Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

APR-DRG 42.00: VIRAL ILLNESS

Facility

$7,791.34

Service Code	APR-DRG 7234
Min. Negotiated Rate	$7,420.32
Max. Negotiated Rate	$7,791.34
Rate for Payer: BCBS Complete	$7,791.34
Rate for Payer: Mclaren Medicaid	$7,420.32
Rate for Payer: Meridian Medicaid	$7,791.34
Rate for Payer: Priority Health Choice Medicaid	$7,420.32
Rate for Payer: UHCCP Medicaid	$7,791.34

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$6,600.99

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,286.66
Max. Negotiated Rate	$6,600.99
Rate for Payer: BCBS Complete	$6,600.99
Rate for Payer: Mclaren Medicaid	$6,286.66
Rate for Payer: Meridian Medicaid	$6,600.99
Rate for Payer: Priority Health Choice Medicaid	$6,286.66
Rate for Payer: UHCCP Medicaid	$6,600.99

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$4,328.52

Service Code	APR-DRG 0512
Min. Negotiated Rate	$4,122.40
Max. Negotiated Rate	$4,328.52
Rate for Payer: BCBS Complete	$4,328.52
Rate for Payer: Mclaren Medicaid	$4,122.40
Rate for Payer: Meridian Medicaid	$4,328.52
Rate for Payer: Priority Health Choice Medicaid	$4,122.40
Rate for Payer: UHCCP Medicaid	$4,328.52

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$10,009.70

Service Code	APR-DRG 0514
Min. Negotiated Rate	$9,533.05
Max. Negotiated Rate	$10,009.70
Rate for Payer: BCBS Complete	$10,009.70
Rate for Payer: Mclaren Medicaid	$9,533.05
Rate for Payer: Meridian Medicaid	$10,009.70
Rate for Payer: Priority Health Choice Medicaid	$9,533.05
Rate for Payer: UHCCP Medicaid	$10,009.70

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$3,516.92

Service Code	APR-DRG 0511
Min. Negotiated Rate	$3,349.45
Max. Negotiated Rate	$3,516.92
Rate for Payer: BCBS Complete	$3,516.92
Rate for Payer: Mclaren Medicaid	$3,349.45
Rate for Payer: Meridian Medicaid	$3,516.92
Rate for Payer: Priority Health Choice Medicaid	$3,349.45
Rate for Payer: UHCCP Medicaid	$3,516.92

APREPITANT 125 MG (1)-80 MG (2) CAPSULES IN A DOSE PACK

Facility

$2,664.42

Service Code	NDC 00006386203
Hospital Charge Code	35490
Hospital Revenue Code	637
Min. Negotiated Rate	$1,065.77
Max. Negotiated Rate	$2,397.98
Rate for Payer: Aetna Commercial	$2,264.76
Rate for Payer: Aetna Medicare	$1,332.21
Rate for Payer: Aetna New Business (MI Preferred)	$1,731.87
Rate for Payer: BCBS Complete	$1,065.77
Rate for Payer: Cash Price	$2,131.54
Rate for Payer: Cofinity Commercial	$1,865.09
Rate for Payer: Cofinity Commercial	$2,291.40
Rate for Payer: Cofinity Medicare Advantage	$1,865.09
Rate for Payer: Encore Health Key Benefits Commercial	$2,131.54
Rate for Payer: Healthscope Commercial	$2,397.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,264.76
Rate for Payer: PHP Commercial	$2,264.76
Rate for Payer: Priority Health Cigna Priority Health	$1,731.87
Rate for Payer: Priority Health SBD	$1,678.58

APREPITANT 80 MG CAPSULE

Facility

$1,505.42

Service Code	NDC 00006046102
Hospital Charge Code	35488
Hospital Revenue Code	637
Min. Negotiated Rate	$602.17
Max. Negotiated Rate	$1,354.88
Rate for Payer: Aetna Commercial	$1,279.61
Rate for Payer: Aetna Medicare	$752.71
Rate for Payer: Aetna New Business (MI Preferred)	$978.52
Rate for Payer: BCBS Complete	$602.17
Rate for Payer: Cash Price	$1,204.34
Rate for Payer: Cofinity Commercial	$1,053.79
Rate for Payer: Cofinity Commercial	$1,294.66
Rate for Payer: Cofinity Medicare Advantage	$1,053.79
Rate for Payer: Encore Health Key Benefits Commercial	$1,204.34
Rate for Payer: Healthscope Commercial	$1,354.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,279.61
Rate for Payer: PHP Commercial	$1,279.61
Rate for Payer: Priority Health Cigna Priority Health	$978.52
Rate for Payer: Priority Health SBD	$948.41

