Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

APR-DRG 42.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$4,242.15

Service Code	APR-DRG 1112
Min. Negotiated Rate	$4,040.14
Max. Negotiated Rate	$4,242.15
Rate for Payer: BCBS Complete	$4,242.15
Rate for Payer: Mclaren Medicaid	$4,040.14
Rate for Payer: Meridian Medicaid	$4,242.15
Rate for Payer: PHP Medicaid	$4,040.14
Rate for Payer: Priority Health Choice Medicaid	$4,040.14
Rate for Payer: UHCCP Medicaid	$4,040.14

APR-DRG 42.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$5,276.82

Service Code	APR-DRG 1113
Min. Negotiated Rate	$5,025.54
Max. Negotiated Rate	$5,276.82
Rate for Payer: BCBS Complete	$5,276.82
Rate for Payer: Mclaren Medicaid	$5,025.54
Rate for Payer: Meridian Medicaid	$5,276.82
Rate for Payer: PHP Medicaid	$5,025.54
Rate for Payer: Priority Health Choice Medicaid	$5,025.54
Rate for Payer: UHCCP Medicaid	$5,025.54

APR-DRG 42.00: VERTIGO AND OTHER LABYRINTH DISORDERS

Facility

$9,001.63

Service Code	APR-DRG 1114
Min. Negotiated Rate	$8,572.98
Max. Negotiated Rate	$9,001.63
Rate for Payer: BCBS Complete	$9,001.63
Rate for Payer: Mclaren Medicaid	$8,572.98
Rate for Payer: Meridian Medicaid	$9,001.63
Rate for Payer: PHP Medicaid	$8,572.98
Rate for Payer: Priority Health Choice Medicaid	$8,572.98
Rate for Payer: UHCCP Medicaid	$8,572.98

APR-DRG 42.00: VIRAL ILLNESS

Facility

$3,155.74

Service Code	APR-DRG 7232
Min. Negotiated Rate	$3,005.47
Max. Negotiated Rate	$3,155.74
Rate for Payer: BCBS Complete	$3,155.74
Rate for Payer: Mclaren Medicaid	$3,005.47
Rate for Payer: Meridian Medicaid	$3,155.74
Rate for Payer: PHP Medicaid	$3,005.47
Rate for Payer: Priority Health Choice Medicaid	$3,005.47
Rate for Payer: UHCCP Medicaid	$3,005.47

APR-DRG 42.00: VIRAL ILLNESS

Facility

$7,449.62

Service Code	APR-DRG 7234
Min. Negotiated Rate	$7,094.88
Max. Negotiated Rate	$7,449.62
Rate for Payer: BCBS Complete	$7,449.62
Rate for Payer: Mclaren Medicaid	$7,094.88
Rate for Payer: Meridian Medicaid	$7,449.62
Rate for Payer: PHP Medicaid	$7,094.88
Rate for Payer: Priority Health Choice Medicaid	$7,094.88
Rate for Payer: UHCCP Medicaid	$7,094.88

APR-DRG 42.00: VIRAL ILLNESS

Facility

$5,483.75

Service Code	APR-DRG 7233
Min. Negotiated Rate	$5,222.62
Max. Negotiated Rate	$5,483.75
Rate for Payer: BCBS Complete	$5,483.75
Rate for Payer: Mclaren Medicaid	$5,222.62
Rate for Payer: Meridian Medicaid	$5,483.75
Rate for Payer: PHP Medicaid	$5,222.62
Rate for Payer: Priority Health Choice Medicaid	$5,222.62
Rate for Payer: UHCCP Medicaid	$5,222.62

APR-DRG 42.00: VIRAL ILLNESS

Facility

$2,534.94

Service Code	APR-DRG 7231
Min. Negotiated Rate	$2,414.23
Max. Negotiated Rate	$2,534.94
Rate for Payer: BCBS Complete	$2,534.94
Rate for Payer: Mclaren Medicaid	$2,414.23
Rate for Payer: Meridian Medicaid	$2,534.94
Rate for Payer: PHP Medicaid	$2,414.23
Rate for Payer: Priority Health Choice Medicaid	$2,414.23
Rate for Payer: UHCCP Medicaid	$2,414.23

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$4,138.68

Service Code	APR-DRG 0512
Min. Negotiated Rate	$3,941.60
Max. Negotiated Rate	$4,138.68
Rate for Payer: BCBS Complete	$4,138.68
Rate for Payer: Mclaren Medicaid	$3,941.60
Rate for Payer: Meridian Medicaid	$4,138.68
Rate for Payer: PHP Medicaid	$3,941.60
Rate for Payer: Priority Health Choice Medicaid	$3,941.60
Rate for Payer: UHCCP Medicaid	$3,941.60

