Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION

Facility

$124.60

Service Code	NDC 00781304072
Hospital Charge Code	11237
Hospital Revenue Code	250
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$112.14
Rate for Payer: Aetna Commercial	$105.91
Rate for Payer: Aetna Medicare	$62.30
Rate for Payer: Aetna New Business (MI Preferred)	$80.99
Rate for Payer: BCBS Complete	$49.84
Rate for Payer: Cash Price	$99.68
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Cofinity Commercial	$87.22
Rate for Payer: Cofinity Medicare Advantage	$87.22
Rate for Payer: Encore Health Key Benefits Commercial	$99.68
Rate for Payer: Healthscope Commercial	$112.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.91
Rate for Payer: PHP Commercial	$105.91
Rate for Payer: Priority Health Cigna Priority Health	$80.99
Rate for Payer: Priority Health SBD	$78.50

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION

Facility

$124.60

Service Code	NDC 00781304072
Hospital Charge Code	11237
Hospital Revenue Code	250
Min. Negotiated Rate	$78.50
Max. Negotiated Rate	$112.14
Rate for Payer: Aetna Commercial	$105.91
Rate for Payer: Aetna New Business (MI Preferred)	$80.99
Rate for Payer: Cash Price	$99.68
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Cofinity Commercial	$87.22
Rate for Payer: Cofinity Medicare Advantage	$87.22
Rate for Payer: Encore Health Key Benefits Commercial	$99.68
Rate for Payer: Healthscope Commercial	$112.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.91
Rate for Payer: PHP Commercial	$105.91
Rate for Payer: Priority Health Cigna Priority Health	$80.99
Rate for Payer: Priority Health SBD	$78.50

PYRIDOSTIGMINE BROMIDE 5 MG/ML INJECTION SOLUTION

Facility

$124.60

Service Code	NDC 00781304095
Hospital Charge Code	11237
Hospital Revenue Code	250
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$112.14
Rate for Payer: Aetna Commercial	$105.91
Rate for Payer: Aetna Medicare	$62.30
Rate for Payer: Aetna New Business (MI Preferred)	$80.99
Rate for Payer: BCBS Complete	$49.84
Rate for Payer: Cash Price	$99.68
Rate for Payer: Cofinity Commercial	$107.16
Rate for Payer: Cofinity Commercial	$87.22
Rate for Payer: Cofinity Medicare Advantage	$87.22
Rate for Payer: Encore Health Key Benefits Commercial	$99.68
Rate for Payer: Healthscope Commercial	$112.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.91
Rate for Payer: PHP Commercial	$105.91
Rate for Payer: Priority Health Cigna Priority Health	$80.99
Rate for Payer: Priority Health SBD	$78.50

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$4.76

Service Code	NDC 68084049411
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.81
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.81
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.05
Rate for Payer: PHP Commercial	$4.05
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$3.00

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$433.20

Service Code	NDC 68682030210
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$173.28
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 Commercial	$303.24
Rate for Payer: Cofinity Commercial	$372.55
Rate for Payer: Cofinity Medicare Advantage	$303.24
Rate for Payer: Encore Health Key Benefits Commercial	$346.56
Rate for Payer: Healthscope Commercial	$389.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.22
Rate for Payer: PHP Commercial	$368.22
Rate for Payer: Priority Health Cigna Priority Health	$281.58
Rate for Payer: Priority Health SBD	$272.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$433.20

Service Code	NDC 68682030210
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$272.92
Max. Negotiated Rate	$389.88
Rate for Payer: Aetna Commercial	$368.22
Rate for Payer: Aetna New Business (MI Preferred)	$281.58
Rate for Payer: Cash Price	$346.56
Rate for Payer: Cofinity Commercial	$303.24
Rate for Payer: Cofinity Commercial	$372.55
Rate for Payer: Cofinity Medicare Advantage	$303.24
Rate for Payer: Encore Health Key Benefits Commercial	$346.56
Rate for Payer: Healthscope Commercial	$389.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.22
Rate for Payer: PHP Commercial	$368.22
Rate for Payer: Priority Health Cigna Priority Health	$281.58
Rate for Payer: Priority Health SBD	$272.92

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$429.60

Service Code	NDC 00904662261
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$270.65
Max. Negotiated Rate	$386.64
Rate for Payer: Aetna Commercial	$365.16
Rate for Payer: Aetna New Business (MI Preferred)	$279.24
Rate for Payer: Cash Price	$343.68
Rate for Payer: Cofinity Commercial	$300.72
Rate for Payer: Cofinity Commercial	$369.46
Rate for Payer: Cofinity Medicare Advantage	$300.72
Rate for Payer: Encore Health Key Benefits Commercial	$343.68
Rate for Payer: Healthscope Commercial	$386.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$365.16
Rate for Payer: PHP Commercial	$365.16
Rate for Payer: Priority Health Cigna Priority Health	$279.24
Rate for Payer: Priority Health SBD	$270.65