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION

Facility

$16.19

Service Code	HCPCS J7605
Hospital Charge Code	77581
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Commercial	$18.77
Rate for Payer: Aetna New Business (MI Preferred)	$10.52
Rate for Payer: Aetna New Business (MI Preferred)	$14.35
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cash Price	$17.66
Rate for Payer: Cofinity Commercial	$11.33
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Cofinity Commercial	$18.99
Rate for Payer: Cofinity Commercial	$13.92
Rate for Payer: Cofinity Medicare Advantage	$15.46
Rate for Payer: Cofinity Medicare Advantage	$11.33
Rate for Payer: Encore Health Key Benefits Commercial	$12.95
Rate for Payer: Encore Health Key Benefits Commercial	$17.66
Rate for Payer: Healthscope Commercial	$14.57
Rate for Payer: Healthscope Commercial	$19.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.77
Rate for Payer: PHP Commercial	$13.76
Rate for Payer: PHP Commercial	$18.77
Rate for Payer: Priority Health Cigna Priority Health	$14.35
Rate for Payer: Priority Health Cigna Priority Health	$10.52
Rate for Payer: Priority Health SBD	$13.91
Rate for Payer: Priority Health SBD	$10.20

ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION

Facility

$16.19

Service Code	HCPCS J7605
Hospital Charge Code	77581
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna Commercial	$13.76
Rate for Payer: Aetna Commercial	$18.77
Rate for Payer: Aetna Medicare	$11.04
Rate for Payer: Aetna Medicare	$8.10
Rate for Payer: Aetna New Business (MI Preferred)	$10.52
Rate for Payer: Aetna New Business (MI Preferred)	$14.35
Rate for Payer: BCBS Complete	$6.48
Rate for Payer: BCBS Complete	$8.83
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cash Price	$17.66
Rate for Payer: Cash Price	$17.66
Rate for Payer: Cash Price	$12.95
Rate for Payer: Cofinity Commercial	$11.33
Rate for Payer: Cofinity Commercial	$13.92
Rate for Payer: Cofinity Commercial	$18.99
Rate for Payer: Cofinity Commercial	$15.46
Rate for Payer: Cofinity Medicare Advantage	$15.46
Rate for Payer: Cofinity Medicare Advantage	$11.33
Rate for Payer: Encore Health Key Benefits Commercial	$17.66
Rate for Payer: Encore Health Key Benefits Commercial	$12.95
Rate for Payer: Healthscope Commercial	$14.57
Rate for Payer: Healthscope Commercial	$19.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.77
Rate for Payer: PHP Commercial	$13.76
Rate for Payer: PHP Commercial	$18.77
Rate for Payer: Priority Health Cigna Priority Health	$14.35
Rate for Payer: Priority Health Cigna Priority Health	$10.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$0.81
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$0.81
Rate for Payer: Priority Health Narrow Network	$0.65
Rate for Payer: Priority Health Narrow Network	$0.65
Rate for Payer: Priority Health SBD	$13.91
Rate for Payer: Priority Health SBD	$10.20

ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$421.08

Service Code	HCPCS J0883
Hospital Charge Code	152708
Hospital Revenue Code	636
Min. Negotiated Rate	$265.28
Max. Negotiated Rate	$378.97
Rate for Payer: Aetna Commercial	$357.92
Rate for Payer: Aetna Commercial	$367.78
Rate for Payer: Aetna New Business (MI Preferred)	$273.70
Rate for Payer: Aetna New Business (MI Preferred)	$281.24
Rate for Payer: Cash Price	$336.86
Rate for Payer: Cash Price	$346.14
Rate for Payer: Cofinity Commercial	$294.76
Rate for Payer: Cofinity Commercial	$302.88
Rate for Payer: Cofinity Commercial	$372.10
Rate for Payer: Cofinity Commercial	$362.13
Rate for Payer: Cofinity Medicare Advantage	$302.88
Rate for Payer: Cofinity Medicare Advantage	$294.76
Rate for Payer: Encore Health Key Benefits Commercial	$336.86
Rate for Payer: Encore Health Key Benefits Commercial	$346.14
Rate for Payer: Healthscope Commercial	$378.97
Rate for Payer: Healthscope Commercial	$389.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.78
Rate for Payer: PHP Commercial	$357.92
Rate for Payer: PHP Commercial	$367.78
Rate for Payer: Priority Health Cigna Priority Health	$281.24
Rate for Payer: Priority Health Cigna Priority Health	$273.70
Rate for Payer: Priority Health SBD	$272.59
Rate for Payer: Priority Health SBD	$265.28

ARGATROBAN 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION

Facility

$432.68

Service Code	HCPCS J0883
Hospital Charge Code	152708
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$389.41
Rate for Payer: Aetna Commercial	$367.78
Rate for Payer: Aetna Commercial	$357.92
Rate for Payer: Aetna Medicare	$0.83
Rate for Payer: Aetna Medicare	$0.83
Rate for Payer: Aetna New Business (MI Preferred)	$281.24
Rate for Payer: Aetna New Business (MI Preferred)	$273.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.00
Rate for Payer: Amish Plain Church Group Commercial	$1.00
Rate for Payer: Amish Plain Church Group Commercial	$1.00
Rate for Payer: BCBS Complete	$0.45
Rate for Payer: BCBS Complete	$0.45
Rate for Payer: BCBS MAPPO	$0.80
Rate for Payer: BCBS MAPPO	$0.80
Rate for Payer: BCBS Trust/PPO	$4.77
Rate for Payer: BCBS Trust/PPO	$4.77
Rate for Payer: BCN Commercial	$4.77
Rate for Payer: BCN Commercial	$4.77
Rate for Payer: BCN Medicare Advantage	$0.80
Rate for Payer: BCN Medicare Advantage	$0.80
Rate for Payer: Cash Price	$336.86
Rate for Payer: Cash Price	$336.86
Rate for Payer: Cash Price	$346.14
Rate for Payer: Cash Price	$346.14
Rate for Payer: Cofinity Commercial	$302.88
Rate for Payer: Cofinity Commercial	$294.76
Rate for Payer: Cofinity Commercial	$372.10
Rate for Payer: Cofinity Commercial	$362.13
Rate for Payer: Cofinity Medicare Advantage	$294.76
Rate for Payer: Cofinity Medicare Advantage	$302.88
Rate for Payer: Encore Health Key Benefits Commercial	$346.14
Rate for Payer: Encore Health Key Benefits Commercial	$336.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.80
Rate for Payer: Healthscope Commercial	$389.41
Rate for Payer: Healthscope Commercial	$378.97
Rate for Payer: Mclaren Medicaid	$0.43
Rate for Payer: Mclaren Medicaid	$0.43
Rate for Payer: Mclaren Medicare	$0.80
Rate for Payer: Mclaren Medicare	$0.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.84
Rate for Payer: Meridian Medicaid	$0.45
Rate for Payer: Meridian Medicaid	$0.45
Rate for Payer: MI Amish Medical Board Commercial	$0.92
Rate for Payer: MI Amish Medical Board Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$367.78
Rate for Payer: Nomi Health Commercial	$2.40
Rate for Payer: Nomi Health Commercial	$2.40
Rate for Payer: PACE Medicare	$0.76
Rate for Payer: PACE Medicare	$0.76
Rate for Payer: PACE SWMI	$0.80
Rate for Payer: PACE SWMI	$0.80
Rate for Payer: PHP Commercial	$367.78
Rate for Payer: PHP Commercial	$357.92
Rate for Payer: PHP Medicare Advantage	$0.80
Rate for Payer: PHP Medicare Advantage	$0.80
Rate for Payer: Priority Health Choice Medicaid	$0.43
Rate for Payer: Priority Health Choice Medicaid	$0.43
Rate for Payer: Priority Health Cigna Priority Health	$273.70
Rate for Payer: Priority Health Cigna Priority Health	$281.24
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3.62
Rate for Payer: Priority Health Medicare	$0.80
Rate for Payer: Priority Health Medicare	$0.80
Rate for Payer: Priority Health Narrow Network	$2.90
Rate for Payer: Priority Health Narrow Network	$2.90
Rate for Payer: Priority Health SBD	$272.59
Rate for Payer: Priority Health SBD	$265.28
Rate for Payer: Railroad Medicare Medicare	$0.80
Rate for Payer: Railroad Medicare Medicare	$0.80
Rate for Payer: UHC All Payor (Choice/PPO)	$2.25
Rate for Payer: UHC All Payor (Choice/PPO)	$2.25
Rate for Payer: UHC Dual Complete DSNP	$0.80
Rate for Payer: UHC Dual Complete DSNP	$0.80
Rate for Payer: UHC Medicare Advantage	$0.80
Rate for Payer: UHC Medicare Advantage	$0.80
Rate for Payer: UHCCP Medicaid	$0.45
Rate for Payer: UHCCP Medicaid	$0.45
Rate for Payer: VA VA	$0.80
Rate for Payer: VA VA	$0.80

