Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 42.00: VIRAL ILLNESS

Facility

$2,834.38

Service Code	APR-DRG 7231
Min. Negotiated Rate	$2,699.41
Max. Negotiated Rate	$2,834.38
Rate for Payer: BCBS Complete	$2,834.38
Rate for Payer: Mclaren Medicaid	$2,699.41
Rate for Payer: Meridian Medicaid	$2,834.38
Rate for Payer: Priority Health Choice Medicaid	$2,699.41
Rate for Payer: UHCCP Medicaid	$2,699.41

APR-DRG 42.00: VIRAL ILLNESS

Facility

$6,131.52

Service Code	APR-DRG 7233
Min. Negotiated Rate	$5,839.54
Max. Negotiated Rate	$6,131.52
Rate for Payer: BCBS Complete	$6,131.52
Rate for Payer: Mclaren Medicaid	$5,839.54
Rate for Payer: Meridian Medicaid	$6,131.52
Rate for Payer: Priority Health Choice Medicaid	$5,839.54
Rate for Payer: UHCCP Medicaid	$5,839.54

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$7,057.03

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,720.98
Max. Negotiated Rate	$7,057.03
Rate for Payer: BCBS Complete	$7,057.03
Rate for Payer: Mclaren Medicaid	$6,720.98
Rate for Payer: Meridian Medicaid	$7,057.03
Rate for Payer: Priority Health Choice Medicaid	$6,720.98
Rate for Payer: UHCCP Medicaid	$6,720.98

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$4,627.56

Service Code	APR-DRG 0512
Min. Negotiated Rate	$4,407.20
Max. Negotiated Rate	$4,627.56
Rate for Payer: BCBS Complete	$4,627.56
Rate for Payer: Mclaren Medicaid	$4,407.20
Rate for Payer: Meridian Medicaid	$4,627.56
Rate for Payer: Priority Health Choice Medicaid	$4,407.20
Rate for Payer: UHCCP Medicaid	$4,407.20

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$3,759.89

Service Code	APR-DRG 0511
Min. Negotiated Rate	$3,580.85
Max. Negotiated Rate	$3,759.89
Rate for Payer: BCBS Complete	$3,759.89
Rate for Payer: Mclaren Medicaid	$3,580.85
Rate for Payer: Meridian Medicaid	$3,759.89
Rate for Payer: Priority Health Choice Medicaid	$3,580.85
Rate for Payer: UHCCP Medicaid	$3,580.85

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$10,701.23

Service Code	APR-DRG 0514
Min. Negotiated Rate	$10,191.65
Max. Negotiated Rate	$10,701.23
Rate for Payer: BCBS Complete	$10,701.23
Rate for Payer: Mclaren Medicaid	$10,191.65
Rate for Payer: Meridian Medicaid	$10,701.23
Rate for Payer: Priority Health Choice Medicaid	$10,191.65
Rate for Payer: UHCCP Medicaid	$10,191.65

APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION

Facility

$1,176.23

Service Code	NDC 00006306601
Hospital Charge Code	179507
Hospital Revenue Code	637
Min. Negotiated Rate	$517.54
Max. Negotiated Rate	$1,058.61
Rate for Payer: Aetna American Axle	$764.55
Rate for Payer: Aetna Commercial	$999.80
Rate for Payer: Aetna New Business (MI Preferred)	$764.55
Rate for Payer: Cash Price	$940.98
Rate for Payer: Cofinity Commercial	$1,011.56
Rate for Payer: Cofinity Commercial	$823.36
Rate for Payer: Cofinity Medicare Advantage	$823.36
Rate for Payer: Encore Health Key Benefits Commercial	$940.98
Rate for Payer: Healthscope Commercial	$1,058.61
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$823.36
Rate for Payer: Lakeland Regional Health Systems Commercial	$882.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$999.80
Rate for Payer: PHP Commercial	$999.80
Rate for Payer: Priority Health Cigna Priority Health	$764.55
Rate for Payer: Priority Health SBD	$741.02
Rate for Payer: UMR Bronson Commercial	$517.54
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$882.17

APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION

Facility

$1,176.23

Service Code	NDC 00006306601
Hospital Charge Code	179507
Hospital Revenue Code	637
Min. Negotiated Rate	$435.21
Max. Negotiated Rate	$1,058.61
Rate for Payer: Aetna American Axle	$764.55
Rate for Payer: Aetna Commercial	$999.80
Rate for Payer: Aetna Medicare	$588.12
Rate for Payer: Aetna New Business (MI Preferred)	$764.55
Rate for Payer: BCBS Complete	$470.49
Rate for Payer: Cash Price	$940.98
Rate for Payer: Cofinity Commercial	$1,011.56
Rate for Payer: Cofinity Commercial	$823.36
Rate for Payer: Cofinity Medicare Advantage	$823.36
Rate for Payer: Encore Health Key Benefits Commercial	$940.98
Rate for Payer: Healthscope Commercial	$1,058.61
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$823.36
Rate for Payer: Lakeland Regional Health Systems Commercial	$882.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$999.80
Rate for Payer: PHP Commercial	$999.80
Rate for Payer: Priority Health Cigna Priority Health	$764.55
Rate for Payer: Priority Health SBD	$741.02
Rate for Payer: UMR Bronson Commercial	$435.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$882.17

APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION

Facility

$1,176.23

Service Code	NDC 00006306603
Hospital Charge Code	179507
Hospital Revenue Code	637
Min. Negotiated Rate	$435.21
Max. Negotiated Rate	$1,058.61
Rate for Payer: Aetna American Axle	$764.55
Rate for Payer: Aetna Commercial	$999.80
Rate for Payer: Aetna Medicare	$588.12
Rate for Payer: Aetna New Business (MI Preferred)	$764.55
Rate for Payer: BCBS Complete	$470.49
Rate for Payer: Cash Price	$940.98
Rate for Payer: Cofinity Commercial	$1,011.56
Rate for Payer: Cofinity Commercial	$823.36
Rate for Payer: Cofinity Medicare Advantage	$823.36
Rate for Payer: Encore Health Key Benefits Commercial	$940.98
Rate for Payer: Healthscope Commercial	$1,058.61
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$823.36
Rate for Payer: Lakeland Regional Health Systems Commercial	$882.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$999.80
Rate for Payer: PHP Commercial	$999.80
Rate for Payer: Priority Health Cigna Priority Health	$764.55
Rate for Payer: Priority Health SBD	$741.02
Rate for Payer: UMR Bronson Commercial	$435.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$882.17

APREPITANT 125 MG (25 MG/ML FINAL CONCENTRATION) ORAL SUSPENSION

Facility

$1,176.23

Service Code	NDC 00006306603
Hospital Charge Code	179507
Hospital Revenue Code	637
Min. Negotiated Rate	$517.54
Max. Negotiated Rate	$1,058.61
Rate for Payer: Aetna American Axle	$764.55
Rate for Payer: Aetna Commercial	$999.80
Rate for Payer: Aetna New Business (MI Preferred)	$764.55
Rate for Payer: Cash Price	$940.98
Rate for Payer: Cofinity Commercial	$1,011.56
Rate for Payer: Cofinity Commercial	$823.36
Rate for Payer: Cofinity Medicare Advantage	$823.36
Rate for Payer: Encore Health Key Benefits Commercial	$940.98
Rate for Payer: Healthscope Commercial	$1,058.61
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$823.36
Rate for Payer: Lakeland Regional Health Systems Commercial	$882.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$999.80
Rate for Payer: PHP Commercial	$999.80
Rate for Payer: Priority Health Cigna Priority Health	$764.55
Rate for Payer: Priority Health SBD	$741.02
Rate for Payer: UMR Bronson Commercial	$517.54
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$882.17

APREPITANT 125 MG CAPSULE

Facility

$739.51

Service Code	NDC 00781232306
Hospital Charge Code	35489
Hospital Revenue Code	637
Min. Negotiated Rate	$325.38
Max. Negotiated Rate	$665.56
Rate for Payer: Aetna American Axle	$480.68
Rate for Payer: Aetna Commercial	$628.58
Rate for Payer: Aetna New Business (MI Preferred)	$480.68
Rate for Payer: Cash Price	$591.61
Rate for Payer: Cofinity Commercial	$517.66
Rate for Payer: Cofinity Commercial	$635.98
Rate for Payer: Cofinity Medicare Advantage	$517.66
Rate for Payer: Encore Health Key Benefits Commercial	$591.61
Rate for Payer: Healthscope Commercial	$665.56
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$517.66
Rate for Payer: Lakeland Regional Health Systems Commercial	$554.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$628.58
Rate for Payer: PHP Commercial	$628.58
Rate for Payer: Priority Health Cigna Priority Health	$480.68
Rate for Payer: Priority Health SBD	$465.89
Rate for Payer: UMR Bronson Commercial	$325.38
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$554.63

