Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

QUETIAPINE 25 MG TABLET

Facility

$3.32

Service Code	NDC 50268063011
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Advantage	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health SBD	$2.09

QUETIAPINE 25 MG TABLET

Facility

$4.45

Service Code	NDC 60687032711
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: Cash Price	$3.56
Rate for Payer: Cofinity Advantage	$3.12
Rate for Payer: Cofinity Commercial	$3.83
Rate for Payer: Encore Health Key Benefits Commercial	$3.56
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.34
Rate for Payer: PHP Commercial	$3.78
Rate for Payer: Priority Health SBD	$2.80

QUETIAPINE 25 MG TABLET

Facility

$77.55

Service Code	NDC 67877024201
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$30.48
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna Medicare	$38.77
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: BCBS Complete	$31.02
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: MI Amish Medical Board Commercial	$62.04
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
Rate for Payer: UHC All Payor (Choice/PPO)	$50.41
Rate for Payer: UHC Core	$40.40
Rate for Payer: UHC Exchange	$30.48

QUETIAPINE 25 MG TABLET

Facility

$444.15

Service Code	NDC 60687032701
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$174.55
Max. Negotiated Rate	$399.74
Rate for Payer: Aetna Commercial	$377.53
Rate for Payer: Aetna Medicare	$222.07
Rate for Payer: Aetna New Business (MI Preferred)	$288.70
Rate for Payer: BCBS Complete	$177.66
Rate for Payer: Cash Price	$355.32
Rate for Payer: Cofinity Advantage	$310.90
Rate for Payer: Cofinity Commercial	$381.97
Rate for Payer: Encore Health Key Benefits Commercial	$355.32
Rate for Payer: Healthscope Commercial	$399.74
Rate for Payer: MI Amish Medical Board Commercial	$355.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$333.11
Rate for Payer: PHP Commercial	$377.53
Rate for Payer: Priority Health SBD	$279.81
Rate for Payer: UHC All Payor (Choice/PPO)	$288.70
Rate for Payer: UHC Core	$231.40
Rate for Payer: UHC Exchange	$174.55

QUETIAPINE 25 MG TABLET

Facility

$3.32

Service Code	NDC 50268063011
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: BCBS Complete	$1.33
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Advantage	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: MI Amish Medical Board Commercial	$2.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health SBD	$2.09
Rate for Payer: UHC All Payor (Choice/PPO)	$2.16
Rate for Payer: UHC Core	$1.73
Rate for Payer: UHC Exchange	$1.30

QUETIAPINE 25 MG TABLET

Facility

$404.20

Service Code	NDC 00904663861
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$158.85
Max. Negotiated Rate	$363.78
Rate for Payer: Aetna Commercial	$343.57
Rate for Payer: Aetna Medicare	$202.10
Rate for Payer: Aetna New Business (MI Preferred)	$262.73
Rate for Payer: BCBS Complete	$161.68
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: MI Amish Medical Board Commercial	$323.36
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
Rate for Payer: UHC All Payor (Choice/PPO)	$262.73
Rate for Payer: UHC Core	$210.59
Rate for Payer: UHC Exchange	$158.85

QUETIAPINE 25 MG TABLET

Facility

$4.45

Service Code	NDC 60687032711
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.75
Max. Negotiated Rate	$4.00
Rate for Payer: Aetna Commercial	$3.78
Rate for Payer: Aetna Medicare	$2.23
Rate for Payer: Aetna New Business (MI Preferred)	$2.89
Rate for Payer: BCBS Complete	$1.78
Rate for Payer: Cash Price	$3.56
Rate for Payer: Cofinity Advantage	$3.12
Rate for Payer: Cofinity Commercial	$3.83
Rate for Payer: Encore Health Key Benefits Commercial	$3.56
Rate for Payer: Healthscope Commercial	$4.00
Rate for Payer: MI Amish Medical Board Commercial	$3.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.34
Rate for Payer: PHP Commercial	$3.78
Rate for Payer: Priority Health SBD	$2.80
Rate for Payer: UHC All Payor (Choice/PPO)	$2.89
Rate for Payer: UHC Core	$2.32
Rate for Payer: UHC Exchange	$1.75

QUETIAPINE 25 MG TABLET

Facility

$444.15

Service Code	NDC 60687032701
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$279.81
Max. Negotiated Rate	$399.74
Rate for Payer: Aetna Commercial	$377.53
Rate for Payer: Aetna New Business (MI Preferred)	$288.70
Rate for Payer: Cash Price	$355.32
Rate for Payer: Cofinity Advantage	$310.90
Rate for Payer: Cofinity Commercial	$381.97
Rate for Payer: Encore Health Key Benefits Commercial	$355.32
Rate for Payer: Healthscope Commercial	$399.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$377.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$333.11
Rate for Payer: PHP Commercial	$377.53
Rate for Payer: Priority Health SBD	$279.81