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$6,311.49

Service Code	APR-DRG 0513
Min. Negotiated Rate	$6,010.94
Max. Negotiated Rate	$6,311.49
Rate for Payer: BCBS Complete	$6,311.49
Rate for Payer: Mclaren Medicaid	$6,010.94
Rate for Payer: Meridian Medicaid	$6,311.49
Rate for Payer: PHP Medicaid	$6,010.94
Rate for Payer: Priority Health Choice Medicaid	$6,010.94
Rate for Payer: UHCCP Medicaid	$6,010.94

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$3,362.68

Service Code	APR-DRG 0511
Min. Negotiated Rate	$3,202.55
Max. Negotiated Rate	$3,362.68
Rate for Payer: BCBS Complete	$3,362.68
Rate for Payer: Mclaren Medicaid	$3,202.55
Rate for Payer: Meridian Medicaid	$3,362.68
Rate for Payer: PHP Medicaid	$3,202.55
Rate for Payer: Priority Health Choice Medicaid	$3,202.55
Rate for Payer: UHCCP Medicaid	$3,202.55

APR-DRG 42.00: VIRAL MENINGITIS

Facility

$9,570.70

Service Code	APR-DRG 0514
Min. Negotiated Rate	$9,114.95
Max. Negotiated Rate	$9,570.70
Rate for Payer: BCBS Complete	$9,570.70
Rate for Payer: Mclaren Medicaid	$9,114.95
Rate for Payer: Meridian Medicaid	$9,570.70
Rate for Payer: PHP Medicaid	$9,114.95
Rate for Payer: Priority Health Choice Medicaid	$9,114.95
Rate for Payer: UHCCP Medicaid	$9,114.95

ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION

Facility

$311.51

Service Code	HCPCS J0883
Hospital Charge Code	28947
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$311.51
Rate for Payer: Aetna Commercial	$280.36
Rate for Payer: Aetna Medicare	$0.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.00
Rate for Payer: Amish Plain Church Group Commercial	$1.00
Rate for Payer: ASR ASR	$302.16
Rate for Payer: ASR Commercial	$302.16
Rate for Payer: BCBS Complete	$0.45
Rate for Payer: BCBS MAPPO	$0.80
Rate for Payer: BCBS Trust/PPO	$255.10
Rate for Payer: BCN Commercial	$241.51
Rate for Payer: BCN Medicare Advantage	$0.80
Rate for Payer: Cash Price	$249.21
Rate for Payer: Cash Price	$249.21
Rate for Payer: Cofinity Commercial	$292.82
Rate for Payer: Encore Health Key Benefits Commercial	$249.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.80
Rate for Payer: Healthscope Commercial	$311.51
Rate for Payer: Healthscope Whirlpool	$302.16
Rate for Payer: Humana Choice PPO Medicare	$0.80
Rate for Payer: Mclaren Commercial	$280.36
Rate for Payer: Mclaren Medicaid	$0.43
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 Medicaid	$0.45
Rate for Payer: MI Amish Medical Board Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.78
Rate for Payer: Nomi Health Commercial	$255.44
Rate for Payer: PACE Medicare	$0.76
Rate for Payer: PACE SWMI	$0.80
Rate for Payer: PHP Commercial	$0.88
Rate for Payer: PHP Medicaid	$0.43
Rate for Payer: PHP Medicare Advantage	$0.80
Rate for Payer: Priority Health Choice Medicaid	$0.43
Rate for Payer: Priority Health Cigna Priority Health	$202.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$0.99
Rate for Payer: Priority Health Medicare	$0.80
Rate for Payer: Priority Health Narrow Network	$0.79
Rate for Payer: Railroad Medicare Medicare	$0.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$274.13
Rate for Payer: UHC Dual Complete DSNP	$0.80
Rate for Payer: UHC Exchange	$1.24
Rate for Payer: UHC Medicare Advantage	$0.80
Rate for Payer: UHCCP DNSP	$0.80
Rate for Payer: UHCCP Medicaid	$0.43
Rate for Payer: VA VA	$0.80

