Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

RENAL DIALYSIS ACCESS PROCEDURES

Facility

$11,410.73

Service Code	APR-DRG 4443
Min. Negotiated Rate	$10,867.36
Max. Negotiated Rate	$11,410.73
Rate for Payer: BCBS Complete	$11,410.73
Rate for Payer: Mclaren Medicaid	$10,867.36
Rate for Payer: Meridian Medicaid	$11,410.73
Rate for Payer: Priority Health Choice Medicaid	$10,867.36
Rate for Payer: UHC Medicaid	$10,867.36
Rate for Payer: UHCCP Medicaid	$10,867.36

RESPIRATORY FAILURE

Facility

$3,370.11

Service Code	APR-DRG 1331
Min. Negotiated Rate	$3,209.63
Max. Negotiated Rate	$3,370.11
Rate for Payer: BCBS Complete	$3,370.11
Rate for Payer: Mclaren Medicaid	$3,209.63
Rate for Payer: Meridian Medicaid	$3,370.11
Rate for Payer: Priority Health Choice Medicaid	$3,209.63
Rate for Payer: UHC Medicaid	$3,209.63
Rate for Payer: UHCCP Medicaid	$3,209.63

RESPIRATORY FAILURE

Facility

$11,404.42

Service Code	APR-DRG 1334
Min. Negotiated Rate	$10,861.35
Max. Negotiated Rate	$11,404.42
Rate for Payer: BCBS Complete	$11,404.42
Rate for Payer: Mclaren Medicaid	$10,861.35
Rate for Payer: Meridian Medicaid	$11,404.42
Rate for Payer: Priority Health Choice Medicaid	$10,861.35
Rate for Payer: UHC Medicaid	$10,861.35
Rate for Payer: UHCCP Medicaid	$10,861.35

RESPIRATORY FAILURE

Facility

$4,623.19

Service Code	APR-DRG 1332
Min. Negotiated Rate	$4,403.03
Max. Negotiated Rate	$4,623.19
Rate for Payer: BCBS Complete	$4,623.19
Rate for Payer: Mclaren Medicaid	$4,403.03
Rate for Payer: Meridian Medicaid	$4,623.19
Rate for Payer: Priority Health Choice Medicaid	$4,403.03
Rate for Payer: UHC Medicaid	$4,403.03
Rate for Payer: UHCCP Medicaid	$4,403.03

RESPIRATORY FAILURE

Facility

$7,117.77

Service Code	APR-DRG 1333
Min. Negotiated Rate	$6,778.83
Max. Negotiated Rate	$7,117.77
Rate for Payer: BCBS Complete	$7,117.77
Rate for Payer: Mclaren Medicaid	$6,778.83
Rate for Payer: Meridian Medicaid	$7,117.77
Rate for Payer: Priority Health Choice Medicaid	$6,778.83
Rate for Payer: UHC Medicaid	$6,778.83
Rate for Payer: UHCCP Medicaid	$6,778.83

RESPIRATORY MALIGNANCY

Facility

$11,530.09

Service Code	APR-DRG 1364
Min. Negotiated Rate	$10,981.04
Max. Negotiated Rate	$11,530.09
Rate for Payer: BCBS Complete	$11,530.09
Rate for Payer: Mclaren Medicaid	$10,981.04
Rate for Payer: Meridian Medicaid	$11,530.09
Rate for Payer: Priority Health Choice Medicaid	$10,981.04
Rate for Payer: UHC Medicaid	$10,981.04
Rate for Payer: UHCCP Medicaid	$10,981.04

RESPIRATORY MALIGNANCY

Facility

$6,102.90

Service Code	APR-DRG 1362
Min. Negotiated Rate	$5,812.28
Max. Negotiated Rate	$6,102.90
Rate for Payer: BCBS Complete	$6,102.90
Rate for Payer: Mclaren Medicaid	$5,812.28
Rate for Payer: Meridian Medicaid	$6,102.90
Rate for Payer: Priority Health Choice Medicaid	$5,812.28
Rate for Payer: UHC Medicaid	$5,812.28
Rate for Payer: UHCCP Medicaid	$5,812.28

