Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$544.80

Service Code	NDC 68084049401
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$343.22
Max. Negotiated Rate	$490.32
Rate for Payer: Aetna Commercial	$463.08
Rate for Payer: Aetna New Business (MI Preferred)	$354.12
Rate for Payer: Cash Price	$435.84
Rate for Payer: Cofinity Advantage	$381.36
Rate for Payer: Cofinity Commercial	$468.53
Rate for Payer: Encore Health Key Benefits Commercial	$435.84
Rate for Payer: Healthscope Commercial	$490.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$408.60
Rate for Payer: PHP Commercial	$463.08
Rate for Payer: Priority Health SBD	$343.22

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$433.20

Service Code	NDC 68682030210
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$170.25
Max. Negotiated Rate	$389.88
Rate for Payer: Aetna Commercial	$368.22
Rate for Payer: Aetna Medicare	$216.60
Rate for Payer: Aetna New Business (MI Preferred)	$281.58
Rate for Payer: BCBS Complete	$173.28
Rate for Payer: Cash Price	$346.56
Rate for Payer: Cofinity Advantage	$303.24
Rate for Payer: Cofinity Commercial	$372.55
Rate for Payer: Encore Health Key Benefits Commercial	$346.56
Rate for Payer: Healthscope Commercial	$389.88
Rate for Payer: MI Amish Medical Board Commercial	$346.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$324.90
Rate for Payer: PHP Commercial	$368.22
Rate for Payer: Priority Health SBD	$272.92
Rate for Payer: UHC All Payor (Choice/PPO)	$281.58
Rate for Payer: UHC Core	$225.70
Rate for Payer: UHC Exchange	$170.25

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$494.88

Service Code	NDC 00904662261
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$311.77
Max. Negotiated Rate	$445.39
Rate for Payer: Aetna Commercial	$420.65
Rate for Payer: Aetna New Business (MI Preferred)	$321.67
Rate for Payer: Cash Price	$395.90
Rate for Payer: Cofinity Advantage	$346.42
Rate for Payer: Cofinity Commercial	$425.60
Rate for Payer: Encore Health Key Benefits Commercial	$395.90
Rate for Payer: Healthscope Commercial	$445.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.16
Rate for Payer: PHP Commercial	$420.65
Rate for Payer: Priority Health SBD	$311.77

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$544.80

Service Code	NDC 68084049401
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$214.11
Max. Negotiated Rate	$490.32
Rate for Payer: Aetna Commercial	$463.08
Rate for Payer: Aetna Medicare	$272.40
Rate for Payer: Aetna New Business (MI Preferred)	$354.12
Rate for Payer: BCBS Complete	$217.92
Rate for Payer: Cash Price	$435.84
Rate for Payer: Cofinity Advantage	$381.36
Rate for Payer: Cofinity Commercial	$468.53
Rate for Payer: Encore Health Key Benefits Commercial	$435.84
Rate for Payer: Healthscope Commercial	$490.32
Rate for Payer: MI Amish Medical Board Commercial	$435.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$463.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$408.60
Rate for Payer: PHP Commercial	$463.08
Rate for Payer: Priority Health SBD	$343.22
Rate for Payer: UHC All Payor (Choice/PPO)	$354.12
Rate for Payer: UHC Core	$283.84
Rate for Payer: UHC Exchange	$214.11

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$494.88

Service Code	NDC 00904662261
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$194.49
Max. Negotiated Rate	$445.39
Rate for Payer: Aetna Commercial	$420.65
Rate for Payer: Aetna Medicare	$247.44
Rate for Payer: Aetna New Business (MI Preferred)	$321.67
Rate for Payer: BCBS Complete	$197.95
Rate for Payer: Cash Price	$395.90
Rate for Payer: Cofinity Advantage	$346.42
Rate for Payer: Cofinity Commercial	$425.60
Rate for Payer: Encore Health Key Benefits Commercial	$395.90
Rate for Payer: Healthscope Commercial	$445.39
Rate for Payer: MI Amish Medical Board Commercial	$395.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$420.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.16
Rate for Payer: PHP Commercial	$420.65
Rate for Payer: Priority Health SBD	$311.77
Rate for Payer: UHC All Payor (Choice/PPO)	$321.67
Rate for Payer: UHC Core	$257.83
Rate for Payer: UHC Exchange	$194.49

