Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$346.28
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	$346.28
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

$349.60

Service Code	NDC 00904664261
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$139.84
Max. Negotiated Rate	$314.64
Rate for Payer: Aetna Commercial	$297.16
Rate for Payer: Aetna Medicare	$174.80
Rate for Payer: Aetna New Business (MI Preferred)	$227.24
Rate for Payer: BCBS Complete	$139.84
Rate for Payer: Cash Price	$279.68
Rate for Payer: Cofinity Commercial	$244.72
Rate for Payer: Cofinity Commercial	$300.66
Rate for Payer: Cofinity Medicare Advantage	$244.72
Rate for Payer: Encore Health Key Benefits Commercial	$279.68
Rate for Payer: Healthscope Commercial	$314.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.16
Rate for Payer: PHP Commercial	$297.16
Rate for Payer: Priority Health Cigna Priority Health	$227.24
Rate for Payer: Priority Health SBD	$220.25

QUETIAPINE 300 MG TABLET

Facility

$222.78

Service Code	NDC 67877024760
Hospital Charge Code	29267
Hospital Revenue Code	637
Min. Negotiated Rate	$89.11
Max. Negotiated Rate	$200.50
Rate for Payer: Aetna Commercial	$189.36
Rate for Payer: Aetna Medicare	$111.39
Rate for Payer: Aetna New Business (MI Preferred)	$144.81
Rate for Payer: BCBS Complete	$89.11
Rate for Payer: Cash Price	$178.22
Rate for Payer: Cofinity Commercial	$155.95
Rate for Payer: Cofinity Commercial	$191.59
Rate for Payer: Cofinity Medicare Advantage	$155.95
Rate for Payer: Encore Health Key Benefits Commercial	$178.22
Rate for Payer: Healthscope Commercial	$200.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.36
Rate for Payer: PHP Commercial	$189.36
Rate for Payer: Priority Health Cigna Priority Health	$144.81
Rate for Payer: Priority Health SBD	$140.35

QUETIAPINE 400 MG TABLET

Facility

$463.68

Service Code	NDC 00904664361
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$185.47
Max. Negotiated Rate	$417.31
Rate for Payer: Aetna Commercial	$394.13
Rate for Payer: Aetna Medicare	$231.84
Rate for Payer: Aetna New Business (MI Preferred)	$301.39
Rate for Payer: BCBS Complete	$185.47
Rate for Payer: Cash Price	$370.94
Rate for Payer: Cofinity Commercial	$324.58
Rate for Payer: Cofinity Commercial	$398.76
Rate for Payer: Cofinity Medicare Advantage	$324.58
Rate for Payer: Encore Health Key Benefits Commercial	$370.94
Rate for Payer: Healthscope Commercial	$417.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.13
Rate for Payer: PHP Commercial	$394.13
Rate for Payer: Priority Health Cigna Priority Health	$301.39
Rate for Payer: Priority Health SBD	$292.12

QUETIAPINE 400 MG TABLET

Facility

$413.28

Service Code	NDC 47335090788
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$165.31
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 Commercial	$289.30
Rate for Payer: Cofinity Commercial	$355.42
Rate for Payer: Cofinity Medicare Advantage	$289.30
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: PHP Commercial	$351.29
Rate for Payer: Priority Health Cigna Priority Health	$268.63
Rate for Payer: Priority Health SBD	$260.37

QUETIAPINE 400 MG TABLET

Facility

$463.68

Service Code	NDC 00904664361
Hospital Charge Code	70398
Hospital Revenue Code	637
Min. Negotiated Rate	$292.12
Max. Negotiated Rate	$417.31
Rate for Payer: Aetna Commercial	$394.13
Rate for Payer: Aetna New Business (MI Preferred)	$301.39
Rate for Payer: Cash Price	$370.94
Rate for Payer: Cofinity Commercial	$324.58
Rate for Payer: Cofinity Commercial	$398.76
Rate for Payer: Cofinity Medicare Advantage	$324.58
Rate for Payer: Encore Health Key Benefits Commercial	$370.94
Rate for Payer: Healthscope Commercial	$417.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$394.13
Rate for Payer: PHP Commercial	$394.13
Rate for Payer: Priority Health Cigna Priority Health	$301.39
Rate for Payer: Priority Health SBD	$292.12