RESPIRATORY MALIGNANCY

Facility

$7,537.92

Service Code	APR-DRG 1363
Min. Negotiated Rate	$7,178.97
Max. Negotiated Rate	$7,537.92
Rate for Payer: BCBS Complete	$7,537.92
Rate for Payer: Mclaren Medicaid	$7,178.97
Rate for Payer: Meridian Medicaid	$7,537.92
Rate for Payer: Priority Health Choice Medicaid	$7,178.97
Rate for Payer: UHC Medicaid	$7,178.97
Rate for Payer: UHCCP Medicaid	$7,178.97

RESPIRATORY MALIGNANCY

Facility

$5,607.03

Service Code	APR-DRG 1361
Min. Negotiated Rate	$5,340.03
Max. Negotiated Rate	$5,607.03
Rate for Payer: BCBS Complete	$5,607.03
Rate for Payer: Mclaren Medicaid	$5,340.03
Rate for Payer: Meridian Medicaid	$5,607.03
Rate for Payer: Priority Health Choice Medicaid	$5,340.03
Rate for Payer: UHC Medicaid	$5,340.03
Rate for Payer: UHCCP Medicaid	$5,340.03

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$2,775.38

Service Code	APR-DRG 1441
Min. Negotiated Rate	$2,643.22
Max. Negotiated Rate	$2,775.38
Rate for Payer: BCBS Complete	$2,775.38
Rate for Payer: Mclaren Medicaid	$2,643.22
Rate for Payer: Meridian Medicaid	$2,775.38
Rate for Payer: Priority Health Choice Medicaid	$2,643.22
Rate for Payer: UHC Medicaid	$2,643.22
Rate for Payer: UHCCP Medicaid	$2,643.22

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$10,334.86

Service Code	APR-DRG 1444
Min. Negotiated Rate	$9,842.72
Max. Negotiated Rate	$10,334.86
Rate for Payer: BCBS Complete	$10,334.86
Rate for Payer: Mclaren Medicaid	$9,842.72
Rate for Payer: Meridian Medicaid	$10,334.86
Rate for Payer: Priority Health Choice Medicaid	$9,842.72
Rate for Payer: UHC Medicaid	$9,842.72
Rate for Payer: UHCCP Medicaid	$9,842.72

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$6,563.53

Service Code	APR-DRG 1443
Min. Negotiated Rate	$6,250.99
Max. Negotiated Rate	$6,563.53
Rate for Payer: BCBS Complete	$6,563.53
Rate for Payer: Mclaren Medicaid	$6,250.99
Rate for Payer: Meridian Medicaid	$6,563.53
Rate for Payer: Priority Health Choice Medicaid	$6,250.99
Rate for Payer: UHC Medicaid	$6,250.99
Rate for Payer: UHCCP Medicaid	$6,250.99

RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES

Facility

$4,938.69

Service Code	APR-DRG 1442
Min. Negotiated Rate	$4,703.51
Max. Negotiated Rate	$4,938.69
Rate for Payer: BCBS Complete	$4,938.69
Rate for Payer: Mclaren Medicaid	$4,703.51
Rate for Payer: Meridian Medicaid	$4,938.69
Rate for Payer: Priority Health Choice Medicaid	$4,703.51
Rate for Payer: UHC Medicaid	$4,703.51
Rate for Payer: UHCCP Medicaid	$4,703.51

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$16,825.30

Service Code	APR-DRG 1302
Min. Negotiated Rate	$16,024.10
Max. Negotiated Rate	$16,825.30
Rate for Payer: BCBS Complete	$16,825.30
Rate for Payer: Mclaren Medicaid	$16,024.10
Rate for Payer: Meridian Medicaid	$16,825.30
Rate for Payer: Priority Health Choice Medicaid	$16,024.10
Rate for Payer: UHC Medicaid	$16,024.10
Rate for Payer: UHCCP Medicaid	$16,024.10

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$22,806.73

Service Code	APR-DRG 1303
Min. Negotiated Rate	$21,720.70
Max. Negotiated Rate	$22,806.73
Rate for Payer: BCBS Complete	$22,806.73
Rate for Payer: Mclaren Medicaid	$21,720.70
Rate for Payer: Meridian Medicaid	$22,806.73
Rate for Payer: Priority Health Choice Medicaid	$21,720.70
Rate for Payer: UHC Medicaid	$21,720.70
Rate for Payer: UHCCP Medicaid	$21,720.70