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION

Facility

$50.12

Service Code	HCPCS J3415
Hospital Charge Code	6744
Hospital Revenue Code	636
Min. Negotiated Rate	$31.58
Max. Negotiated Rate	$45.11
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna New Business (MI Preferred)	$32.58
Rate for Payer: Cash Price	$40.10
Rate for Payer: Cofinity Advantage	$35.08
Rate for Payer: Cofinity Commercial	$43.10
Rate for Payer: Encore Health Key Benefits Commercial	$40.10
Rate for Payer: Healthscope Commercial	$45.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.59
Rate for Payer: PHP Commercial	$42.60
Rate for Payer: Priority Health SBD	$31.58

PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION

Facility

$50.12

Service Code	HCPCS J3415
Hospital Charge Code	6744
Hospital Revenue Code	636
Min. Negotiated Rate	$20.05
Max. Negotiated Rate	$45.11
Rate for Payer: Aetna Commercial	$42.60
Rate for Payer: Aetna Medicare	$25.06
Rate for Payer: Aetna New Business (MI Preferred)	$32.58
Rate for Payer: BCBS Complete	$20.05
Rate for Payer: BCBS Trust/PPO	$39.00
Rate for Payer: BCN Commercial	$39.00
Rate for Payer: Cash Price	$40.10
Rate for Payer: Cash Price	$40.10
Rate for Payer: Cofinity Advantage	$35.08
Rate for Payer: Cofinity Commercial	$43.10
Rate for Payer: Encore Health Key Benefits Commercial	$40.10
Rate for Payer: Healthscope Commercial	$45.11
Rate for Payer: MI Amish Medical Board Commercial	$40.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.59
Rate for Payer: PHP Commercial	$42.60
Rate for Payer: Priority Health SBD	$31.58
Rate for Payer: UHC All Payor (Choice/PPO)	$25.67
Rate for Payer: UHC Core	$25.67
Rate for Payer: UHC Exchange	$25.67

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$1.45

Service Code	NDC 77333094025
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$1.23
Rate for Payer: Aetna New Business (MI Preferred)	$0.94
Rate for Payer: Cash Price	$1.16
Rate for Payer: Cofinity Advantage	$1.01
Rate for Payer: Cofinity Commercial	$1.25
Rate for Payer: Encore Health Key Benefits Commercial	$1.16
Rate for Payer: Healthscope Commercial	$1.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.09
Rate for Payer: PHP Commercial	$1.23
Rate for Payer: Priority Health SBD	$0.91

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$144.10

Service Code	NDC 77333094010
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$90.78
Max. Negotiated Rate	$129.69
Rate for Payer: Aetna Commercial	$122.48
Rate for Payer: Aetna New Business (MI Preferred)	$93.67
Rate for Payer: Cash Price	$115.28
Rate for Payer: Cofinity Advantage	$100.87
Rate for Payer: Cofinity Commercial	$123.93
Rate for Payer: Encore Health Key Benefits Commercial	$115.28
Rate for Payer: Healthscope Commercial	$129.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.08
Rate for Payer: PHP Commercial	$122.48
Rate for Payer: Priority Health SBD	$90.78

