: Cofinity Medicare Advantage	$52.12
Rate for Payer: Encore Health Key Benefits Commercial	$59.56
Rate for Payer: Healthscope Commercial	$67.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.28
Rate for Payer: PHP Commercial	$63.28
Rate for Payer: Priority Health Cigna Priority Health	$48.39
Rate for Payer: Priority Health SBD	$46.90

RISPERIDONE 1 MG/ML ORAL SOLUTION

Facility

$93.75

Service Code	NDC 65162067384
Hospital Charge Code	17377
Hospital Revenue Code	637
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: Aetna Medicare	$46.88
Rate for Payer: Aetna New Business (MI Preferred)	$60.94
Rate for Payer: BCBS Complete	$37.50
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Commercial	$65.62
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Cofinity Medicare Advantage	$65.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$60.94
Rate for Payer: Priority Health SBD	$59.06

RISPERIDONE 1 MG TABLET

Facility

$1,684.98

Service Code	NDC 50458030001
Hospital Charge Code	18313
Hospital Revenue Code	637
Min. Negotiated Rate	$673.99
Max. Negotiated Rate	$1,516.48
Rate for Payer: Aetna Commercial	$1,432.23
Rate for Payer: Aetna Medicare	$842.49
Rate for Payer: Aetna New Business (MI Preferred)	$1,095.24
Rate for Payer: BCBS Complete	$673.99
Rate for Payer: Cash Price	$1,347.98
Rate for Payer: Cofinity Commercial	$1,179.49
Rate for Payer: Cofinity Commercial	$1,449.08
Rate for Payer: Cofinity Medicare Advantage	$1,179.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,347.98
Rate for Payer: Healthscope Commercial	$1,516.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,432.23
Rate for Payer: PHP Commercial	$1,432.23
Rate for Payer: Priority Health Cigna Priority Health	$1,095.24
Rate for Payer: Priority Health SBD	$1,061.54

RISPERIDONE 1 MG TABLET

Facility

$1,684.98

Service Code	NDC 50458030001
Hospital Charge Code	18313
Hospital Revenue Code	637
Min. Negotiated Rate	$1,061.54
Max. Negotiated Rate	$1,516.48
Rate for Payer: Aetna Commercial	$1,432.23
Rate for Payer: Aetna New Business (MI Preferred)	$1,095.24
Rate for Payer: Cash Price	$1,347.98
Rate for Payer: Cofinity Commercial	$1,179.49
Rate for Payer: Cofinity Commercial	$1,449.08
Rate for Payer: Cofinity Medicare Advantage	$1,179.49
Rate for Payer: Encore Health Key Benefits Commercial	$1,347.98
Rate for Payer: Healthscope Commercial	$1,516.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,432.23
Rate for Payer: PHP Commercial	$1,432.23
Rate for Payer: Priority Health Cigna Priority Health	$1,095.24
Rate for Payer: Priority Health SBD	$1,061.54

RISPERIDONE 1 MG TABLET

Facility

$338.40

Service Code	NDC 00904635961
Hospital Charge Code	18313
Hospital Revenue Code	637
Min. Negotiated Rate	$135.36
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Cofinity Medicare Advantage	$236.88
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health SBD	$213.19

RISPERIDONE 1 MG TABLET

Facility

$338.40

Service Code	NDC 00904635961
Hospital Charge Code	18313
Hospital Revenue Code	637
Min. Negotiated Rate	$213.19
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Commercial	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Cofinity Medicare Advantage	$236.88
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health Cigna Priority Health	$219.96
Rate for Payer: Priority Health SBD	$213.19

RISPERIDONE 2 MG DISINTEGRATING TABLET

Facility

$99.06

Service Code	NDC 59746003022
Hospital Charge Code	35688
Hospital Revenue Code	637
Min. Negotiated Rate	$62.41
Max. Negotiated Rate	$89.15
Rate for Payer: Aetna Commercial	$84.20
Rate for Payer: Aetna New Business (MI Preferred)	$64.39
Rate for Payer: Cash Price	$79.25
Rate for Payer: Cofinity Commercial	$69.34
Rate for Payer: Cofinity Commercial	$85.19
Rate for Payer: Cofinity Medicare Advantage	$69.34
Rate for Payer: Encore Health Key Benefits Commercial	$79.25
Rate for Payer: Healthscope Commercial	$89.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.20
Rate for Payer: PHP Commercial	$84.20
Rate for Payer: Priority Health Cigna Priority Health	$64.39
Rate for Payer: Priority Health SBD	$62.41