ARGATROBAN 100 MG/ML INTRAVENOUS SOLUTION

Facility

$311.51

Service Code	HCPCS J0883
Hospital Charge Code	28947
Hospital Revenue Code	636
Min. Negotiated Rate	$202.48
Max. Negotiated Rate	$311.51
Rate for Payer: Aetna Commercial	$280.36
Rate for Payer: ASR ASR	$302.16
Rate for Payer: ASR Commercial	$302.16
Rate for Payer: BCBS Trust/PPO	$253.85
Rate for Payer: BCN Commercial	$241.51
Rate for Payer: Cash Price	$249.21
Rate for Payer: Cofinity Commercial	$292.82
Rate for Payer: Encore Health Key Benefits Commercial	$249.21
Rate for Payer: Healthscope Commercial	$311.51
Rate for Payer: Healthscope Whirlpool	$302.16
Rate for Payer: Mclaren Commercial	$280.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.78
Rate for Payer: Nomi Health Commercial	$255.44
Rate for Payer: Priority Health Cigna Priority Health	$202.48
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$274.13

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

Facility

$333.15

Service Code	HCPCS J0883
Hospital Charge Code	152708
Hospital Revenue Code	636
Min. Negotiated Rate	$216.55
Max. Negotiated Rate	$333.15
Rate for Payer: Aetna Commercial	$299.84
Rate for Payer: ASR ASR	$323.16
Rate for Payer: ASR Commercial	$323.16
Rate for Payer: BCBS Trust/PPO	$271.48
Rate for Payer: BCN Commercial	$258.29
Rate for Payer: Cash Price	$266.52
Rate for Payer: Cofinity Commercial	$313.16
Rate for Payer: Encore Health Key Benefits Commercial	$266.52
Rate for Payer: Healthscope Commercial	$333.15
Rate for Payer: Healthscope Whirlpool	$323.16
Rate for Payer: Mclaren Commercial	$299.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.18
Rate for Payer: Nomi Health Commercial	$273.18
Rate for Payer: Priority Health Cigna Priority Health	$216.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$293.17

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

Facility

$333.15

Service Code	HCPCS J0883
Hospital Charge Code	152708
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$333.15
Rate for Payer: Aetna Commercial	$299.84
Rate for Payer: Aetna Medicare	$0.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.00
Rate for Payer: Amish Plain Church Group Commercial	$1.00
Rate for Payer: ASR ASR	$323.16
Rate for Payer: ASR Commercial	$323.16
Rate for Payer: BCBS Complete	$0.45
Rate for Payer: BCBS MAPPO	$0.80
Rate for Payer: BCBS Trust/PPO	$272.82
Rate for Payer: BCN Commercial	$258.29
Rate for Payer: BCN Medicare Advantage	$0.80
Rate for Payer: Cash Price	$266.52
Rate for Payer: Cash Price	$266.52
Rate for Payer: Cofinity Commercial	$313.16
Rate for Payer: Encore Health Key Benefits Commercial	$266.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.80
Rate for Payer: Healthscope Commercial	$333.15
Rate for Payer: Healthscope Whirlpool	$323.16
Rate for Payer: Humana Choice PPO Medicare	$0.80
Rate for Payer: Mclaren Commercial	$299.84
Rate for Payer: Mclaren Medicaid	$0.43
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 Medicaid	$0.45
Rate for Payer: MI Amish Medical Board Commercial	$0.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$283.18
Rate for Payer: Nomi Health Commercial	$273.18
Rate for Payer: PACE Medicare	$0.76
Rate for Payer: PACE SWMI	$0.80
Rate for Payer: PHP Commercial	$0.88
Rate for Payer: PHP Medicaid	$0.43
Rate for Payer: PHP Medicare Advantage	$0.80
Rate for Payer: Priority Health Choice Medicaid	$0.43
Rate for Payer: Priority Health Cigna Priority Health	$216.55
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$0.99
Rate for Payer: Priority Health Medicare	$0.80
Rate for Payer: Priority Health Narrow Network	$0.79
Rate for Payer: Railroad Medicare Medicare	$0.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$293.17
Rate for Payer: UHC Dual Complete DSNP	$0.80
Rate for Payer: UHC Exchange	$1.24
Rate for Payer: UHC Medicare Advantage	$0.80
Rate for Payer: UHCCP DNSP	$0.80
Rate for Payer: UHCCP Medicaid	$0.43
Rate for Payer: VA VA	$0.80

ARIPIPRAZOLE 15 MG TABLET

Facility

$141.00

Service Code	NDC 65162089903
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$91.65
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Commercial	$126.90
Rate for Payer: ASR ASR	$136.77
Rate for Payer: ASR Commercial	$136.77
Rate for Payer: BCBS Trust/PPO	$114.90
Rate for Payer: BCN Commercial	$109.32
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$132.54
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$141.00
Rate for Payer: Healthscope Whirlpool	$136.77
Rate for Payer: Mclaren Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: Nomi Health Commercial	$115.62
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$124.08