ARIPIPRAZOLE 10 MG TABLET

Facility

$2,008.88

Service Code	NDC 59148000813
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$1,265.59
Max. Negotiated Rate	$1,807.99
Rate for Payer: Aetna Commercial	$1,707.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,305.77
Rate for Payer: Cash Price	$1,607.10
Rate for Payer: Cofinity Commercial	$1,406.22
Rate for Payer: Cofinity Commercial	$1,727.64
Rate for Payer: Cofinity Medicare Advantage	$1,406.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,607.10
Rate for Payer: Healthscope Commercial	$1,807.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,707.55
Rate for Payer: PHP Commercial	$1,707.55
Rate for Payer: Priority Health Cigna Priority Health	$1,305.77
Rate for Payer: Priority Health SBD	$1,265.59

ARIPIPRAZOLE 10 MG TABLET

Facility

$93.75

Service Code	NDC 27241005303
Hospital Charge Code	34369
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

ARIPIPRAZOLE 10 MG TABLET

Facility

$195.27

Service Code	NDC 43547030403
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$123.02
Max. Negotiated Rate	$175.74
Rate for Payer: Aetna Commercial	$165.98
Rate for Payer: Aetna New Business (MI Preferred)	$126.93
Rate for Payer: Cash Price	$156.22
Rate for Payer: Cofinity Commercial	$136.69
Rate for Payer: Cofinity Commercial	$167.93
Rate for Payer: Cofinity Medicare Advantage	$136.69
Rate for Payer: Encore Health Key Benefits Commercial	$156.22
Rate for Payer: Healthscope Commercial	$175.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.98
Rate for Payer: PHP Commercial	$165.98
Rate for Payer: Priority Health Cigna Priority Health	$126.93
Rate for Payer: Priority Health SBD	$123.02

ARIPIPRAZOLE 10 MG TABLET

Facility

$2,008.88

Service Code	NDC 59148000813
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$803.55
Max. Negotiated Rate	$1,807.99
Rate for Payer: Aetna Commercial	$1,707.55
Rate for Payer: Aetna Medicare	$1,004.44
Rate for Payer: Aetna New Business (MI Preferred)	$1,305.77
Rate for Payer: BCBS Complete	$803.55
Rate for Payer: Cash Price	$1,607.10
Rate for Payer: Cofinity Commercial	$1,406.22
Rate for Payer: Cofinity Commercial	$1,727.64
Rate for Payer: Cofinity Medicare Advantage	$1,406.22
Rate for Payer: Encore Health Key Benefits Commercial	$1,607.10
Rate for Payer: Healthscope Commercial	$1,807.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,707.55
Rate for Payer: PHP Commercial	$1,707.55
Rate for Payer: Priority Health Cigna Priority Health	$1,305.77
Rate for Payer: Priority Health SBD	$1,265.59