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$1.45

Service Code	NDC 77333094025
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$1.23
Rate for Payer: Aetna Medicare	$0.73
Rate for Payer: Aetna New Business (MI Preferred)	$0.94
Rate for Payer: BCBS Complete	$0.58
Rate for Payer: Cash Price	$1.16
Rate for Payer: Cofinity Advantage	$1.01
Rate for Payer: Cofinity Commercial	$1.25
Rate for Payer: Encore Health Key Benefits Commercial	$1.16
Rate for Payer: Healthscope Commercial	$1.30
Rate for Payer: MI Amish Medical Board Commercial	$1.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.09
Rate for Payer: PHP Commercial	$1.23
Rate for Payer: Priority Health SBD	$0.91
Rate for Payer: UHC All Payor (Choice/PPO)	$0.94
Rate for Payer: UHC Core	$0.76
Rate for Payer: UHC Exchange	$0.57

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$144.10

Service Code	NDC 77333094010
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$56.63
Max. Negotiated Rate	$129.69
Rate for Payer: Aetna Commercial	$122.48
Rate for Payer: Aetna Medicare	$72.05
Rate for Payer: Aetna New Business (MI Preferred)	$93.67
Rate for Payer: BCBS Complete	$57.64
Rate for Payer: Cash Price	$115.28
Rate for Payer: Cofinity Advantage	$100.87
Rate for Payer: Cofinity Commercial	$123.93
Rate for Payer: Encore Health Key Benefits Commercial	$115.28
Rate for Payer: Healthscope Commercial	$129.69
Rate for Payer: MI Amish Medical Board Commercial	$115.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.08
Rate for Payer: PHP Commercial	$122.48
Rate for Payer: Priority Health SBD	$90.78
Rate for Payer: UHC All Payor (Choice/PPO)	$93.67
Rate for Payer: UHC Core	$75.08
Rate for Payer: UHC Exchange	$56.63

QUETIAPINE 100 MG TABLET

Facility

$281.20

Service Code	NDC 47335090488
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$177.16
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Advantage	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.90
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health SBD	$177.16

QUETIAPINE 100 MG TABLET

Facility

$204.25

Service Code	NDC 00904664061
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$80.27
Max. Negotiated Rate	$183.82
Rate for Payer: Aetna Commercial	$173.61
Rate for Payer: Aetna Medicare	$102.12
Rate for Payer: Aetna New Business (MI Preferred)	$132.76
Rate for Payer: BCBS Complete	$81.70
Rate for Payer: Cash Price	$163.40
Rate for Payer: Cofinity Advantage	$142.97
Rate for Payer: Cofinity Commercial	$175.66
Rate for Payer: Encore Health Key Benefits Commercial	$163.40
Rate for Payer: Healthscope Commercial	$183.82
Rate for Payer: MI Amish Medical Board Commercial	$163.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.19
Rate for Payer: PHP Commercial	$173.61
Rate for Payer: Priority Health SBD	$128.68
Rate for Payer: UHC All Payor (Choice/PPO)	$132.76
Rate for Payer: UHC Core	$106.41
Rate for Payer: UHC Exchange	$80.27

QUETIAPINE 100 MG TABLET

Facility

$204.25

Service Code	NDC 00904664061
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$128.68
Max. Negotiated Rate	$183.82
Rate for Payer: Aetna Commercial	$173.61
Rate for Payer: Aetna New Business (MI Preferred)	$132.76
Rate for Payer: Cash Price	$163.40
Rate for Payer: Cofinity Advantage	$142.97
Rate for Payer: Cofinity Commercial	$175.66
Rate for Payer: Encore Health Key Benefits Commercial	$163.40
Rate for Payer: Healthscope Commercial	$183.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.19
Rate for Payer: PHP Commercial	$173.61
Rate for Payer: Priority Health SBD	$128.68

QUETIAPINE 100 MG TABLET

Facility

$281.20

Service Code	NDC 47335090488
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$110.51
Max. Negotiated Rate	$253.08
Rate for Payer: Aetna Commercial	$239.02
Rate for Payer: Aetna Medicare	$140.60
Rate for Payer: Aetna New Business (MI Preferred)	$182.78
Rate for Payer: BCBS Complete	$112.48
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Advantage	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$253.08
Rate for Payer: MI Amish Medical Board Commercial	$224.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$239.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.90
Rate for Payer: PHP Commercial	$239.02
Rate for Payer: Priority Health SBD	$177.16
Rate for Payer: UHC All Payor (Choice/PPO)	$182.78
Rate for Payer: UHC Core	$146.51
Rate for Payer: UHC Exchange	$110.51