APREPITANT 125 MG CAPSULE

Facility

$4,437.05

Service Code	NDC 00781232368
Hospital Charge Code	35489
Hospital Revenue Code	637
Min. Negotiated Rate	$1,952.30
Max. Negotiated Rate	$3,993.34
Rate for Payer: Aetna American Axle	$2,884.08
Rate for Payer: Aetna Commercial	$3,771.49
Rate for Payer: Aetna New Business (MI Preferred)	$2,884.08
Rate for Payer: Cash Price	$3,549.64
Rate for Payer: Cofinity Commercial	$3,105.94
Rate for Payer: Cofinity Commercial	$3,815.86
Rate for Payer: Cofinity Medicare Advantage	$3,105.94
Rate for Payer: Encore Health Key Benefits Commercial	$3,549.64
Rate for Payer: Healthscope Commercial	$3,993.34
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$3,105.94
Rate for Payer: Lakeland Regional Health Systems Commercial	$3,327.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,771.49
Rate for Payer: PHP Commercial	$3,771.49
Rate for Payer: Priority Health Cigna Priority Health	$2,884.08
Rate for Payer: Priority Health SBD	$2,795.34
Rate for Payer: UMR Bronson Commercial	$1,952.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$3,327.79

APREPITANT 125 MG CAPSULE

Facility

$739.51

Service Code	NDC 00781232306
Hospital Charge Code	35489
Hospital Revenue Code	637
Min. Negotiated Rate	$273.62
Max. Negotiated Rate	$665.56
Rate for Payer: Aetna American Axle	$480.68
Rate for Payer: Aetna Commercial	$628.58
Rate for Payer: Aetna Medicare	$369.76
Rate for Payer: Aetna New Business (MI Preferred)	$480.68
Rate for Payer: BCBS Complete	$295.80
Rate for Payer: Cash Price	$591.61
Rate for Payer: Cofinity Commercial	$517.66
Rate for Payer: Cofinity Commercial	$635.98
Rate for Payer: Cofinity Medicare Advantage	$517.66
Rate for Payer: Encore Health Key Benefits Commercial	$591.61
Rate for Payer: Healthscope Commercial	$665.56
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$517.66
Rate for Payer: Lakeland Regional Health Systems Commercial	$554.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$628.58
Rate for Payer: PHP Commercial	$628.58
Rate for Payer: Priority Health Cigna Priority Health	$480.68
Rate for Payer: Priority Health SBD	$465.89
Rate for Payer: UMR Bronson Commercial	$273.62
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$554.63

APREPITANT 125 MG CAPSULE

Facility

$4,437.05

Service Code	NDC 00781232368
Hospital Charge Code	35489
Hospital Revenue Code	637
Min. Negotiated Rate	$1,641.71
Max. Negotiated Rate	$3,993.34
Rate for Payer: Aetna American Axle	$2,884.08
Rate for Payer: Aetna Commercial	$3,771.49
Rate for Payer: Aetna Medicare	$2,218.52
Rate for Payer: Aetna New Business (MI Preferred)	$2,884.08
Rate for Payer: BCBS Complete	$1,774.82
Rate for Payer: Cash Price	$3,549.64
Rate for Payer: Cofinity Commercial	$3,105.94
Rate for Payer: Cofinity Commercial	$3,815.86
Rate for Payer: Cofinity Medicare Advantage	$3,105.94
Rate for Payer: Encore Health Key Benefits Commercial	$3,549.64
Rate for Payer: Healthscope Commercial	$3,993.34
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$3,105.94
Rate for Payer: Lakeland Regional Health Systems Commercial	$3,327.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,771.49
Rate for Payer: PHP Commercial	$3,771.49
Rate for Payer: Priority Health Cigna Priority Health	$2,884.08
Rate for Payer: Priority Health SBD	$2,795.34
Rate for Payer: UMR Bronson Commercial	$1,641.71
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$3,327.79