ARIPIPRAZOLE 10 MG TABLET

Facility

$71.54

Service Code	NDC 65162089803
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$45.07
Max. Negotiated Rate	$64.39
Rate for Payer: Aetna Commercial	$60.81
Rate for Payer: Aetna New Business (MI Preferred)	$46.50
Rate for Payer: Cash Price	$57.23
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$61.52
Rate for Payer: Cofinity Medicare Advantage	$50.08
Rate for Payer: Encore Health Key Benefits Commercial	$57.23
Rate for Payer: Healthscope Commercial	$64.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.81
Rate for Payer: PHP Commercial	$60.81
Rate for Payer: Priority Health Cigna Priority Health	$46.50
Rate for Payer: Priority Health SBD	$45.07

ARIPIPRAZOLE 10 MG TABLET

Facility

$71.54

Service Code	NDC 65162089803
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$28.62
Max. Negotiated Rate	$64.39
Rate for Payer: Aetna Commercial	$60.81
Rate for Payer: Aetna Medicare	$35.77
Rate for Payer: Aetna New Business (MI Preferred)	$46.50
Rate for Payer: BCBS Complete	$28.62
Rate for Payer: Cash Price	$57.23
Rate for Payer: Cofinity Commercial	$50.08
Rate for Payer: Cofinity Commercial	$61.52
Rate for Payer: Cofinity Medicare Advantage	$50.08
Rate for Payer: Encore Health Key Benefits Commercial	$57.23
Rate for Payer: Healthscope Commercial	$64.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$60.81
Rate for Payer: PHP Commercial	$60.81
Rate for Payer: Priority Health Cigna Priority Health	$46.50
Rate for Payer: Priority Health SBD	$45.07

ARIPIPRAZOLE 10 MG TABLET

Facility

$195.27

Service Code	NDC 43547030403
Hospital Charge Code	34369
Hospital Revenue Code	637
Min. Negotiated Rate	$78.11
Max. Negotiated Rate	$175.74
Rate for Payer: Aetna Commercial	$165.98
Rate for Payer: Aetna Medicare	$97.64
Rate for Payer: Aetna New Business (MI Preferred)	$126.93
Rate for Payer: BCBS Complete	$78.11
Rate for Payer: Cash Price	$156.22
Rate for Payer: Cofinity Commercial	$136.69
Rate for Payer: Cofinity Commercial	$167.93
Rate for Payer: Cofinity Medicare Advantage	$136.69
Rate for Payer: Encore Health Key Benefits Commercial	$156.22
Rate for Payer: Healthscope Commercial	$175.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.98
Rate for Payer: PHP Commercial	$165.98
Rate for Payer: Priority Health Cigna Priority Health	$126.93
Rate for Payer: Priority Health SBD	$123.02

ARIPIPRAZOLE 10 MG TABLET

Facility

$93.75

Service Code	NDC 27241005303
Hospital Charge Code	34369
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

ARIPIPRAZOLE 15 MG TABLET

Facility

$27.29

Service Code	NDC 60687019111
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$17.19
Max. Negotiated Rate	$24.56
Rate for Payer: Aetna Commercial	$23.20
Rate for Payer: Aetna New Business (MI Preferred)	$17.74
Rate for Payer: Cash Price	$21.83
Rate for Payer: Cofinity Commercial	$19.10
Rate for Payer: Cofinity Commercial	$23.47
Rate for Payer: Cofinity Medicare Advantage	$19.10
Rate for Payer: Encore Health Key Benefits Commercial	$21.83
Rate for Payer: Healthscope Commercial	$24.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.20
Rate for Payer: PHP Commercial	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$17.74
Rate for Payer: Priority Health SBD	$17.19

ARIPIPRAZOLE 15 MG TABLET

Facility

$818.63

Service Code	NDC 60687019121
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$515.74
Max. Negotiated Rate	$736.77
Rate for Payer: Aetna Commercial	$695.84
Rate for Payer: Aetna New Business (MI Preferred)	$532.11
Rate for Payer: Cash Price	$654.90
Rate for Payer: Cofinity Commercial	$573.04
Rate for Payer: Cofinity Commercial	$704.02
Rate for Payer: Cofinity Medicare Advantage	$573.04
Rate for Payer: Encore Health Key Benefits Commercial	$654.90
Rate for Payer: Healthscope Commercial	$736.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$695.84
Rate for Payer: PHP Commercial	$695.84
Rate for Payer: Priority Health Cigna Priority Health	$532.11
Rate for Payer: Priority Health SBD	$515.74