QUETIAPINE 200 MG TABLET

Facility

$363.85

Service Code	NDC 00904664161
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$142.99
Max. Negotiated Rate	$327.46
Rate for Payer: Aetna Commercial	$309.27
Rate for Payer: Aetna Medicare	$181.93
Rate for Payer: Aetna New Business (MI Preferred)	$236.50
Rate for Payer: BCBS Complete	$145.54
Rate for Payer: Cash Price	$291.08
Rate for Payer: Cofinity Advantage	$254.69
Rate for Payer: Cofinity Commercial	$312.91
Rate for Payer: Encore Health Key Benefits Commercial	$291.08
Rate for Payer: Healthscope Commercial	$327.46
Rate for Payer: MI Amish Medical Board Commercial	$291.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$272.89
Rate for Payer: PHP Commercial	$309.27
Rate for Payer: Priority Health SBD	$229.23
Rate for Payer: UHC All Payor (Choice/PPO)	$236.50
Rate for Payer: UHC Core	$189.57
Rate for Payer: UHC Exchange	$142.99

QUETIAPINE 200 MG TABLET

Facility

$4,327.89

Service Code	NDC 00310027210
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$2,726.57
Max. Negotiated Rate	$3,895.10
Rate for Payer: Aetna Commercial	$3,678.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,813.13
Rate for Payer: Cash Price	$3,462.31
Rate for Payer: Cofinity Advantage	$3,029.52
Rate for Payer: Cofinity Commercial	$3,721.99
Rate for Payer: Encore Health Key Benefits Commercial	$3,462.31
Rate for Payer: Healthscope Commercial	$3,895.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,678.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,245.92
Rate for Payer: PHP Commercial	$3,678.71
Rate for Payer: Priority Health SBD	$2,726.57

QUETIAPINE 200 MG TABLET

Facility

$265.55

Service Code	NDC 67877024601
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$104.36
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna Medicare	$132.78
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: BCBS Complete	$106.22
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Advantage	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: MI Amish Medical Board Commercial	$212.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.16
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health SBD	$167.30
Rate for Payer: UHC All Payor (Choice/PPO)	$172.61
Rate for Payer: UHC Core	$138.35
Rate for Payer: UHC Exchange	$104.36

QUETIAPINE 200 MG TABLET

Facility

$265.55

Service Code	NDC 67877024601
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$167.30
Max. Negotiated Rate	$239.00
Rate for Payer: Aetna Commercial	$225.72
Rate for Payer: Aetna New Business (MI Preferred)	$172.61
Rate for Payer: Cash Price	$212.44
Rate for Payer: Cofinity Advantage	$185.88
Rate for Payer: Cofinity Commercial	$228.37
Rate for Payer: Encore Health Key Benefits Commercial	$212.44
Rate for Payer: Healthscope Commercial	$239.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.16
Rate for Payer: PHP Commercial	$225.72
Rate for Payer: Priority Health SBD	$167.30

QUETIAPINE 200 MG TABLET

Facility

$4,327.89

Service Code	NDC 00310027210
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$1,700.86
Max. Negotiated Rate	$3,895.10
Rate for Payer: Aetna Commercial	$3,678.71
Rate for Payer: Aetna Medicare	$2,163.95
Rate for Payer: Aetna New Business (MI Preferred)	$2,813.13
Rate for Payer: BCBS Complete	$1,731.16
Rate for Payer: Cash Price	$3,462.31
Rate for Payer: Cofinity Advantage	$3,029.52
Rate for Payer: Cofinity Commercial	$3,721.99
Rate for Payer: Encore Health Key Benefits Commercial	$3,462.31
Rate for Payer: Healthscope Commercial	$3,895.10
Rate for Payer: MI Amish Medical Board Commercial	$3,462.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,678.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,245.92
Rate for Payer: PHP Commercial	$3,678.71
Rate for Payer: Priority Health SBD	$2,726.57
Rate for Payer: UHC All Payor (Choice/PPO)	$2,813.13
Rate for Payer: UHC Core	$2,254.83
Rate for Payer: UHC Exchange	$1,700.86