QUETIAPINE 300 MG TABLET

Facility

$235.47

Service Code	NDC 67877024760
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$148.35
Max. Negotiated Rate	$211.92
Rate for Payer: Aetna Commercial	$200.15
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Advantage	$164.83
Rate for Payer: Cofinity Commercial	$202.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$176.60
Rate for Payer: PHP Commercial	$200.15
Rate for Payer: Priority Health SBD	$148.35

QUETIAPINE 300 MG TABLET

Facility

$361.00

Service Code	NDC 00904664261
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$227.43
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Advantage	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Encore Health Key Benefits Commercial	$288.80
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.75
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health SBD	$227.43

QUETIAPINE 300 MG TABLET

Facility

$397.10

Service Code	NDC 60687037101
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$250.17
Max. Negotiated Rate	$357.39
Rate for Payer: Aetna Commercial	$337.54
Rate for Payer: Aetna New Business (MI Preferred)	$258.12
Rate for Payer: Cash Price	$317.68
Rate for Payer: Cofinity Advantage	$277.97
Rate for Payer: Cofinity Commercial	$341.51
Rate for Payer: Encore Health Key Benefits Commercial	$317.68
Rate for Payer: Healthscope Commercial	$357.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$297.82
Rate for Payer: PHP Commercial	$337.54
Rate for Payer: Priority Health SBD	$250.17

QUETIAPINE 300 MG TABLET

Facility

$235.47

Service Code	NDC 67877024760
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$92.54
Max. Negotiated Rate	$211.92
Rate for Payer: Aetna Commercial	$200.15
Rate for Payer: Aetna Medicare	$117.73
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: BCBS Complete	$94.19
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Advantage	$164.83
Rate for Payer: Cofinity Commercial	$202.50
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.92
Rate for Payer: MI Amish Medical Board Commercial	$188.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$176.60
Rate for Payer: PHP Commercial	$200.15
Rate for Payer: Priority Health SBD	$148.35
Rate for Payer: UHC All Payor (Choice/PPO)	$153.06
Rate for Payer: UHC Core	$122.68
Rate for Payer: UHC Exchange	$92.54

QUETIAPINE 300 MG TABLET

Facility

$3.98

Service Code	NDC 60687037111
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna New Business (MI Preferred)	$2.59
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cofinity Advantage	$2.79
Rate for Payer: Cofinity Commercial	$3.42
Rate for Payer: Encore Health Key Benefits Commercial	$3.18
Rate for Payer: Healthscope Commercial	$3.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.98
Rate for Payer: PHP Commercial	$3.38
Rate for Payer: Priority Health SBD	$2.51

QUETIAPINE 300 MG TABLET

Facility

$211.11

Service Code	NDC 47335090686
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$179.44
Rate for Payer: Aetna New Business (MI Preferred)	$137.22
Rate for Payer: Cash Price	$168.89
Rate for Payer: Cofinity Advantage	$147.78
Rate for Payer: Cofinity Commercial	$181.55
Rate for Payer: Encore Health Key Benefits Commercial	$168.89
Rate for Payer: Healthscope Commercial	$190.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.33
Rate for Payer: PHP Commercial	$179.44
Rate for Payer: Priority Health SBD	$133.00

QUETIAPINE 300 MG TABLET

Facility

$211.11

Service Code	NDC 47335090686
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$82.97
Max. Negotiated Rate	$190.00
Rate for Payer: Aetna Commercial	$179.44
Rate for Payer: Aetna Medicare	$105.56
Rate for Payer: Aetna New Business (MI Preferred)	$137.22
Rate for Payer: BCBS Complete	$84.44
Rate for Payer: Cash Price	$168.89
Rate for Payer: Cofinity Advantage	$147.78
Rate for Payer: Cofinity Commercial	$181.55
Rate for Payer: Encore Health Key Benefits Commercial	$168.89
Rate for Payer: Healthscope Commercial	$190.00
Rate for Payer: MI Amish Medical Board Commercial	$168.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.33
Rate for Payer: PHP Commercial	$179.44
Rate for Payer: Priority Health SBD	$133.00
Rate for Payer: UHC All Payor (Choice/PPO)	$137.22
Rate for Payer: UHC Core	$109.99
Rate for Payer: UHC Exchange	$82.97

