Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

QUETIAPINE 100 MG TABLET

Facility

$451.20

Service Code	NDC 00904664061
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$180.48
Max. Negotiated Rate	$406.08
Rate for Payer: Aetna Commercial	$383.52
Rate for Payer: Aetna Medicare	$225.60
Rate for Payer: Aetna New Business (MI Preferred)	$293.28
Rate for Payer: BCBS Complete	$180.48
Rate for Payer: Cash Price	$360.96
Rate for Payer: Cofinity Commercial	$315.84
Rate for Payer: Cofinity Commercial	$388.03
Rate for Payer: Cofinity Medicare Advantage	$315.84
Rate for Payer: Encore Health Key Benefits Commercial	$360.96
Rate for Payer: Healthscope Commercial	$406.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$383.52
Rate for Payer: PHP Commercial	$383.52
Rate for Payer: Priority Health Cigna Priority Health	$293.28
Rate for Payer: Priority Health SBD	$284.26

QUETIAPINE 100 MG TABLET

Facility

$281.20

Service Code	NDC 47335090488
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$112.48
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 Commercial	$196.84
Rate for Payer: Cofinity Commercial	$241.83
Rate for Payer: Cofinity Medicare Advantage	$196.84
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: PHP Commercial	$239.02
Rate for Payer: Priority Health Cigna Priority Health	$182.78
Rate for Payer: Priority Health SBD	$177.16

QUETIAPINE 200 MG TABLET

Facility

$424.32

Service Code	NDC 63739067710
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$381.89
Rate for Payer: Aetna Commercial	$360.67
Rate for Payer: Aetna New Business (MI Preferred)	$275.81
Rate for Payer: Cash Price	$339.46
Rate for Payer: Cofinity Commercial	$297.02
Rate for Payer: Cofinity Commercial	$364.92
Rate for Payer: Cofinity Medicare Advantage	$297.02
Rate for Payer: Encore Health Key Benefits Commercial	$339.46
Rate for Payer: Healthscope Commercial	$381.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$360.67
Rate for Payer: PHP Commercial	$360.67
Rate for Payer: Priority Health Cigna Priority Health	$275.81
Rate for Payer: Priority Health SBD	$267.32

QUETIAPINE 200 MG TABLET

Facility

$303.05

Service Code	NDC 00904664161
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$121.22
Max. Negotiated Rate	$272.75
Rate for Payer: Aetna Commercial	$257.59
Rate for Payer: Aetna Medicare	$151.53
Rate for Payer: Aetna New Business (MI Preferred)	$196.98
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: Cash Price	$242.44
Rate for Payer: Cofinity Commercial	$212.13
Rate for Payer: Cofinity Commercial	$260.62
Rate for Payer: Cofinity Medicare Advantage	$212.13
Rate for Payer: Encore Health Key Benefits Commercial	$242.44
Rate for Payer: Healthscope Commercial	$272.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.59
Rate for Payer: PHP Commercial	$257.59
Rate for Payer: Priority Health Cigna Priority Health	$196.98
Rate for Payer: Priority Health SBD	$190.92

QUETIAPINE 200 MG TABLET

Facility

$260.85

Service Code	NDC 67877024601
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$164.34
Max. Negotiated Rate	$234.76
Rate for Payer: Aetna Commercial	$221.72
Rate for Payer: Aetna New Business (MI Preferred)	$169.55
Rate for Payer: Cash Price	$208.68
Rate for Payer: Cofinity Commercial	$182.59
Rate for Payer: Cofinity Commercial	$224.33
Rate for Payer: Cofinity Medicare Advantage	$182.59
Rate for Payer: Encore Health Key Benefits Commercial	$208.68
Rate for Payer: Healthscope Commercial	$234.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.72
Rate for Payer: PHP Commercial	$221.72
Rate for Payer: Priority Health Cigna Priority Health	$169.55
Rate for Payer: Priority Health SBD	$164.34

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 Commercial	$3,029.52
Rate for Payer: Cofinity Commercial	$3,721.99
Rate for Payer: Cofinity Medicare Advantage	$3,029.52
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: PHP Commercial	$3,678.71
Rate for Payer: Priority Health Cigna Priority Health	$2,813.13
Rate for Payer: Priority Health SBD	$2,726.57