QUETIAPINE 200 MG TABLET

Facility

$363.85

Service Code	NDC 00904664161
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$229.23
Max. Negotiated Rate	$327.46
Rate for Payer: Aetna Commercial	$309.27
Rate for Payer: Aetna New Business (MI Preferred)	$236.50
Rate for Payer: Cash Price	$291.08
Rate for Payer: Cofinity Advantage	$254.69
Rate for Payer: Cofinity Commercial	$312.91
Rate for Payer: Encore Health Key Benefits Commercial	$291.08
Rate for Payer: Healthscope Commercial	$327.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$272.89
Rate for Payer: PHP Commercial	$309.27
Rate for Payer: Priority Health SBD	$229.23

QUETIAPINE 25 MG TABLET

Facility

$77.55

Service Code	NDC 67877024201
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$48.86
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Advantage	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.16
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health SBD	$48.86

QUETIAPINE 25 MG TABLET

Facility

$165.68

Service Code	NDC 50268063015
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$65.11
Max. Negotiated Rate	$149.11
Rate for Payer: Aetna Commercial	$140.83
Rate for Payer: Aetna Medicare	$82.84
Rate for Payer: Aetna New Business (MI Preferred)	$107.69
Rate for Payer: BCBS Complete	$66.27
Rate for Payer: Cash Price	$132.54
Rate for Payer: Cofinity Advantage	$115.98
Rate for Payer: Cofinity Commercial	$142.48
Rate for Payer: Encore Health Key Benefits Commercial	$132.54
Rate for Payer: Healthscope Commercial	$149.11
Rate for Payer: MI Amish Medical Board Commercial	$132.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.26
Rate for Payer: PHP Commercial	$140.83
Rate for Payer: Priority Health SBD	$104.38
Rate for Payer: UHC All Payor (Choice/PPO)	$107.69
Rate for Payer: UHC Core	$86.32
Rate for Payer: UHC Exchange	$65.11

QUETIAPINE 25 MG TABLET

Facility

$404.20

Service Code	NDC 00904663861
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$254.65
Max. Negotiated Rate	$363.78
Rate for Payer: Aetna Commercial	$343.57
Rate for Payer: Aetna New Business (MI Preferred)	$262.73
Rate for Payer: Cash Price	$323.36
Rate for Payer: Cofinity Advantage	$282.94
Rate for Payer: Cofinity Commercial	$347.61
Rate for Payer: Encore Health Key Benefits Commercial	$323.36
Rate for Payer: Healthscope Commercial	$363.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$343.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.15
Rate for Payer: PHP Commercial	$343.57
Rate for Payer: Priority Health SBD	$254.65

QUETIAPINE 25 MG TABLET

Facility

$165.68

Service Code	NDC 50268063015
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$104.38
Max. Negotiated Rate	$149.11
Rate for Payer: Aetna Commercial	$140.83
Rate for Payer: Aetna New Business (MI Preferred)	$107.69
Rate for Payer: Cash Price	$132.54
Rate for Payer: Cofinity Advantage	$115.98
Rate for Payer: Cofinity Commercial	$142.48
Rate for Payer: Encore Health Key Benefits Commercial	$132.54
Rate for Payer: Healthscope Commercial	$149.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$140.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.26
Rate for Payer: PHP Commercial	$140.83
Rate for Payer: Priority Health SBD	$104.38

Know your out-of-pocket cost for care.

All Charges