QUETIAPINE 300 MG TABLET

Facility

$397.10

Service Code	NDC 60687037101
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$156.06
Max. Negotiated Rate	$357.39
Rate for Payer: Aetna Commercial	$337.54
Rate for Payer: Aetna Medicare	$198.55
Rate for Payer: Aetna New Business (MI Preferred)	$258.12
Rate for Payer: BCBS Complete	$158.84
Rate for Payer: Cash Price	$317.68
Rate for Payer: Cofinity Advantage	$277.97
Rate for Payer: Cofinity Commercial	$341.51
Rate for Payer: Encore Health Key Benefits Commercial	$317.68
Rate for Payer: Healthscope Commercial	$357.39
Rate for Payer: MI Amish Medical Board Commercial	$317.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$297.82
Rate for Payer: PHP Commercial	$337.54
Rate for Payer: Priority Health SBD	$250.17
Rate for Payer: UHC All Payor (Choice/PPO)	$258.12
Rate for Payer: UHC Core	$206.89
Rate for Payer: UHC Exchange	$156.06

QUETIAPINE 300 MG TABLET

Facility

$3.98

Service Code	NDC 60687037111
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.58
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare	$1.99
Rate for Payer: Aetna New Business (MI Preferred)	$2.59
Rate for Payer: BCBS Complete	$1.59
Rate for Payer: Cash Price	$3.18
Rate for Payer: Cofinity Advantage	$2.79
Rate for Payer: Cofinity Commercial	$3.42
Rate for Payer: Encore Health Key Benefits Commercial	$3.18
Rate for Payer: Healthscope Commercial	$3.58
Rate for Payer: MI Amish Medical Board Commercial	$3.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.98
Rate for Payer: PHP Commercial	$3.38
Rate for Payer: Priority Health SBD	$2.51
Rate for Payer: UHC All Payor (Choice/PPO)	$2.59
Rate for Payer: UHC Core	$2.07
Rate for Payer: UHC Exchange	$1.56

QUETIAPINE 300 MG TABLET

Facility

$361.00

Service Code	NDC 00904664261
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$141.87
Max. Negotiated Rate	$324.90
Rate for Payer: Aetna Commercial	$306.85
Rate for Payer: Aetna Medicare	$180.50
Rate for Payer: Aetna New Business (MI Preferred)	$234.65
Rate for Payer: BCBS Complete	$144.40
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cofinity Advantage	$252.70
Rate for Payer: Cofinity Commercial	$310.46
Rate for Payer: Encore Health Key Benefits Commercial	$288.80
Rate for Payer: Healthscope Commercial	$324.90
Rate for Payer: MI Amish Medical Board Commercial	$288.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$306.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.75
Rate for Payer: PHP Commercial	$306.85
Rate for Payer: Priority Health SBD	$227.43
Rate for Payer: UHC All Payor (Choice/PPO)	$234.65
Rate for Payer: UHC Core	$188.08
Rate for Payer: UHC Exchange	$141.87

QUETIAPINE 400 MG TABLET

Facility

$470.88

Service Code	NDC 00904664361
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$185.06
Max. Negotiated Rate	$423.79
Rate for Payer: Aetna Commercial	$400.25
Rate for Payer: Aetna Medicare	$235.44
Rate for Payer: Aetna New Business (MI Preferred)	$306.07
Rate for Payer: BCBS Complete	$188.35
Rate for Payer: Cash Price	$376.70
Rate for Payer: Cofinity Advantage	$329.62
Rate for Payer: Cofinity Commercial	$404.96
Rate for Payer: Encore Health Key Benefits Commercial	$376.70
Rate for Payer: Healthscope Commercial	$423.79
Rate for Payer: MI Amish Medical Board Commercial	$376.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$400.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$353.16
Rate for Payer: PHP Commercial	$400.25
Rate for Payer: Priority Health SBD	$296.65
Rate for Payer: UHC All Payor (Choice/PPO)	$306.07
Rate for Payer: UHC Core	$245.33
Rate for Payer: UHC Exchange	$185.06