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 Commercial	$289.30
Rate for Payer: Cofinity Commercial	$355.42
Rate for Payer: Cofinity Medicare Advantage	$289.30
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: PHP Commercial	$351.29
Rate for Payer: Priority Health Cigna Priority Health	$268.63
Rate for Payer: Priority Health SBD	$260.37

QUETIAPINE 50 MG TABLET

Facility

$371.45

Service Code	NDC 00904663961
Hospital Charge Code	70397
Hospital Revenue Code	637
Min. Negotiated Rate	$234.01
Max. Negotiated Rate	$334.30
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.02
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.02
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

QUETIAPINE 50 MG TABLET

Facility

$371.45

Service Code	NDC 00904663961
Hospital Charge Code	70397
Hospital Revenue Code	637
Min. Negotiated Rate	$148.58
Max. Negotiated Rate	$334.30
Rate for Payer: Aetna Commercial	$315.73
Rate for Payer: Aetna Medicare	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$241.44
Rate for Payer: BCBS Complete	$148.58
Rate for Payer: Cash Price	$297.16
Rate for Payer: Cofinity Commercial	$260.02
Rate for Payer: Cofinity Commercial	$319.45
Rate for Payer: Cofinity Medicare Advantage	$260.02
Rate for Payer: Encore Health Key Benefits Commercial	$297.16
Rate for Payer: Healthscope Commercial	$334.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$315.73
Rate for Payer: PHP Commercial	$315.73
Rate for Payer: Priority Health Cigna Priority Health	$241.44
Rate for Payer: Priority Health SBD	$234.01

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$131.10

Service Code	NDC 68180061307
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$52.44
Max. Negotiated Rate	$117.99
Rate for Payer: Aetna Commercial	$111.44
Rate for Payer: Aetna Medicare	$65.55
Rate for Payer: Aetna New Business (MI Preferred)	$85.22
Rate for Payer: BCBS Complete	$52.44
Rate for Payer: Cash Price	$104.88
Rate for Payer: Cofinity Commercial	$112.75
Rate for Payer: Cofinity Commercial	$91.77
Rate for Payer: Cofinity Medicare Advantage	$91.77
Rate for Payer: Encore Health Key Benefits Commercial	$104.88
Rate for Payer: Healthscope Commercial	$117.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.44
Rate for Payer: PHP Commercial	$111.44
Rate for Payer: Priority Health Cigna Priority Health	$85.22
Rate for Payer: Priority Health SBD	$82.59

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$316.32

Service Code	NDC 00904680261
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$126.53
Max. Negotiated Rate	$284.69
Rate for Payer: Aetna Commercial	$268.87
Rate for Payer: Aetna Medicare	$158.16
Rate for Payer: Aetna New Business (MI Preferred)	$205.61
Rate for Payer: BCBS Complete	$126.53
Rate for Payer: Cash Price	$253.06
Rate for Payer: Cofinity Commercial	$221.42
Rate for Payer: Cofinity Commercial	$272.04
Rate for Payer: Cofinity Medicare Advantage	$221.42
Rate for Payer: Encore Health Key Benefits Commercial	$253.06
Rate for Payer: Healthscope Commercial	$284.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.87
Rate for Payer: PHP Commercial	$268.87
Rate for Payer: Priority Health Cigna Priority Health	$205.61
Rate for Payer: Priority Health SBD	$199.28