QUETIAPINE 200 MG TABLET

Facility

$303.05

Service Code	NDC 00904664161
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$190.92
Max. Negotiated Rate	$272.75
Rate for Payer: Aetna Commercial	$257.59
Rate for Payer: Aetna New Business (MI Preferred)	$196.98
Rate for Payer: Cash Price	$242.44
Rate for Payer: Cofinity Commercial	$212.13
Rate for Payer: Cofinity Commercial	$260.62
Rate for Payer: Cofinity Medicare Advantage	$212.13
Rate for Payer: Encore Health Key Benefits Commercial	$242.44
Rate for Payer: Healthscope Commercial	$272.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$257.59
Rate for Payer: PHP Commercial	$257.59
Rate for Payer: Priority Health Cigna Priority Health	$196.98
Rate for Payer: Priority Health SBD	$190.92

QUETIAPINE 200 MG TABLET

Facility

$4,327.89

Service Code	NDC 00310027210
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$1,731.16
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 Commercial	$3,029.52
Rate for Payer: Cofinity Commercial	$3,721.99
Rate for Payer: Cofinity Medicare Advantage	$3,029.52
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: PHP Commercial	$3,678.71
Rate for Payer: Priority Health Cigna Priority Health	$2,813.13
Rate for Payer: Priority Health SBD	$2,726.57

QUETIAPINE 200 MG TABLET

Facility

$424.32

Service Code	NDC 63739067710
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$169.73
Max. Negotiated Rate	$381.89
Rate for Payer: Aetna Commercial	$360.67
Rate for Payer: Aetna Medicare	$212.16
Rate for Payer: Aetna New Business (MI Preferred)	$275.81
Rate for Payer: BCBS Complete	$169.73
Rate for Payer: Cash Price	$339.46
Rate for Payer: Cofinity Commercial	$297.02
Rate for Payer: Cofinity Commercial	$364.92
Rate for Payer: Cofinity Medicare Advantage	$297.02
Rate for Payer: Encore Health Key Benefits Commercial	$339.46
Rate for Payer: Healthscope Commercial	$381.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$360.67
Rate for Payer: PHP Commercial	$360.67
Rate for Payer: Priority Health Cigna Priority Health	$275.81
Rate for Payer: Priority Health SBD	$267.32

QUETIAPINE 200 MG TABLET

Facility

$260.85

Service Code	NDC 67877024601
Hospital Charge Code	21825
Hospital Revenue Code	637
Min. Negotiated Rate	$104.34
Max. Negotiated Rate	$234.76
Rate for Payer: Aetna Commercial	$221.72
Rate for Payer: Aetna Medicare	$130.43
Rate for Payer: Aetna New Business (MI Preferred)	$169.55
Rate for Payer: BCBS Complete	$104.34
Rate for Payer: Cash Price	$208.68
Rate for Payer: Cofinity Commercial	$182.59
Rate for Payer: Cofinity Commercial	$224.33
Rate for Payer: Cofinity Medicare Advantage	$182.59
Rate for Payer: Encore Health Key Benefits Commercial	$208.68
Rate for Payer: Healthscope Commercial	$234.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.72
Rate for Payer: PHP Commercial	$221.72
Rate for Payer: Priority Health Cigna Priority Health	$169.55
Rate for Payer: Priority Health SBD	$164.34

QUETIAPINE 25 MG TABLET

Facility

$361.90

Service Code	NDC 00904663861
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$144.76
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna Medicare	$180.95
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: BCBS Complete	$144.76
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

QUETIAPINE 25 MG TABLET

Facility

$3.53

Service Code	NDC 50268063011
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$3.18
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna Medicare	$1.76
Rate for Payer: Aetna New Business (MI Preferred)	$2.29
Rate for Payer: BCBS Complete	$1.41
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cofinity Commercial	$2.47
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Cofinity Medicare Advantage	$2.47
Rate for Payer: Encore Health Key Benefits Commercial	$2.82
Rate for Payer: Healthscope Commercial	$3.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.00
Rate for Payer: PHP Commercial	$3.00
Rate for Payer: Priority Health Cigna Priority Health	$2.29
Rate for Payer: Priority Health SBD	$2.22

QUETIAPINE 25 MG TABLET

Facility

$397.15

Service Code	NDC 60687032701
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$158.86
Max. Negotiated Rate	$357.44
Rate for Payer: Aetna Commercial	$337.58
Rate for Payer: Aetna Medicare	$198.57
Rate for Payer: Aetna New Business (MI Preferred)	$258.15
Rate for Payer: BCBS Complete	$158.86
Rate for Payer: Cash Price	$317.72
Rate for Payer: Cofinity Commercial	$278.00
Rate for Payer: Cofinity Commercial	$341.55
Rate for Payer: Cofinity Medicare Advantage	$278.00
Rate for Payer: Encore Health Key Benefits Commercial	$317.72
Rate for Payer: Healthscope Commercial	$357.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.58
Rate for Payer: PHP Commercial	$337.58
Rate for Payer: Priority Health Cigna Priority Health	$258.15
Rate for Payer: Priority Health SBD	$250.20