QUETIAPINE 400 MG TABLET

Facility

$413.28

Service Code	NDC 47335090788
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$162.42
Max. Negotiated Rate	$371.95
Rate for Payer: Aetna Commercial	$351.29
Rate for Payer: Aetna Medicare	$206.64
Rate for Payer: Aetna New Business (MI Preferred)	$268.63
Rate for Payer: BCBS Complete	$165.31
Rate for Payer: Cash Price	$330.62
Rate for Payer: Cofinity Advantage	$289.30
Rate for Payer: Cofinity Commercial	$355.42
Rate for Payer: Encore Health Key Benefits Commercial	$330.62
Rate for Payer: Healthscope Commercial	$371.95
Rate for Payer: MI Amish Medical Board Commercial	$330.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$351.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$309.96
Rate for Payer: PHP Commercial	$351.29
Rate for Payer: Priority Health SBD	$260.37
Rate for Payer: UHC All Payor (Choice/PPO)	$268.63
Rate for Payer: UHC Core	$215.32
Rate for Payer: UHC Exchange	$162.42

QUETIAPINE 400 MG TABLET

Facility

$413.28

Service Code	NDC 47335090788
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$260.37
Max. Negotiated Rate	$371.95
Rate for Payer: Aetna Commercial	$351.29
Rate for Payer: Aetna New Business (MI Preferred)	$268.63
Rate for Payer: Cash Price	$330.62
Rate for Payer: Cofinity Advantage	$289.30
Rate for Payer: Cofinity Commercial	$355.42
Rate for Payer: Encore Health Key Benefits Commercial	$330.62
Rate for Payer: Healthscope Commercial	$371.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$351.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$309.96
Rate for Payer: PHP Commercial	$351.29
Rate for Payer: Priority Health SBD	$260.37

QUETIAPINE 400 MG TABLET

Facility

$470.88

Service Code	NDC 00904664361
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$296.65
Max. Negotiated Rate	$423.79
Rate for Payer: Aetna Commercial	$400.25
Rate for Payer: Aetna New Business (MI Preferred)	$306.07
Rate for Payer: Cash Price	$376.70
Rate for Payer: Cofinity Advantage	$329.62
Rate for Payer: Cofinity Commercial	$404.96
Rate for Payer: Encore Health Key Benefits Commercial	$376.70
Rate for Payer: Healthscope Commercial	$423.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$400.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$353.16
Rate for Payer: PHP Commercial	$400.25
Rate for Payer: Priority Health SBD	$296.65

QUETIAPINE 50 MG TABLET

Facility

$299.25

Service Code	NDC 00904663961
Hospital Charge Code	70397
Hospital Revenue Code	637
Min. Negotiated Rate	$188.53
Max. Negotiated Rate	$269.32
Rate for Payer: Aetna Commercial	$254.36
Rate for Payer: Aetna New Business (MI Preferred)	$194.51
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cofinity Advantage	$209.47
Rate for Payer: Cofinity Commercial	$257.36
Rate for Payer: Encore Health Key Benefits Commercial	$239.40
Rate for Payer: Healthscope Commercial	$269.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$224.44
Rate for Payer: PHP Commercial	$254.36
Rate for Payer: Priority Health SBD	$188.53

QUETIAPINE 50 MG TABLET

Facility

$299.25

Service Code	NDC 00904663961
Hospital Charge Code	70397
Hospital Revenue Code	637
Min. Negotiated Rate	$117.61
Max. Negotiated Rate	$269.32
Rate for Payer: Aetna Commercial	$254.36
Rate for Payer: Aetna Medicare	$149.62
Rate for Payer: Aetna New Business (MI Preferred)	$194.51
Rate for Payer: BCBS Complete	$119.70
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cofinity Advantage	$209.47
Rate for Payer: Cofinity Commercial	$257.36
Rate for Payer: Encore Health Key Benefits Commercial	$239.40
Rate for Payer: Healthscope Commercial	$269.32
Rate for Payer: MI Amish Medical Board Commercial	$239.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$224.44
Rate for Payer: PHP Commercial	$254.36
Rate for Payer: Priority Health SBD	$188.53
Rate for Payer: UHC All Payor (Choice/PPO)	$194.51
Rate for Payer: UHC Core	$155.91
Rate for Payer: UHC Exchange	$117.61

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$425.76

Service Code	NDC 00904680361
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$268.23
Max. Negotiated Rate	$383.18
Rate for Payer: Aetna Commercial	$361.90
Rate for Payer: Aetna New Business (MI Preferred)	$276.74
Rate for Payer: Cash Price	$340.61
Rate for Payer: Cofinity Advantage	$298.03
Rate for Payer: Cofinity Commercial	$366.15
Rate for Payer: Encore Health Key Benefits Commercial	$340.61
Rate for Payer: Healthscope Commercial	$383.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$361.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$319.32
Rate for Payer: PHP Commercial	$361.90
Rate for Payer: Priority Health SBD	$268.23

Know your out-of-pocket cost for care.

All Charges