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$475.20

Service Code	NDC 68084049401
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$190.08
Max. Negotiated Rate	$427.68
Rate for Payer: Aetna Commercial	$403.92
Rate for Payer: Aetna Medicare	$237.60
Rate for Payer: Aetna New Business (MI Preferred)	$308.88
Rate for Payer: BCBS Complete	$190.08
Rate for Payer: Cash Price	$380.16
Rate for Payer: Cofinity Commercial	$332.64
Rate for Payer: Cofinity Commercial	$408.67
Rate for Payer: Cofinity Medicare Advantage	$332.64
Rate for Payer: Encore Health Key Benefits Commercial	$380.16
Rate for Payer: Healthscope Commercial	$427.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.92
Rate for Payer: PHP Commercial	$403.92
Rate for Payer: Priority Health Cigna Priority Health	$308.88
Rate for Payer: Priority Health SBD	$299.38

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$429.60

Service Code	NDC 00904662261
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$171.84
Max. Negotiated Rate	$386.64
Rate for Payer: Aetna Commercial	$365.16
Rate for Payer: Aetna Medicare	$214.80
Rate for Payer: Aetna New Business (MI Preferred)	$279.24
Rate for Payer: BCBS Complete	$171.84
Rate for Payer: Cash Price	$343.68
Rate for Payer: Cofinity Commercial	$300.72
Rate for Payer: Cofinity Commercial	$369.46
Rate for Payer: Cofinity Medicare Advantage	$300.72
Rate for Payer: Encore Health Key Benefits Commercial	$343.68
Rate for Payer: Healthscope Commercial	$386.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$365.16
Rate for Payer: PHP Commercial	$365.16
Rate for Payer: Priority Health Cigna Priority Health	$279.24
Rate for Payer: Priority Health SBD	$270.65

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$364.32

Service Code	NDC 00115351101
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$229.52
Max. Negotiated Rate	$327.89
Rate for Payer: Aetna Commercial	$309.67
Rate for Payer: Aetna New Business (MI Preferred)	$236.81
Rate for Payer: Cash Price	$291.46
Rate for Payer: Cofinity Commercial	$255.02
Rate for Payer: Cofinity Commercial	$313.32
Rate for Payer: Cofinity Medicare Advantage	$255.02
Rate for Payer: Encore Health Key Benefits Commercial	$291.46
Rate for Payer: Healthscope Commercial	$327.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.67
Rate for Payer: PHP Commercial	$309.67
Rate for Payer: Priority Health Cigna Priority Health	$236.81
Rate for Payer: Priority Health SBD	$229.52

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$364.32

Service Code	NDC 00115351101
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$145.73
Max. Negotiated Rate	$327.89
Rate for Payer: Aetna Commercial	$309.67
Rate for Payer: Aetna Medicare	$182.16
Rate for Payer: Aetna New Business (MI Preferred)	$236.81
Rate for Payer: BCBS Complete	$145.73
Rate for Payer: Cash Price	$291.46
Rate for Payer: Cofinity Commercial	$255.02
Rate for Payer: Cofinity Commercial	$313.32
Rate for Payer: Cofinity Medicare Advantage	$255.02
Rate for Payer: Encore Health Key Benefits Commercial	$291.46
Rate for Payer: Healthscope Commercial	$327.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$309.67
Rate for Payer: PHP Commercial	$309.67
Rate for Payer: Priority Health Cigna Priority Health	$236.81
Rate for Payer: Priority Health SBD	$229.52

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$4.76

Service Code	NDC 68084049411
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: Cash Price	$3.81
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.81
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.05
Rate for Payer: PHP Commercial	$4.05
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$3.00

PYRIDOSTIGMINE BROMIDE 60 MG TABLET

Facility

$475.20

Service Code	NDC 68084049401
Hospital Charge Code	11239
Hospital Revenue Code	637
Min. Negotiated Rate	$299.38
Max. Negotiated Rate	$427.68
Rate for Payer: Aetna Commercial	$403.92
Rate for Payer: Aetna New Business (MI Preferred)	$308.88
Rate for Payer: Cash Price	$380.16
Rate for Payer: Cofinity Commercial	$332.64
Rate for Payer: Cofinity Commercial	$408.67
Rate for Payer: Cofinity Medicare Advantage	$332.64
Rate for Payer: Encore Health Key Benefits Commercial	$380.16
Rate for Payer: Healthscope Commercial	$427.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.92
Rate for Payer: PHP Commercial	$403.92
Rate for Payer: Priority Health Cigna Priority Health	$308.88
Rate for Payer: Priority Health SBD	$299.38