APREPITANT 130 MG/18 ML (7.2 MG/ML) INTRAVENOUS EMULSION

Facility

$890.20

Service Code	HCPCS J0185
Hospital Charge Code	185153
Hospital Revenue Code	636
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$801.18
Rate for Payer: Aetna American Axle	$578.63
Rate for Payer: Aetna Commercial	$756.67
Rate for Payer: Aetna Medicare	$1.77
Rate for Payer: Aetna New Business (MI Preferred)	$578.63
Rate for Payer: Allen County Amish Medical Aid Commercial	$2.12
Rate for Payer: Amish Plain Church Group Commercial	$2.12
Rate for Payer: BCBS Complete	$0.96
Rate for Payer: BCBS MAPPO	$1.70
Rate for Payer: BCBS Trust/PPO	$4.74
Rate for Payer: BCN Commercial	$4.74
Rate for Payer: BCN Medicare Advantage	$1.70
Rate for Payer: Cash Price	$712.16
Rate for Payer: Cash Price	$712.16
Rate for Payer: Cofinity Commercial	$765.57
Rate for Payer: Cofinity Commercial	$623.14
Rate for Payer: Cofinity Medicare Advantage	$623.14
Rate for Payer: Encore Health Key Benefits Commercial	$712.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$1.70
Rate for Payer: Healthscope Commercial	$801.18
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$623.14
Rate for Payer: Lakeland Regional Health Systems Commercial	$667.65
Rate for Payer: Mclaren Medicaid	$0.91
Rate for Payer: Mclaren Medicare	$1.70
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.78
Rate for Payer: Meridian Medicaid	$0.96
Rate for Payer: MI Amish Medical Board Commercial	$1.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$756.67
Rate for Payer: Nomi Health Commercial	$5.10
Rate for Payer: PACE Medicare	$1.62
Rate for Payer: PACE SWMI	$1.70
Rate for Payer: PHP Commercial	$756.67
Rate for Payer: PHP Medicare Advantage	$1.70
Rate for Payer: Priority Health Choice Medicaid	$0.91
Rate for Payer: Priority Health Cigna Priority Health	$578.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.08
Rate for Payer: Priority Health Medicare	$1.70
Rate for Payer: Priority Health Narrow Network	$4.06
Rate for Payer: Priority Health SBD	$560.83
Rate for Payer: Railroad Medicare Medicare	$1.70
Rate for Payer: UHC All Payor (Choice/PPO)	$4.79
Rate for Payer: UHC Dual Complete DSNP	$1.70
Rate for Payer: UHC Exchange	$3.25
Rate for Payer: UHC Medicare Advantage	$1.70
Rate for Payer: UHCCP Medicaid	$0.91
Rate for Payer: UMR Bronson Commercial	$329.37
Rate for Payer: VA VA	$1.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$667.65

APREPITANT 40 MG CAPSULE

Facility

$173.76

Service Code	NDC 13668059180
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$76.45
Max. Negotiated Rate	$156.38
Rate for Payer: Aetna American Axle	$112.94
Rate for Payer: Aetna Commercial	$147.70
Rate for Payer: Aetna New Business (MI Preferred)	$112.94
Rate for Payer: Cash Price	$139.01
Rate for Payer: Cofinity Commercial	$121.63
Rate for Payer: Cofinity Commercial	$149.43
Rate for Payer: Cofinity Medicare Advantage	$121.63
Rate for Payer: Encore Health Key Benefits Commercial	$139.01
Rate for Payer: Healthscope Commercial	$156.38
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$121.63
Rate for Payer: Lakeland Regional Health Systems Commercial	$130.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.70
Rate for Payer: PHP Commercial	$147.70
Rate for Payer: Priority Health Cigna Priority Health	$112.94
Rate for Payer: Priority Health SBD	$109.47
Rate for Payer: UMR Bronson Commercial	$76.45
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$130.32

APREPITANT 40 MG CAPSULE

Facility

$923.49

Service Code	NDC 13668059182
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$406.34
Max. Negotiated Rate	$831.14
Rate for Payer: Aetna American Axle	$600.27
Rate for Payer: Aetna Commercial	$784.97
Rate for Payer: Aetna New Business (MI Preferred)	$600.27
Rate for Payer: Cash Price	$738.79
Rate for Payer: Cofinity Commercial	$646.44
Rate for Payer: Cofinity Commercial	$794.20
Rate for Payer: Cofinity Medicare Advantage	$646.44
Rate for Payer: Encore Health Key Benefits Commercial	$738.79
Rate for Payer: Healthscope Commercial	$831.14
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$646.44
Rate for Payer: Lakeland Regional Health Systems Commercial	$692.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$784.97
Rate for Payer: PHP Commercial	$784.97
Rate for Payer: Priority Health Cigna Priority Health	$600.27
Rate for Payer: Priority Health SBD	$581.80
Rate for Payer: UMR Bronson Commercial	$406.34
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$692.62