RISPERIDONE 2 MG DISINTEGRATING TABLET

Facility

$99.06

Service Code	NDC 59746003022
Hospital Charge Code	35688
Hospital Revenue Code	637
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$89.15
Rate for Payer: Aetna Commercial	$84.20
Rate for Payer: Aetna Medicare	$49.53
Rate for Payer: Aetna New Business (MI Preferred)	$64.39
Rate for Payer: BCBS Complete	$39.62
Rate for Payer: Cash Price	$79.25
Rate for Payer: Cofinity Commercial	$69.34
Rate for Payer: Cofinity Commercial	$85.19
Rate for Payer: Cofinity Medicare Advantage	$69.34
Rate for Payer: Encore Health Key Benefits Commercial	$79.25
Rate for Payer: Healthscope Commercial	$89.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$84.20
Rate for Payer: PHP Commercial	$84.20
Rate for Payer: Priority Health Cigna Priority Health	$64.39
Rate for Payer: Priority Health SBD	$62.41

RISPERIDONE 3 MG DISINTEGRATING TABLET

Facility

$140.59

Service Code	NDC 59746004022
Hospital Charge Code	70257
Hospital Revenue Code	637
Min. Negotiated Rate	$88.57
Max. Negotiated Rate	$126.53
Rate for Payer: Aetna Commercial	$119.50
Rate for Payer: Aetna New Business (MI Preferred)	$91.38
Rate for Payer: Cash Price	$112.47
Rate for Payer: Cofinity Commercial	$120.91
Rate for Payer: Cofinity Commercial	$98.41
Rate for Payer: Cofinity Medicare Advantage	$98.41
Rate for Payer: Encore Health Key Benefits Commercial	$112.47
Rate for Payer: Healthscope Commercial	$126.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.50
Rate for Payer: PHP Commercial	$119.50
Rate for Payer: Priority Health Cigna Priority Health	$91.38
Rate for Payer: Priority Health SBD	$88.57

RISPERIDONE 3 MG DISINTEGRATING TABLET

Facility

$140.59

Service Code	NDC 59746004022
Hospital Charge Code	70257
Hospital Revenue Code	637
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$126.53
Rate for Payer: Aetna Commercial	$119.50
Rate for Payer: Aetna Medicare	$70.30
Rate for Payer: Aetna New Business (MI Preferred)	$91.38
Rate for Payer: BCBS Complete	$56.24
Rate for Payer: Cash Price	$112.47
Rate for Payer: Cofinity Commercial	$120.91
Rate for Payer: Cofinity Commercial	$98.41
Rate for Payer: Cofinity Medicare Advantage	$98.41
Rate for Payer: Encore Health Key Benefits Commercial	$112.47
Rate for Payer: Healthscope Commercial	$126.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.50
Rate for Payer: PHP Commercial	$119.50
Rate for Payer: Priority Health Cigna Priority Health	$91.38
Rate for Payer: Priority Health SBD	$88.57

RISPERIDONE 3 MG TABLET

Facility

$401.85

Service Code	NDC 00904636161
Hospital Charge Code	18312
Hospital Revenue Code	637
Min. Negotiated Rate	$160.74
Max. Negotiated Rate	$361.67
Rate for Payer: Aetna Commercial	$341.57
Rate for Payer: Aetna Medicare	$200.93
Rate for Payer: Aetna New Business (MI Preferred)	$261.20
Rate for Payer: BCBS Complete	$160.74
Rate for Payer: Cash Price	$321.48
Rate for Payer: Cofinity Commercial	$281.30
Rate for Payer: Cofinity Commercial	$345.59
Rate for Payer: Cofinity Medicare Advantage	$281.30
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$341.57
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health Cigna Priority Health	$261.20
Rate for Payer: Priority Health SBD	$253.17

RISPERIDONE 3 MG TABLET

Facility

$401.85

Service Code	NDC 00904636161
Hospital Charge Code	18312
Hospital Revenue Code	637
Min. Negotiated Rate	$253.17
Max. Negotiated Rate	$361.67
Rate for Payer: Aetna Commercial	$341.57
Rate for Payer: Aetna New Business (MI Preferred)	$261.20
Rate for Payer: Cash Price	$321.48
Rate for Payer: Cofinity Commercial	$281.30
Rate for Payer: Cofinity Commercial	$345.59
Rate for Payer: Cofinity Medicare Advantage	$281.30
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$341.57
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health Cigna Priority Health	$261.20
Rate for Payer: Priority Health SBD	$253.17