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$131.10

Service Code	NDC 68180061307
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$82.59
Max. Negotiated Rate	$117.99
Rate for Payer: Aetna Commercial	$111.44
Rate for Payer: Aetna New Business (MI Preferred)	$85.22
Rate for Payer: Cash Price	$104.88
Rate for Payer: Cofinity Commercial	$112.75
Rate for Payer: Cofinity Commercial	$91.77
Rate for Payer: Cofinity Medicare Advantage	$91.77
Rate for Payer: Encore Health Key Benefits Commercial	$104.88
Rate for Payer: Healthscope Commercial	$117.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$111.44
Rate for Payer: PHP Commercial	$111.44
Rate for Payer: Priority Health Cigna Priority Health	$85.22
Rate for Payer: Priority Health SBD	$82.59

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,861.81

Service Code	NDC 00310028160
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$1,144.72
Max. Negotiated Rate	$2,575.63
Rate for Payer: Aetna Commercial	$2,432.54
Rate for Payer: Aetna Medicare	$1,430.90
Rate for Payer: Aetna New Business (MI Preferred)	$1,860.18
Rate for Payer: BCBS Complete	$1,144.72
Rate for Payer: Cash Price	$2,289.45
Rate for Payer: Cofinity Commercial	$2,003.27
Rate for Payer: Cofinity Commercial	$2,461.16
Rate for Payer: Cofinity Medicare Advantage	$2,003.27
Rate for Payer: Encore Health Key Benefits Commercial	$2,289.45
Rate for Payer: Healthscope Commercial	$2,575.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,432.54
Rate for Payer: PHP Commercial	$2,432.54
Rate for Payer: Priority Health Cigna Priority Health	$1,860.18
Rate for Payer: Priority Health SBD	$1,802.94

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$2,861.81

Service Code	NDC 00310028160
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$1,802.94
Max. Negotiated Rate	$2,575.63
Rate for Payer: Aetna Commercial	$2,432.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,860.18
Rate for Payer: Cash Price	$2,289.45
Rate for Payer: Cofinity Commercial	$2,003.27
Rate for Payer: Cofinity Commercial	$2,461.16
Rate for Payer: Cofinity Medicare Advantage	$2,003.27
Rate for Payer: Encore Health Key Benefits Commercial	$2,289.45
Rate for Payer: Healthscope Commercial	$2,575.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,432.54
Rate for Payer: PHP Commercial	$2,432.54
Rate for Payer: Priority Health Cigna Priority Health	$1,860.18
Rate for Payer: Priority Health SBD	$1,802.94

QUETIAPINE ER 150 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$316.32

Service Code	NDC 00904680261
Hospital Charge Code	96233
Hospital Revenue Code	637
Min. Negotiated Rate	$199.28
Max. Negotiated Rate	$284.69
Rate for Payer: Aetna Commercial	$268.87
Rate for Payer: Aetna New Business (MI Preferred)	$205.61
Rate for Payer: Cash Price	$253.06
Rate for Payer: Cofinity Commercial	$221.42
Rate for Payer: Cofinity Commercial	$272.04
Rate for Payer: Cofinity Medicare Advantage	$221.42
Rate for Payer: Encore Health Key Benefits Commercial	$253.06
Rate for Payer: Healthscope Commercial	$284.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$268.87
Rate for Payer: PHP Commercial	$268.87
Rate for Payer: Priority Health Cigna Priority Health	$205.61
Rate for Payer: Priority Health SBD	$199.28

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$433.92

Service Code	NDC 00904680361
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$173.57
Max. Negotiated Rate	$390.53
Rate for Payer: Aetna Commercial	$368.83
Rate for Payer: Aetna Medicare	$216.96
Rate for Payer: Aetna New Business (MI Preferred)	$282.05
Rate for Payer: BCBS Complete	$173.57
Rate for Payer: Cash Price	$347.14
Rate for Payer: Cofinity Commercial	$303.74
Rate for Payer: Cofinity Commercial	$373.17
Rate for Payer: Cofinity Medicare Advantage	$303.74
Rate for Payer: Encore Health Key Benefits Commercial	$347.14
Rate for Payer: Healthscope Commercial	$390.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.83
Rate for Payer: PHP Commercial	$368.83
Rate for Payer: Priority Health Cigna Priority Health	$282.05
Rate for Payer: Priority Health SBD	$273.37