ARIPIPRAZOLE 15 MG TABLET

Facility

$6.28

Service Code	NDC 50268009011
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: Aetna Medicare	$3.14
Rate for Payer: ASR ASR	$6.09
Rate for Payer: ASR Commercial	$6.09
Rate for Payer: BCBS Complete	$2.51
Rate for Payer: BCBS Trust/PPO	$5.14
Rate for Payer: BCN Commercial	$4.87
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$5.02
Rate for Payer: Healthscope Commercial	$6.28
Rate for Payer: Healthscope Whirlpool	$6.09
Rate for Payer: Mclaren Commercial	$5.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.34
Rate for Payer: Nomi Health Commercial	$5.15
Rate for Payer: Priority Health Cigna Priority Health	$4.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5.50
Rate for Payer: Priority Health Narrow Network	$4.40
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.53

ARIPIPRAZOLE 15 MG TABLET

Facility

$125.57

Service Code	NDC 50268009012
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$81.62
Max. Negotiated Rate	$125.57
Rate for Payer: Aetna Commercial	$113.01
Rate for Payer: ASR ASR	$121.80
Rate for Payer: ASR Commercial	$121.80
Rate for Payer: BCBS Trust/PPO	$102.33
Rate for Payer: BCN Commercial	$97.35
Rate for Payer: Cash Price	$100.45
Rate for Payer: Cofinity Commercial	$118.04
Rate for Payer: Encore Health Key Benefits Commercial	$100.46
Rate for Payer: Healthscope Commercial	$125.57
Rate for Payer: Healthscope Whirlpool	$121.80
Rate for Payer: Mclaren Commercial	$113.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.73
Rate for Payer: Nomi Health Commercial	$102.97
Rate for Payer: Priority Health Cigna Priority Health	$81.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.50

ARIPIPRAZOLE 15 MG TABLET

Facility

$125.57

Service Code	NDC 50268009012
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$50.23
Max. Negotiated Rate	$125.57
Rate for Payer: Aetna Commercial	$113.01
Rate for Payer: Aetna Medicare	$62.78
Rate for Payer: ASR ASR	$121.80
Rate for Payer: ASR Commercial	$121.80
Rate for Payer: BCBS Complete	$50.23
Rate for Payer: BCBS Trust/PPO	$102.83
Rate for Payer: BCN Commercial	$97.35
Rate for Payer: Cash Price	$100.45
Rate for Payer: Cofinity Commercial	$118.04
Rate for Payer: Encore Health Key Benefits Commercial	$100.46
Rate for Payer: Healthscope Commercial	$125.57
Rate for Payer: Healthscope Whirlpool	$121.80
Rate for Payer: Mclaren Commercial	$113.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.73
Rate for Payer: Nomi Health Commercial	$102.97
Rate for Payer: Priority Health Cigna Priority Health	$81.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$110.02
Rate for Payer: Priority Health Narrow Network	$88.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.50

ARIPIPRAZOLE 15 MG TABLET

Facility

$141.00

Service Code	NDC 65162089903
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$56.40
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Commercial	$126.90
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: ASR ASR	$136.77
Rate for Payer: ASR Commercial	$136.77
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: BCBS Trust/PPO	$115.46
Rate for Payer: BCN Commercial	$109.32
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$132.54
Rate for Payer: Encore Health Key Benefits Commercial	$112.80
Rate for Payer: Healthscope Commercial	$141.00
Rate for Payer: Healthscope Whirlpool	$136.77
Rate for Payer: Mclaren Commercial	$126.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.85
Rate for Payer: Nomi Health Commercial	$115.62
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.54
Rate for Payer: Priority Health Narrow Network	$98.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$124.08

ARIPIPRAZOLE 15 MG TABLET

Facility

$6.28

Service Code	NDC 50268009011
Hospital Charge Code	34370
Hospital Revenue Code	637
Min. Negotiated Rate	$4.08
Max. Negotiated Rate	$6.28
Rate for Payer: Aetna Commercial	$5.65
Rate for Payer: ASR ASR	$6.09
Rate for Payer: ASR Commercial	$6.09
Rate for Payer: BCBS Trust/PPO	$5.12
Rate for Payer: BCN Commercial	$4.87
Rate for Payer: Cash Price	$5.02
Rate for Payer: Cofinity Commercial	$5.90
Rate for Payer: Encore Health Key Benefits Commercial	$5.02
Rate for Payer: Healthscope Commercial	$6.28
Rate for Payer: Healthscope Whirlpool	$6.09
Rate for Payer: Mclaren Commercial	$5.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.34
Rate for Payer: Nomi Health Commercial	$5.15
Rate for Payer: Priority Health Cigna Priority Health	$4.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$5.53