RISPERIDONE 4 MG TABLET

Facility

$197.60

Service Code	NDC 00904636261
Hospital Charge Code	18310
Hospital Revenue Code	637
Min. Negotiated Rate	$79.04
Max. Negotiated Rate	$177.84
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna Medicare	$98.80
Rate for Payer: Aetna New Business (MI Preferred)	$128.44
Rate for Payer: BCBS Complete	$79.04
Rate for Payer: Cash Price	$158.08
Rate for Payer: Cofinity Commercial	$138.32
Rate for Payer: Cofinity Commercial	$169.94
Rate for Payer: Cofinity Medicare Advantage	$138.32
Rate for Payer: Encore Health Key Benefits Commercial	$158.08
Rate for Payer: Healthscope Commercial	$177.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$167.96
Rate for Payer: PHP Commercial	$167.96
Rate for Payer: Priority Health Cigna Priority Health	$128.44
Rate for Payer: Priority Health SBD	$124.49

RISPERIDONE 4 MG TABLET

Facility

$3.70

Service Code	NDC 68084027711
Hospital Charge Code	18310
Hospital Revenue Code	637
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$3.33
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: Cash Price	$2.96
Rate for Payer: Cofinity Commercial	$2.59
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Medicare Advantage	$2.59
Rate for Payer: Encore Health Key Benefits Commercial	$2.96
Rate for Payer: Healthscope Commercial	$3.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.15
Rate for Payer: PHP Commercial	$3.15
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.33

RISPERIDONE 4 MG TABLET

Facility

$197.60

Service Code	NDC 00904636261
Hospital Charge Code	18310
Hospital Revenue Code	637
Min. Negotiated Rate	$124.49
Max. Negotiated Rate	$177.84
Rate for Payer: Aetna Commercial	$167.96
Rate for Payer: Aetna New Business (MI Preferred)	$128.44
Rate for Payer: Cash Price	$158.08
Rate for Payer: Cofinity Commercial	$138.32
Rate for Payer: Cofinity Commercial	$169.94
Rate for Payer: Cofinity Medicare Advantage	$138.32
Rate for Payer: Encore Health Key Benefits Commercial	$158.08
Rate for Payer: Healthscope Commercial	$177.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$167.96
Rate for Payer: PHP Commercial	$167.96
Rate for Payer: Priority Health Cigna Priority Health	$128.44
Rate for Payer: Priority Health SBD	$124.49

RISPERIDONE 4 MG TABLET

Facility

$3.70

Service Code	NDC 68084027711
Hospital Charge Code	18310
Hospital Revenue Code	637
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.33
Rate for Payer: Aetna Commercial	$3.15
Rate for Payer: Aetna Medicare	$1.85
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: BCBS Complete	$1.48
Rate for Payer: Cash Price	$2.96
Rate for Payer: Cofinity Commercial	$2.59
Rate for Payer: Cofinity Commercial	$3.18
Rate for Payer: Cofinity Medicare Advantage	$2.59
Rate for Payer: Encore Health Key Benefits Commercial	$2.96
Rate for Payer: Healthscope Commercial	$3.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.15
Rate for Payer: PHP Commercial	$3.15
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.33

RITONAVIR 100 MG TABLET

Facility

$927.74

Service Code	NDC 00074333330
Hospital Charge Code	100995
Hospital Revenue Code	637
Min. Negotiated Rate	$371.10
Max. Negotiated Rate	$834.97
Rate for Payer: Aetna Commercial	$788.58
Rate for Payer: Aetna Medicare	$463.87
Rate for Payer: Aetna New Business (MI Preferred)	$603.03
Rate for Payer: BCBS Complete	$371.10
Rate for Payer: Cash Price	$742.19
Rate for Payer: Cofinity Commercial	$649.42
Rate for Payer: Cofinity Commercial	$797.86
Rate for Payer: Cofinity Medicare Advantage	$649.42
Rate for Payer: Encore Health Key Benefits Commercial	$742.19
Rate for Payer: Healthscope Commercial	$834.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.58
Rate for Payer: PHP Commercial	$788.58
Rate for Payer: Priority Health Cigna Priority Health	$603.03
Rate for Payer: Priority Health SBD	$584.48

RITONAVIR 100 MG TABLET

Facility

$927.74

Service Code	NDC 00074333330
Hospital Charge Code	100995
Hospital Revenue Code	637
Min. Negotiated Rate	$584.48
Max. Negotiated Rate	$834.97
Rate for Payer: Aetna Commercial	$788.58
Rate for Payer: Aetna New Business (MI Preferred)	$603.03
Rate for Payer: Cash Price	$742.19
Rate for Payer: Cofinity Commercial	$649.42
Rate for Payer: Cofinity Commercial	$797.86
Rate for Payer: Cofinity Medicare Advantage	$649.42
Rate for Payer: Encore Health Key Benefits Commercial	$742.19
Rate for Payer: Healthscope Commercial	$834.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$788.58
Rate for Payer: PHP Commercial	$788.58
Rate for Payer: Priority Health Cigna Priority Health	$603.03
Rate for Payer: Priority Health SBD	$584.48

Know your out-of-pocket cost for care.

All Charges