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$247.38

Service Code	NDC 16729009512
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$98.95
Max. Negotiated Rate	$222.64
Rate for Payer: Aetna Commercial	$210.27
Rate for Payer: Aetna Medicare	$123.69
Rate for Payer: Aetna New Business (MI Preferred)	$160.80
Rate for Payer: BCBS Complete	$98.95
Rate for Payer: Cash Price	$197.90
Rate for Payer: Cofinity Commercial	$173.17
Rate for Payer: Cofinity Commercial	$212.75
Rate for Payer: Cofinity Medicare Advantage	$173.17
Rate for Payer: Encore Health Key Benefits Commercial	$197.90
Rate for Payer: Healthscope Commercial	$222.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.27
Rate for Payer: PHP Commercial	$210.27
Rate for Payer: Priority Health Cigna Priority Health	$160.80
Rate for Payer: Priority Health SBD	$155.85

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3,149.74

Service Code	NDC 00310028260
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$1,984.34
Max. Negotiated Rate	$2,834.77
Rate for Payer: Aetna Commercial	$2,677.28
Rate for Payer: Aetna New Business (MI Preferred)	$2,047.33
Rate for Payer: Cash Price	$2,519.79
Rate for Payer: Cofinity Commercial	$2,204.82
Rate for Payer: Cofinity Commercial	$2,708.78
Rate for Payer: Cofinity Medicare Advantage	$2,204.82
Rate for Payer: Encore Health Key Benefits Commercial	$2,519.79
Rate for Payer: Healthscope Commercial	$2,834.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,677.28
Rate for Payer: PHP Commercial	$2,677.28
Rate for Payer: Priority Health Cigna Priority Health	$2,047.33
Rate for Payer: Priority Health SBD	$1,984.34

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$433.92

Service Code	NDC 00904680361
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$273.37
Max. Negotiated Rate	$390.53
Rate for Payer: Aetna Commercial	$368.83
Rate for Payer: Aetna New Business (MI Preferred)	$282.05
Rate for Payer: Cash Price	$347.14
Rate for Payer: Cofinity Commercial	$303.74
Rate for Payer: Cofinity Commercial	$373.17
Rate for Payer: Cofinity Medicare Advantage	$303.74
Rate for Payer: Encore Health Key Benefits Commercial	$347.14
Rate for Payer: Healthscope Commercial	$390.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$368.83
Rate for Payer: PHP Commercial	$368.83
Rate for Payer: Priority Health Cigna Priority Health	$282.05
Rate for Payer: Priority Health SBD	$273.37

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$3,149.74

Service Code	NDC 00310028260
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$1,259.90
Max. Negotiated Rate	$2,834.77
Rate for Payer: Aetna Commercial	$2,677.28
Rate for Payer: Aetna Medicare	$1,574.87
Rate for Payer: Aetna New Business (MI Preferred)	$2,047.33
Rate for Payer: BCBS Complete	$1,259.90
Rate for Payer: Cash Price	$2,519.79
Rate for Payer: Cofinity Commercial	$2,204.82
Rate for Payer: Cofinity Commercial	$2,708.78
Rate for Payer: Cofinity Medicare Advantage	$2,204.82
Rate for Payer: Encore Health Key Benefits Commercial	$2,519.79
Rate for Payer: Healthscope Commercial	$2,834.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,677.28
Rate for Payer: PHP Commercial	$2,677.28
Rate for Payer: Priority Health Cigna Priority Health	$2,047.33
Rate for Payer: Priority Health SBD	$1,984.34