APREPITANT 40 MG CAPSULE

Facility

$255.38

Service Code	NDC 00781232106
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$112.37
Max. Negotiated Rate	$229.84
Rate for Payer: Aetna American Axle	$166.00
Rate for Payer: Aetna Commercial	$217.07
Rate for Payer: Aetna New Business (MI Preferred)	$166.00
Rate for Payer: Cash Price	$204.30
Rate for Payer: Cofinity Commercial	$178.77
Rate for Payer: Cofinity Commercial	$219.63
Rate for Payer: Cofinity Medicare Advantage	$178.77
Rate for Payer: Encore Health Key Benefits Commercial	$204.30
Rate for Payer: Healthscope Commercial	$229.84
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$178.77
Rate for Payer: Lakeland Regional Health Systems Commercial	$191.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.07
Rate for Payer: PHP Commercial	$217.07
Rate for Payer: Priority Health Cigna Priority Health	$166.00
Rate for Payer: Priority Health SBD	$160.89
Rate for Payer: UMR Bronson Commercial	$112.37
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$191.54

APREPITANT 40 MG CAPSULE

Facility

$1,545.68

Service Code	NDC 68462058385
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$571.90
Max. Negotiated Rate	$1,391.11
Rate for Payer: Aetna American Axle	$1,004.69
Rate for Payer: Aetna Commercial	$1,313.83
Rate for Payer: Aetna Medicare	$772.84
Rate for Payer: Aetna New Business (MI Preferred)	$1,004.69
Rate for Payer: BCBS Complete	$618.27
Rate for Payer: Cash Price	$1,236.54
Rate for Payer: Cofinity Commercial	$1,081.98
Rate for Payer: Cofinity Commercial	$1,329.28
Rate for Payer: Cofinity Medicare Advantage	$1,081.98
Rate for Payer: Encore Health Key Benefits Commercial	$1,236.54
Rate for Payer: Healthscope Commercial	$1,391.11
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,081.98
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,159.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,313.83
Rate for Payer: PHP Commercial	$1,313.83
Rate for Payer: Priority Health Cigna Priority Health	$1,004.69
Rate for Payer: Priority Health SBD	$973.78
Rate for Payer: UMR Bronson Commercial	$571.90
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,159.26

APREPITANT 40 MG CAPSULE

Facility

$255.38

Service Code	NDC 00781232106
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$94.49
Max. Negotiated Rate	$229.84
Rate for Payer: Aetna American Axle	$166.00
Rate for Payer: Aetna Commercial	$217.07
Rate for Payer: Aetna Medicare	$127.69
Rate for Payer: Aetna New Business (MI Preferred)	$166.00
Rate for Payer: BCBS Complete	$102.15
Rate for Payer: Cash Price	$204.30
Rate for Payer: Cofinity Commercial	$178.77
Rate for Payer: Cofinity Commercial	$219.63
Rate for Payer: Cofinity Medicare Advantage	$178.77
Rate for Payer: Encore Health Key Benefits Commercial	$204.30
Rate for Payer: Healthscope Commercial	$229.84
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$178.77
Rate for Payer: Lakeland Regional Health Systems Commercial	$191.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$217.07
Rate for Payer: PHP Commercial	$217.07
Rate for Payer: Priority Health Cigna Priority Health	$166.00
Rate for Payer: Priority Health SBD	$160.89
Rate for Payer: UMR Bronson Commercial	$94.49
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$191.54

APREPITANT 40 MG CAPSULE

Facility

$923.49

Service Code	NDC 13668059182
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$341.69
Max. Negotiated Rate	$831.14
Rate for Payer: Aetna American Axle	$600.27
Rate for Payer: Aetna Commercial	$784.97
Rate for Payer: Aetna Medicare	$461.74
Rate for Payer: Aetna New Business (MI Preferred)	$600.27
Rate for Payer: BCBS Complete	$369.40
Rate for Payer: Cash Price	$738.79
Rate for Payer: Cofinity Commercial	$646.44
Rate for Payer: Cofinity Commercial	$794.20
Rate for Payer: Cofinity Medicare Advantage	$646.44
Rate for Payer: Encore Health Key Benefits Commercial	$738.79
Rate for Payer: Healthscope Commercial	$831.14
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$646.44
Rate for Payer: Lakeland Regional Health Systems Commercial	$692.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$784.97
Rate for Payer: PHP Commercial	$784.97
Rate for Payer: Priority Health Cigna Priority Health	$600.27
Rate for Payer: Priority Health SBD	$581.80
Rate for Payer: UMR Bronson Commercial	$341.69
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$692.62