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$13,222.25

Service Code	APR-DRG 1301
Min. Negotiated Rate	$12,592.62
Max. Negotiated Rate	$13,222.25
Rate for Payer: BCBS Complete	$13,222.25
Rate for Payer: Mclaren Medicaid	$12,592.62
Rate for Payer: Meridian Medicaid	$13,222.25
Rate for Payer: Priority Health Choice Medicaid	$12,592.62
Rate for Payer: UHC Medicaid	$12,592.62
Rate for Payer: UHCCP Medicaid	$12,592.62

RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS

Facility

$25,462.75

Service Code	APR-DRG 1304
Min. Negotiated Rate	$24,250.24
Max. Negotiated Rate	$25,462.75
Rate for Payer: BCBS Complete	$25,462.75
Rate for Payer: Mclaren Medicaid	$24,250.24
Rate for Payer: Meridian Medicaid	$25,462.75
Rate for Payer: Priority Health Choice Medicaid	$24,250.24
Rate for Payer: UHC Medicaid	$24,250.24
Rate for Payer: UHCCP Medicaid	$24,250.24

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE

Facility

$242.43

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	636
Min. Negotiated Rate	$42.74
Max. Negotiated Rate	$218.19
Rate for Payer: Aetna Commercial	$206.07
Rate for Payer: Aetna Commercial	$244.21
Rate for Payer: Aetna Medicare	$74.70
Rate for Payer: Aetna Medicare	$63.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$89.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$75.76
Rate for Payer: Amish Plain Church Group Commercial	$75.76
Rate for Payer: Amish Plain Church Group Commercial	$89.78
Rate for Payer: BCBS Complete	$44.87
Rate for Payer: BCBS Complete	$53.18
Rate for Payer: BCBS MAPPO	$60.61
Rate for Payer: BCBS MAPPO	$71.83
Rate for Payer: BCBS Trust/PPO	$199.30
Rate for Payer: BCBS Trust/PPO	$236.20
Rate for Payer: BCN Commercial	$236.20
Rate for Payer: BCN Commercial	$199.30
Rate for Payer: BCN Medicare Advantage	$71.83
Rate for Payer: BCN Medicare Advantage	$60.61
Rate for Payer: Cash Price	$193.94
Rate for Payer: Cash Price	$229.85
Rate for Payer: Cofinity Commercial	$208.49
Rate for Payer: Cofinity Commercial	$247.09
Rate for Payer: Encore Health Key Benefits Commercial	$229.85
Rate for Payer: Encore Health Key Benefits Commercial	$193.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$71.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$60.61
Rate for Payer: Healthscope Commercial	$218.19
Rate for Payer: Healthscope Commercial	$258.58
Rate for Payer: Lakeland Regional Health Systems Commercial	$181.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$215.48
Rate for Payer: Mclaren Medicaid	$50.65
Rate for Payer: Mclaren Medicaid	$42.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$75.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$63.64
Rate for Payer: Meridian Medicaid	$44.87
Rate for Payer: Meridian Medicaid	$53.18
Rate for Payer: MI Amish Medical Board Commercial	$82.60
Rate for Payer: MI Amish Medical Board Commercial	$69.70
Rate for Payer: Molina Medicare/Medicaid	$79.01
Rate for Payer: Molina Medicare/Medicaid	$66.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.07
Rate for Payer: Nomi Health Commercial	$235.59
Rate for Payer: Nomi Health Commercial	$198.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$181.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.48
Rate for Payer: PACE Senior Care Partners	$68.24
Rate for Payer: PACE Senior Care Partners	$57.58
Rate for Payer: PACE SWMI	$71.83
Rate for Payer: PACE SWMI	$60.61
Rate for Payer: PHP Commercial	$206.07
Rate for Payer: PHP Commercial	$244.21
Rate for Payer: PHP Medicare Advantage	$60.61
Rate for Payer: PHP Medicare Advantage	$71.83
Rate for Payer: Priority Health Choice Medicaid	$50.65
Rate for Payer: Priority Health Choice Medicaid	$42.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$249.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.91
Rate for Payer: Priority Health Medicare	$72.55
Rate for Payer: Priority Health Medicare	$61.21
Rate for Payer: Priority Health Narrow/Tiered Network	$168.73
Rate for Payer: Priority Health Narrow/Tiered Network	$199.97
Rate for Payer: Railroad Medicare Medicare	$60.61
Rate for Payer: Railroad Medicare Medicare	$71.83
Rate for Payer: UHC All Payor (Choice/PPO)	$213.34
Rate for Payer: UHC All Payor (Choice/PPO)	$252.83
Rate for Payer: UHC Core	$239.90
Rate for Payer: UHC Core	$202.43
Rate for Payer: UHC Exchange	$71.83
Rate for Payer: UHC Exchange	$60.61
Rate for Payer: UHC Medicaid	$50.65
Rate for Payer: UHC Medicaid	$42.74
Rate for Payer: UHC Medicare Advantage	$60.61
Rate for Payer: UHC Medicare Advantage	$71.83
Rate for Payer: UHCCP Medicaid	$42.74
Rate for Payer: UHCCP Medicaid	$50.65
Rate for Payer: VA VA	$60.61
Rate for Payer: VA VA	$71.83
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$215.48
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$181.82

RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE

Facility

$242.43

Service Code	HCPCS J2790
Hospital Charge Code	11283
Hospital Revenue Code	636
Min. Negotiated Rate	$168.73
Max. Negotiated Rate	$218.19
Rate for Payer: Aetna Commercial	$206.07
Rate for Payer: Aetna Commercial	$244.21
Rate for Payer: BCBS Trust/PPO	$200.22
Rate for Payer: BCBS Trust/PPO	$237.29
Rate for Payer: BCN Commercial	$200.22
Rate for Payer: BCN Commercial	$237.29
Rate for Payer: Cash Price	$193.94
Rate for Payer: Cash Price	$229.85
Rate for Payer: Cofinity Commercial	$247.09
Rate for Payer: Cofinity Commercial	$208.49
Rate for Payer: Encore Health Key Benefits Commercial	$229.85
Rate for Payer: Encore Health Key Benefits Commercial	$193.94
Rate for Payer: Healthscope Commercial	$218.19
Rate for Payer: Healthscope Commercial	$258.58
Rate for Payer: Lakeland Regional Health Systems Commercial	$181.82
Rate for Payer: Lakeland Regional Health Systems Commercial	$215.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.21
Rate for Payer: Nomi Health Commercial	$198.79
Rate for Payer: Nomi Health Commercial	$235.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$181.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.48
Rate for Payer: PHP Commercial	$244.21
Rate for Payer: PHP Commercial	$206.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$249.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.91
Rate for Payer: Priority Health Narrow/Tiered Network	$168.73
Rate for Payer: Priority Health Narrow/Tiered Network	$199.97
Rate for Payer: UHC All Payor (Choice/PPO)	$213.34
Rate for Payer: UHC All Payor (Choice/PPO)	$252.83
Rate for Payer: UHC Core	$202.43
Rate for Payer: UHC Core	$239.90
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$181.82
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$215.48

RIFAXIMIN 550 MG TABLET

Facility

$11,916.96

Service Code	NDC 65649030303
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$2,100.96
Max. Negotiated Rate	$10,725.26
Rate for Payer: Aetna Commercial	$10,129.42
Rate for Payer: Aetna Medicare	$3,098.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,724.05
Rate for Payer: Amish Plain Church Group Commercial	$3,724.05
Rate for Payer: BCBS Complete	$2,205.83
Rate for Payer: BCBS MAPPO	$2,979.24
Rate for Payer: BCBS Trust/PPO	$9,796.93
Rate for Payer: BCN Commercial	$9,796.93
Rate for Payer: BCN Medicare Advantage	$2,979.24
Rate for Payer: Cash Price	$9,533.57
Rate for Payer: Cofinity Commercial	$10,248.59
Rate for Payer: Encore Health Key Benefits Commercial	$9,533.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,979.24
Rate for Payer: Healthscope Commercial	$10,725.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$8,937.72
Rate for Payer: Mclaren Medicaid	$2,100.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,128.20
Rate for Payer: Meridian Medicaid	$2,205.83
Rate for Payer: MI Amish Medical Board Commercial	$3,426.13
Rate for Payer: Molina Medicare/Medicaid	$3,277.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,129.42
Rate for Payer: Nomi Health Commercial	$9,771.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,937.72
Rate for Payer: PACE Senior Care Partners	$2,830.28
Rate for Payer: PACE SWMI	$2,979.24
Rate for Payer: PHP Commercial	$10,129.42
Rate for Payer: PHP Medicare Advantage	$2,979.24
Rate for Payer: Priority Health Choice Medicaid	$2,100.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$10,367.76
Rate for Payer: Priority Health Medicare	$3,009.03
Rate for Payer: Priority Health Narrow/Tiered Network	$8,294.20
Rate for Payer: Railroad Medicare Medicare	$2,979.24
Rate for Payer: UHC All Payor (Choice/PPO)	$10,486.92
Rate for Payer: UHC Core	$9,950.66
Rate for Payer: UHC Exchange	$2,979.24
Rate for Payer: UHC Medicaid	$2,100.96
Rate for Payer: UHC Medicare Advantage	$2,979.24
Rate for Payer: UHCCP Medicaid	$2,100.96
Rate for Payer: VA VA	$2,979.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$8,937.72