QUETIAPINE 25 MG TABLET

Facility

$176.25

Service Code	NDC 50268063015
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$158.62
Rate for Payer: Aetna Commercial	$149.81
Rate for Payer: Aetna Medicare	$88.12
Rate for Payer: Aetna New Business (MI Preferred)	$114.56
Rate for Payer: BCBS Complete	$70.50
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cofinity Commercial	$123.38
Rate for Payer: Cofinity Commercial	$151.57
Rate for Payer: Cofinity Medicare Advantage	$123.38
Rate for Payer: Encore Health Key Benefits Commercial	$141.00
Rate for Payer: Healthscope Commercial	$158.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.81
Rate for Payer: PHP Commercial	$149.81
Rate for Payer: Priority Health Cigna Priority Health	$114.56
Rate for Payer: Priority Health SBD	$111.04

QUETIAPINE 25 MG TABLET

Facility

$3.53

Service Code	NDC 50268063011
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$2.22
Max. Negotiated Rate	$3.18
Rate for Payer: Aetna Commercial	$3.00
Rate for Payer: Aetna New Business (MI Preferred)	$2.29
Rate for Payer: Cash Price	$2.82
Rate for Payer: Cofinity Commercial	$2.47
Rate for Payer: Cofinity Commercial	$3.04
Rate for Payer: Cofinity Medicare Advantage	$2.47
Rate for Payer: Encore Health Key Benefits Commercial	$2.82
Rate for Payer: Healthscope Commercial	$3.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.00
Rate for Payer: PHP Commercial	$3.00
Rate for Payer: Priority Health Cigna Priority Health	$2.29
Rate for Payer: Priority Health SBD	$2.22

QUETIAPINE 25 MG TABLET

Facility

$397.15

Service Code	NDC 60687032701
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$250.20
Max. Negotiated Rate	$357.44
Rate for Payer: Aetna Commercial	$337.58
Rate for Payer: Aetna New Business (MI Preferred)	$258.15
Rate for Payer: Cash Price	$317.72
Rate for Payer: Cofinity Commercial	$278.00
Rate for Payer: Cofinity Commercial	$341.55
Rate for Payer: Cofinity Medicare Advantage	$278.00
Rate for Payer: Encore Health Key Benefits Commercial	$317.72
Rate for Payer: Healthscope Commercial	$357.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$337.58
Rate for Payer: PHP Commercial	$337.58
Rate for Payer: Priority Health Cigna Priority Health	$258.15
Rate for Payer: Priority Health SBD	$250.20

QUETIAPINE 25 MG TABLET

Facility

$3.98

Service Code	NDC 60687032711
Hospital Charge Code	21823
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 Commercial	$2.79
Rate for Payer: Cofinity Commercial	$3.42
Rate for Payer: Cofinity Medicare Advantage	$2.79
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: PHP Commercial	$3.38
Rate for Payer: Priority Health Cigna Priority Health	$2.59
Rate for Payer: Priority Health SBD	$2.51

QUETIAPINE 25 MG TABLET

Facility

$63.45

Service Code	NDC 67877024201
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$57.10
Rate for Payer: Aetna Commercial	$53.93
Rate for Payer: Aetna Medicare	$31.73
Rate for Payer: Aetna New Business (MI Preferred)	$41.24
Rate for Payer: BCBS Complete	$25.38
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$44.41
Rate for Payer: Cofinity Commercial	$54.57
Rate for Payer: Cofinity Medicare Advantage	$44.41
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: PHP Commercial	$53.93
Rate for Payer: Priority Health Cigna Priority Health	$41.24
Rate for Payer: Priority Health SBD	$39.97

QUETIAPINE 25 MG TABLET

Facility

$361.90

Service Code	NDC 00904663861
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$228.00
Max. Negotiated Rate	$325.71
Rate for Payer: Aetna Commercial	$307.62
Rate for Payer: Aetna New Business (MI Preferred)	$235.24
Rate for Payer: Cash Price	$289.52
Rate for Payer: Cofinity Commercial	$253.33
Rate for Payer: Cofinity Commercial	$311.23
Rate for Payer: Cofinity Medicare Advantage	$253.33
Rate for Payer: Encore Health Key Benefits Commercial	$289.52
Rate for Payer: Healthscope Commercial	$325.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.62
Rate for Payer: PHP Commercial	$307.62
Rate for Payer: Priority Health Cigna Priority Health	$235.24
Rate for Payer: Priority Health SBD	$228.00