ARIPIPRAZOLE 20 MG TABLET

Facility

$85.78

Service Code	NDC 65162090103
Hospital Charge Code	34371
Hospital Revenue Code	637
Min. Negotiated Rate	$55.76
Max. Negotiated Rate	$85.78
Rate for Payer: Aetna Commercial	$77.20
Rate for Payer: ASR ASR	$83.21
Rate for Payer: ASR Commercial	$83.21
Rate for Payer: BCBS Trust/PPO	$69.90
Rate for Payer: BCN Commercial	$66.51
Rate for Payer: Cash Price	$68.63
Rate for Payer: Cofinity Commercial	$80.63
Rate for Payer: Encore Health Key Benefits Commercial	$68.62
Rate for Payer: Healthscope Commercial	$85.78
Rate for Payer: Healthscope Whirlpool	$83.21
Rate for Payer: Mclaren Commercial	$77.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.91
Rate for Payer: Nomi Health Commercial	$70.34
Rate for Payer: Priority Health Cigna Priority Health	$55.76
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$75.49

ARIPIPRAZOLE 20 MG TABLET

Facility

$85.78

Service Code	NDC 65162090103
Hospital Charge Code	34371
Hospital Revenue Code	637
Min. Negotiated Rate	$34.31
Max. Negotiated Rate	$85.78
Rate for Payer: Aetna Commercial	$77.20
Rate for Payer: Aetna Medicare	$42.89
Rate for Payer: ASR ASR	$83.21
Rate for Payer: ASR Commercial	$83.21
Rate for Payer: BCBS Complete	$34.31
Rate for Payer: BCBS Trust/PPO	$70.25
Rate for Payer: BCN Commercial	$66.51
Rate for Payer: Cash Price	$68.63
Rate for Payer: Cofinity Commercial	$80.63
Rate for Payer: Encore Health Key Benefits Commercial	$68.62
Rate for Payer: Healthscope Commercial	$85.78
Rate for Payer: Healthscope Whirlpool	$83.21
Rate for Payer: Mclaren Commercial	$77.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$72.91
Rate for Payer: Nomi Health Commercial	$70.34
Rate for Payer: Priority Health Cigna Priority Health	$55.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.16
Rate for Payer: Priority Health Narrow Network	$60.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$75.49

ARIPIPRAZOLE 5 MG TABLET

Facility

$81.22

Service Code	NDC 65162089703
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$32.49
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna Commercial	$73.10
Rate for Payer: Aetna Medicare	$40.61
Rate for Payer: ASR ASR	$78.78
Rate for Payer: ASR Commercial	$78.78
Rate for Payer: BCBS Complete	$32.49
Rate for Payer: BCBS Trust/PPO	$66.51
Rate for Payer: BCN Commercial	$62.97
Rate for Payer: Cash Price	$64.98
Rate for Payer: Cofinity Commercial	$76.35
Rate for Payer: Encore Health Key Benefits Commercial	$64.98
Rate for Payer: Healthscope Commercial	$81.22
Rate for Payer: Healthscope Whirlpool	$78.78
Rate for Payer: Mclaren Commercial	$73.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.04
Rate for Payer: Nomi Health Commercial	$66.60
Rate for Payer: Priority Health Cigna Priority Health	$52.79
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.16
Rate for Payer: Priority Health Narrow Network	$56.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.47

ARIPIPRAZOLE 5 MG TABLET

Facility

$81.22

Service Code	NDC 65162089703
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$52.79
Max. Negotiated Rate	$81.22
Rate for Payer: Aetna Commercial	$73.10
Rate for Payer: ASR ASR	$78.78
Rate for Payer: ASR Commercial	$78.78
Rate for Payer: BCBS Trust/PPO	$66.19
Rate for Payer: BCN Commercial	$62.97
Rate for Payer: Cash Price	$64.98
Rate for Payer: Cofinity Commercial	$76.35
Rate for Payer: Encore Health Key Benefits Commercial	$64.98
Rate for Payer: Healthscope Commercial	$81.22
Rate for Payer: Healthscope Whirlpool	$78.78
Rate for Payer: Mclaren Commercial	$73.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.04
Rate for Payer: Nomi Health Commercial	$66.60
Rate for Payer: Priority Health Cigna Priority Health	$52.79
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$71.47

Know your out-of-pocket cost for care.

All Charges