RIFAXIMIN 550 MG TABLET

Facility

$11,916.96

Service Code	NDC 65649030303
Hospital Charge Code	104604
Hospital Revenue Code	637
Min. Negotiated Rate	$8,294.20
Max. Negotiated Rate	$10,725.26
Rate for Payer: Aetna Commercial	$10,129.42
Rate for Payer: BCBS Trust/PPO	$9,842.22
Rate for Payer: BCN Commercial	$9,842.22
Rate for Payer: Cash Price	$9,533.57
Rate for Payer: Cofinity Commercial	$10,248.59
Rate for Payer: Encore Health Key Benefits Commercial	$9,533.57
Rate for Payer: Healthscope Commercial	$10,725.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$8,937.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$10,129.42
Rate for Payer: Nomi Health Commercial	$9,771.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,937.72
Rate for Payer: PHP Commercial	$10,129.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$10,367.76
Rate for Payer: Priority Health Narrow/Tiered Network	$8,294.20
Rate for Payer: UHC All Payor (Choice/PPO)	$10,486.92
Rate for Payer: UHC Core	$9,950.66
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$8,937.72

RISPERIDONE 0.25 MG TABLET

Facility

$413.60

Service Code	NDC 00904736061
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$72.92
Max. Negotiated Rate	$372.24
Rate for Payer: Aetna Commercial	$351.56
Rate for Payer: Aetna Medicare	$107.54
Rate for Payer: Allen County Amish Medical Aid Commercial	$129.25
Rate for Payer: Amish Plain Church Group Commercial	$129.25
Rate for Payer: BCBS Complete	$76.56
Rate for Payer: BCBS MAPPO	$103.40
Rate for Payer: BCBS Trust/PPO	$340.02
Rate for Payer: BCN Commercial	$340.02
Rate for Payer: BCN Medicare Advantage	$103.40
Rate for Payer: Cash Price	$330.88
Rate for Payer: Cofinity Commercial	$355.70
Rate for Payer: Encore Health Key Benefits Commercial	$330.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.40
Rate for Payer: Healthscope Commercial	$372.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$310.20
Rate for Payer: Mclaren Medicaid	$72.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$108.57
Rate for Payer: Meridian Medicaid	$76.56
Rate for Payer: MI Amish Medical Board Commercial	$118.91
Rate for Payer: Molina Medicare/Medicaid	$113.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$351.56
Rate for Payer: Nomi Health Commercial	$339.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.20
Rate for Payer: PACE Senior Care Partners	$98.23
Rate for Payer: PACE SWMI	$103.40
Rate for Payer: PHP Commercial	$351.56
Rate for Payer: PHP Medicare Advantage	$103.40
Rate for Payer: Priority Health Choice Medicaid	$72.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$359.83
Rate for Payer: Priority Health Medicare	$104.43
Rate for Payer: Priority Health Narrow/Tiered Network	$287.87
Rate for Payer: Railroad Medicare Medicare	$103.40
Rate for Payer: UHC All Payor (Choice/PPO)	$363.97
Rate for Payer: UHC Core	$345.36
Rate for Payer: UHC Exchange	$103.40
Rate for Payer: UHC Medicaid	$72.92
Rate for Payer: UHC Medicare Advantage	$103.40
Rate for Payer: UHCCP Medicaid	$72.92
Rate for Payer: VA VA	$103.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$310.20