QUETIAPINE 25 MG TABLET

Facility

$176.25

Service Code	NDC 50268063015
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$111.04
Max. Negotiated Rate	$158.62
Rate for Payer: Aetna Commercial	$149.81
Rate for Payer: Aetna New Business (MI Preferred)	$114.56
Rate for Payer: Cash Price	$141.00
Rate for Payer: Cofinity Commercial	$123.38
Rate for Payer: Cofinity Commercial	$151.57
Rate for Payer: Cofinity Medicare Advantage	$123.38
Rate for Payer: Encore Health Key Benefits Commercial	$141.00
Rate for Payer: Healthscope Commercial	$158.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$149.81
Rate for Payer: PHP Commercial	$149.81
Rate for Payer: Priority Health Cigna Priority Health	$114.56
Rate for Payer: Priority Health SBD	$111.04

QUETIAPINE 25 MG TABLET

Facility

$63.45

Service Code	NDC 67877024201
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$39.97
Max. Negotiated Rate	$57.10
Rate for Payer: Aetna Commercial	$53.93
Rate for Payer: Aetna New Business (MI Preferred)	$41.24
Rate for Payer: Cash Price	$50.76
Rate for Payer: Cofinity Commercial	$44.41
Rate for Payer: Cofinity Commercial	$54.57
Rate for Payer: Cofinity Medicare Advantage	$44.41
Rate for Payer: Encore Health Key Benefits Commercial	$50.76
Rate for Payer: Healthscope Commercial	$57.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.93
Rate for Payer: PHP Commercial	$53.93
Rate for Payer: Priority Health Cigna Priority Health	$41.24
Rate for Payer: Priority Health SBD	$39.97

QUETIAPINE 25 MG TABLET

Facility

$3.98

Service Code	NDC 60687032711
Hospital Charge Code	21823
Hospital Revenue Code	637
Min. Negotiated Rate	$1.59
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 Commercial	$2.79
Rate for Payer: Cofinity Commercial	$3.42
Rate for Payer: Cofinity Medicare Advantage	$2.79
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: PHP Commercial	$3.38
Rate for Payer: Priority Health Cigna Priority Health	$2.59
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 Commercial	$147.78
Rate for Payer: Cofinity Commercial	$181.55
Rate for Payer: Cofinity Medicare Advantage	$147.78
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: PHP Commercial	$179.44
Rate for Payer: Priority Health Cigna Priority Health	$137.22
Rate for Payer: Priority Health SBD	$133.00

QUETIAPINE 300 MG TABLET

Facility

$384.75

Service Code	NDC 60687037101
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$346.27
Rate for Payer: Aetna Commercial	$327.04
Rate for Payer: Aetna Medicare	$192.38
Rate for Payer: Aetna New Business (MI Preferred)	$250.09
Rate for Payer: BCBS Complete	$153.90
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cofinity Commercial	$269.32
Rate for Payer: Cofinity Commercial	$330.88
Rate for Payer: Cofinity Medicare Advantage	$269.32
Rate for Payer: Encore Health Key Benefits Commercial	$307.80
Rate for Payer: Healthscope Commercial	$346.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.04
Rate for Payer: PHP Commercial	$327.04
Rate for Payer: Priority Health Cigna Priority Health	$250.09
Rate for Payer: Priority Health SBD	$242.39

QUETIAPINE 300 MG TABLET

Facility

$3.85

Service Code	NDC 60687037111
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$3.46
Rate for Payer: Aetna Commercial	$3.27
Rate for Payer: Aetna Medicare	$1.93
Rate for Payer: Aetna New Business (MI Preferred)	$2.50
Rate for Payer: BCBS Complete	$1.54
Rate for Payer: Cash Price	$3.08
Rate for Payer: Cofinity Commercial	$2.69
Rate for Payer: Cofinity Commercial	$3.31
Rate for Payer: Cofinity Medicare Advantage	$2.69
Rate for Payer: Encore Health Key Benefits Commercial	$3.08
Rate for Payer: Healthscope Commercial	$3.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.27
Rate for Payer: PHP Commercial	$3.27
Rate for Payer: Priority Health Cigna Priority Health	$2.50
Rate for Payer: Priority Health SBD	$2.43

Know your out-of-pocket cost for care.

All Charges