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$152.19

Service Code	NDC 68180061407
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$60.88
Max. Negotiated Rate	$136.97
Rate for Payer: Aetna Commercial	$129.36
Rate for Payer: Aetna Medicare	$76.10
Rate for Payer: Aetna New Business (MI Preferred)	$98.92
Rate for Payer: BCBS Complete	$60.88
Rate for Payer: Cash Price	$121.75
Rate for Payer: Cofinity Commercial	$106.53
Rate for Payer: Cofinity Commercial	$130.88
Rate for Payer: Cofinity Medicare Advantage	$106.53
Rate for Payer: Encore Health Key Benefits Commercial	$121.75
Rate for Payer: Healthscope Commercial	$136.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.36
Rate for Payer: PHP Commercial	$129.36
Rate for Payer: Priority Health Cigna Priority Health	$98.92
Rate for Payer: Priority Health SBD	$95.88

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$247.38

Service Code	NDC 16729009512
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$155.85
Max. Negotiated Rate	$222.64
Rate for Payer: Aetna Commercial	$210.27
Rate for Payer: Aetna New Business (MI Preferred)	$160.80
Rate for Payer: Cash Price	$197.90
Rate for Payer: Cofinity Commercial	$173.17
Rate for Payer: Cofinity Commercial	$212.75
Rate for Payer: Cofinity Medicare Advantage	$173.17
Rate for Payer: Encore Health Key Benefits Commercial	$197.90
Rate for Payer: Healthscope Commercial	$222.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$210.27
Rate for Payer: PHP Commercial	$210.27
Rate for Payer: Priority Health Cigna Priority Health	$160.80
Rate for Payer: Priority Health SBD	$155.85

QUETIAPINE ER 200 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$152.19

Service Code	NDC 68180061407
Hospital Charge Code	82089
Hospital Revenue Code	637
Min. Negotiated Rate	$95.88
Max. Negotiated Rate	$136.97
Rate for Payer: Aetna Commercial	$129.36
Rate for Payer: Aetna New Business (MI Preferred)	$98.92
Rate for Payer: Cash Price	$121.75
Rate for Payer: Cofinity Commercial	$106.53
Rate for Payer: Cofinity Commercial	$130.88
Rate for Payer: Cofinity Medicare Advantage	$106.53
Rate for Payer: Encore Health Key Benefits Commercial	$121.75
Rate for Payer: Healthscope Commercial	$136.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$129.36
Rate for Payer: PHP Commercial	$129.36
Rate for Payer: Priority Health Cigna Priority Health	$98.92
Rate for Payer: Priority Health SBD	$95.88

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$469.44

Service Code	NDC 00904680461
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$187.78
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$399.02
Rate for Payer: Aetna Medicare	$234.72
Rate for Payer: Aetna New Business (MI Preferred)	$305.14
Rate for Payer: BCBS Complete	$187.78
Rate for Payer: Cash Price	$375.55
Rate for Payer: Cofinity Commercial	$328.61
Rate for Payer: Cofinity Commercial	$403.72
Rate for Payer: Cofinity Medicare Advantage	$328.61
Rate for Payer: Encore Health Key Benefits Commercial	$375.55
Rate for Payer: Healthscope Commercial	$422.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$399.02
Rate for Payer: PHP Commercial	$399.02
Rate for Payer: Priority Health Cigna Priority Health	$305.14
Rate for Payer: Priority Health SBD	$295.75

QUETIAPINE ER 300 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$469.44

Service Code	NDC 00904680461
Hospital Charge Code	82090
Hospital Revenue Code	637
Min. Negotiated Rate	$295.75
Max. Negotiated Rate	$422.50
Rate for Payer: Aetna Commercial	$399.02
Rate for Payer: Aetna New Business (MI Preferred)	$305.14
Rate for Payer: Cash Price	$375.55
Rate for Payer: Cofinity Commercial	$328.61
Rate for Payer: Cofinity Commercial	$403.72
Rate for Payer: Cofinity Medicare Advantage	$328.61
Rate for Payer: Encore Health Key Benefits Commercial	$375.55
Rate for Payer: Healthscope Commercial	$422.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$399.02
Rate for Payer: PHP Commercial	$399.02
Rate for Payer: Priority Health Cigna Priority Health	$305.14
Rate for Payer: Priority Health SBD	$295.75

Know your out-of-pocket cost for care.

All Charges