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 Commercial	$35.08
Rate for Payer: Cofinity Commercial	$43.10
Rate for Payer: Cofinity Medicare Advantage	$35.08
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: PHP Commercial	$42.60
Rate for Payer: Priority Health Cigna Priority Health	$32.58
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	$49.82
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	$49.82
Rate for Payer: BCN Commercial	$49.82
Rate for Payer: Cash Price	$40.10
Rate for Payer: Cash Price	$40.10
Rate for Payer: Cofinity Commercial	$35.08
Rate for Payer: Cofinity Commercial	$43.10
Rate for Payer: Cofinity Medicare Advantage	$35.08
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: PHP Commercial	$42.60
Rate for Payer: Priority Health Cigna Priority Health	$32.58
Rate for Payer: Priority Health SBD	$31.58

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$1.25

Service Code	NDC 77333094025
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Cofinity Medicare Advantage	$0.88
Rate for Payer: Encore Health Key Benefits Commercial	$1.00
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.81
Rate for Payer: Priority Health SBD	$0.79

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$1.25

Service Code	NDC 77333094025
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.12
Rate for Payer: Aetna Commercial	$1.06
Rate for Payer: Aetna Medicare	$0.63
Rate for Payer: Aetna New Business (MI Preferred)	$0.81
Rate for Payer: BCBS Complete	$0.50
Rate for Payer: Cash Price	$1.00
Rate for Payer: Cofinity Commercial	$0.88
Rate for Payer: Cofinity Commercial	$1.08
Rate for Payer: Cofinity Medicare Advantage	$0.88
Rate for Payer: Encore Health Key Benefits Commercial	$1.00
Rate for Payer: Healthscope Commercial	$1.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.06
Rate for Payer: PHP Commercial	$1.06
Rate for Payer: Priority Health Cigna Priority Health	$0.81
Rate for Payer: Priority Health SBD	$0.79

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$124.30

Service Code	NDC 77333094010
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$78.31
Max. Negotiated Rate	$111.87
Rate for Payer: Aetna Commercial	$105.66
Rate for Payer: Aetna New Business (MI Preferred)	$80.80
Rate for Payer: Cash Price	$99.44
Rate for Payer: Cofinity Commercial	$106.90
Rate for Payer: Cofinity Commercial	$87.01
Rate for Payer: Cofinity Medicare Advantage	$87.01
Rate for Payer: Encore Health Key Benefits Commercial	$99.44
Rate for Payer: Healthscope Commercial	$111.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.66
Rate for Payer: PHP Commercial	$105.66
Rate for Payer: Priority Health Cigna Priority Health	$80.80
Rate for Payer: Priority Health SBD	$78.31

PYRIDOXINE (VITAMIN B6) 50 MG TABLET

Facility

$124.30

Service Code	NDC 77333094010
Hospital Charge Code	6748
Hospital Revenue Code	637
Min. Negotiated Rate	$49.72
Max. Negotiated Rate	$111.87
Rate for Payer: Aetna Commercial	$105.66
Rate for Payer: Aetna Medicare	$62.15
Rate for Payer: Aetna New Business (MI Preferred)	$80.80
Rate for Payer: BCBS Complete	$49.72
Rate for Payer: Cash Price	$99.44
Rate for Payer: Cofinity Commercial	$106.90
Rate for Payer: Cofinity Commercial	$87.01
Rate for Payer: Cofinity Medicare Advantage	$87.01
Rate for Payer: Encore Health Key Benefits Commercial	$99.44
Rate for Payer: Healthscope Commercial	$111.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.66
Rate for Payer: PHP Commercial	$105.66
Rate for Payer: Priority Health Cigna Priority Health	$80.80
Rate for Payer: Priority Health SBD	$78.31

QUETIAPINE 100 MG TABLET

Facility

$451.20

Service Code	NDC 00904664061
Hospital Charge Code	21824
Hospital Revenue Code	637
Min. Negotiated Rate	$284.26
Max. Negotiated Rate	$406.08
Rate for Payer: Aetna Commercial	$383.52
Rate for Payer: Aetna New Business (MI Preferred)	$293.28
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	$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 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 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 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 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	$272.74
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	$212.14
Rate for Payer: Cofinity Commercial	$260.62
Rate for Payer: Cofinity Medicare Advantage	$212.14
Rate for Payer: Encore Health Key Benefits Commercial	$242.44
Rate for Payer: Healthscope Commercial	$272.74
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	$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

Know your out-of-pocket cost for care.

All Charges