RISPERIDONE 0.25 MG TABLET

Facility

$4.61

Service Code	NDC 68084027011
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: BCBS Trust/PPO	$3.81
Rate for Payer: BCN Commercial	$3.81
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$3.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.92
Rate for Payer: Nomi Health Commercial	$3.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.46
Rate for Payer: PHP Commercial	$3.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.01
Rate for Payer: Priority Health Narrow/Tiered Network	$3.21
Rate for Payer: UHC All Payor (Choice/PPO)	$4.06
Rate for Payer: UHC Core	$3.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$3.46

RISPERIDONE 0.25 MG TABLET

Facility

$460.60

Service Code	NDC 68084027001
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$81.20
Max. Negotiated Rate	$414.54
Rate for Payer: Aetna Commercial	$391.51
Rate for Payer: Aetna Medicare	$119.76
Rate for Payer: Allen County Amish Medical Aid Commercial	$143.94
Rate for Payer: Amish Plain Church Group Commercial	$143.94
Rate for Payer: BCBS Complete	$85.26
Rate for Payer: BCBS MAPPO	$115.15
Rate for Payer: BCBS Trust/PPO	$378.66
Rate for Payer: BCN Commercial	$378.66
Rate for Payer: BCN Medicare Advantage	$115.15
Rate for Payer: Cash Price	$368.48
Rate for Payer: Cofinity Commercial	$396.12
Rate for Payer: Encore Health Key Benefits Commercial	$368.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$115.15
Rate for Payer: Healthscope Commercial	$414.54
Rate for Payer: Lakeland Regional Health Systems Commercial	$345.45
Rate for Payer: Mclaren Medicaid	$81.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$120.91
Rate for Payer: Meridian Medicaid	$85.26
Rate for Payer: MI Amish Medical Board Commercial	$132.42
Rate for Payer: Molina Medicare/Medicaid	$126.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$391.51
Rate for Payer: Nomi Health Commercial	$377.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$345.45
Rate for Payer: PACE Senior Care Partners	$109.39
Rate for Payer: PACE SWMI	$115.15
Rate for Payer: PHP Commercial	$391.51
Rate for Payer: PHP Medicare Advantage	$115.15
Rate for Payer: Priority Health Choice Medicaid	$81.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$400.72
Rate for Payer: Priority Health Medicare	$116.30
Rate for Payer: Priority Health Narrow/Tiered Network	$320.58
Rate for Payer: Railroad Medicare Medicare	$115.15
Rate for Payer: UHC All Payor (Choice/PPO)	$405.33
Rate for Payer: UHC Core	$384.60
Rate for Payer: UHC Exchange	$115.15
Rate for Payer: UHC Medicaid	$81.20
Rate for Payer: UHC Medicare Advantage	$115.15
Rate for Payer: UHCCP Medicaid	$81.20
Rate for Payer: VA VA	$115.15
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$345.45

RISPERIDONE 0.25 MG TABLET

Facility

$460.60

Service Code	NDC 68084027001
Hospital Charge Code	25519
Hospital Revenue Code	637
Min. Negotiated Rate	$320.58
Max. Negotiated Rate	$414.54
Rate for Payer: Aetna Commercial	$391.51
Rate for Payer: BCBS Trust/PPO	$380.41
Rate for Payer: BCN Commercial	$380.41
Rate for Payer: Cash Price	$368.48
Rate for Payer: Cofinity Commercial	$396.12
Rate for Payer: Encore Health Key Benefits Commercial	$368.48
Rate for Payer: Healthscope Commercial	$414.54
Rate for Payer: Lakeland Regional Health Systems Commercial	$345.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$391.51
Rate for Payer: Nomi Health Commercial	$377.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$345.45
Rate for Payer: PHP Commercial	$391.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$400.72
Rate for Payer: Priority Health Narrow/Tiered Network	$320.58
Rate for Payer: UHC All Payor (Choice/PPO)	$405.33
Rate for Payer: UHC Core	$384.60
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$345.45

Know your out-of-pocket cost for care.

All Charges