ARIPIPRAZOLE 15 MG TABLET

Facility

$61.85

Service Code	NDC 13668021930
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$38.97
Max. Negotiated Rate	$55.66
Rate for Payer: Aetna Commercial	$52.57
Rate for Payer: Aetna New Business (MI Preferred)	$40.20
Rate for Payer: Cash Price	$49.48
Rate for Payer: Cofinity Commercial	$43.30
Rate for Payer: Cofinity Commercial	$53.19
Rate for Payer: Cofinity Medicare Advantage	$43.30
Rate for Payer: Encore Health Key Benefits Commercial	$49.48
Rate for Payer: Healthscope Commercial	$55.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.57
Rate for Payer: PHP Commercial	$52.57
Rate for Payer: Priority Health Cigna Priority Health	$40.20
Rate for Payer: Priority Health SBD	$38.97

ARIPIPRAZOLE 15 MG TABLET

Facility

$818.63

Service Code	NDC 60687019121
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$327.45
Max. Negotiated Rate	$736.77
Rate for Payer: Aetna Commercial	$695.84
Rate for Payer: Aetna Medicare	$409.32
Rate for Payer: Aetna New Business (MI Preferred)	$532.11
Rate for Payer: BCBS Complete	$327.45
Rate for Payer: Cash Price	$654.90
Rate for Payer: Cofinity Commercial	$573.04
Rate for Payer: Cofinity Commercial	$704.02
Rate for Payer: Cofinity Medicare Advantage	$573.04
Rate for Payer: Encore Health Key Benefits Commercial	$654.90
Rate for Payer: Healthscope Commercial	$736.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$695.84
Rate for Payer: PHP Commercial	$695.84
Rate for Payer: Priority Health Cigna Priority Health	$532.11
Rate for Payer: Priority Health SBD	$515.74

ARIPIPRAZOLE 15 MG TABLET

Facility

$27.29

Service Code	NDC 60687019111
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$24.56
Rate for Payer: Aetna Commercial	$23.20
Rate for Payer: Aetna Medicare	$13.64
Rate for Payer: Aetna New Business (MI Preferred)	$17.74
Rate for Payer: BCBS Complete	$10.92
Rate for Payer: Cash Price	$21.83
Rate for Payer: Cofinity Commercial	$19.10
Rate for Payer: Cofinity Commercial	$23.47
Rate for Payer: Cofinity Medicare Advantage	$19.10
Rate for Payer: Encore Health Key Benefits Commercial	$21.83
Rate for Payer: Healthscope Commercial	$24.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.20
Rate for Payer: PHP Commercial	$23.20
Rate for Payer: Priority Health Cigna Priority Health	$17.74
Rate for Payer: Priority Health SBD	$17.19

ARIPIPRAZOLE 15 MG TABLET

Facility

$61.85

Service Code	NDC 13668021930
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$24.74
Max. Negotiated Rate	$55.66
Rate for Payer: Aetna Commercial	$52.57
Rate for Payer: Aetna Medicare	$30.92
Rate for Payer: Aetna New Business (MI Preferred)	$40.20
Rate for Payer: BCBS Complete	$24.74
Rate for Payer: Cash Price	$49.48
Rate for Payer: Cofinity Commercial	$43.30
Rate for Payer: Cofinity Commercial	$53.19
Rate for Payer: Cofinity Medicare Advantage	$43.30
Rate for Payer: Encore Health Key Benefits Commercial	$49.48
Rate for Payer: Healthscope Commercial	$55.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.57
Rate for Payer: PHP Commercial	$52.57
Rate for Payer: Priority Health Cigna Priority Health	$40.20
Rate for Payer: Priority Health SBD	$38.97

Know your out-of-pocket cost for care.

All Charges