APREPITANT 40 MG CAPSULE

Facility

$309.14

Service Code	NDC 68462058340
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$114.38
Max. Negotiated Rate	$278.23
Rate for Payer: Aetna American Axle	$200.94
Rate for Payer: Aetna Commercial	$262.77
Rate for Payer: Aetna Medicare	$154.57
Rate for Payer: Aetna New Business (MI Preferred)	$200.94
Rate for Payer: BCBS Complete	$123.66
Rate for Payer: Cash Price	$247.31
Rate for Payer: Cofinity Commercial	$216.40
Rate for Payer: Cofinity Commercial	$265.86
Rate for Payer: Cofinity Medicare Advantage	$216.40
Rate for Payer: Encore Health Key Benefits Commercial	$247.31
Rate for Payer: Healthscope Commercial	$278.23
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$216.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$231.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$262.77
Rate for Payer: PHP Commercial	$262.77
Rate for Payer: Priority Health Cigna Priority Health	$200.94
Rate for Payer: Priority Health SBD	$194.76
Rate for Payer: UMR Bronson Commercial	$114.38
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$231.86

APREPITANT 40 MG CAPSULE

Facility

$1,545.68

Service Code	NDC 68462058385
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$680.10
Max. Negotiated Rate	$1,391.11
Rate for Payer: Aetna American Axle	$1,004.69
Rate for Payer: Aetna Commercial	$1,313.83
Rate for Payer: Aetna New Business (MI Preferred)	$1,004.69
Rate for Payer: Cash Price	$1,236.54
Rate for Payer: Cofinity Commercial	$1,081.98
Rate for Payer: Cofinity Commercial	$1,329.28
Rate for Payer: Cofinity Medicare Advantage	$1,081.98
Rate for Payer: Encore Health Key Benefits Commercial	$1,236.54
Rate for Payer: Healthscope Commercial	$1,391.11
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,081.98
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,159.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,313.83
Rate for Payer: PHP Commercial	$1,313.83
Rate for Payer: Priority Health Cigna Priority Health	$1,004.69
Rate for Payer: Priority Health SBD	$973.78
Rate for Payer: UMR Bronson Commercial	$680.10
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,159.26

APREPITANT 40 MG CAPSULE

Facility

$173.76

Service Code	NDC 13668059180
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$64.29
Max. Negotiated Rate	$156.38
Rate for Payer: Aetna American Axle	$112.94
Rate for Payer: Aetna Commercial	$147.70
Rate for Payer: Aetna Medicare	$86.88
Rate for Payer: Aetna New Business (MI Preferred)	$112.94
Rate for Payer: BCBS Complete	$69.50
Rate for Payer: Cash Price	$139.01
Rate for Payer: Cofinity Commercial	$121.63
Rate for Payer: Cofinity Commercial	$149.43
Rate for Payer: Cofinity Medicare Advantage	$121.63
Rate for Payer: Encore Health Key Benefits Commercial	$139.01
Rate for Payer: Healthscope Commercial	$156.38
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$121.63
Rate for Payer: Lakeland Regional Health Systems Commercial	$130.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$147.70
Rate for Payer: PHP Commercial	$147.70
Rate for Payer: Priority Health Cigna Priority Health	$112.94
Rate for Payer: Priority Health SBD	$109.47
Rate for Payer: UMR Bronson Commercial	$64.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$130.32

APREPITANT 40 MG CAPSULE

Facility

$1,276.73

Service Code	NDC 00781232151
Hospital Charge Code	76843
Hospital Revenue Code	637
Min. Negotiated Rate	$561.76
Max. Negotiated Rate	$1,149.06
Rate for Payer: Aetna American Axle	$829.87
Rate for Payer: Aetna Commercial	$1,085.22
Rate for Payer: Aetna New Business (MI Preferred)	$829.87
Rate for Payer: Cash Price	$1,021.38
Rate for Payer: Cofinity Commercial	$1,097.99
Rate for Payer: Cofinity Commercial	$893.71
Rate for Payer: Cofinity Medicare Advantage	$893.71
Rate for Payer: Encore Health Key Benefits Commercial	$1,021.38
Rate for Payer: Healthscope Commercial	$1,149.06
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$893.71
Rate for Payer: Lakeland Regional Health Systems Commercial	$957.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,085.22
Rate for Payer: PHP Commercial	$1,085.22
Rate for Payer: Priority Health Cigna Priority Health	$829.87
Rate for Payer: Priority Health SBD	$804.34
Rate for Payer: UMR Bronson Commercial	$561.76
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$957.55

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