Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SENNOSIDES 8.6 MG TABLET

Facility

$113.40

Service Code	NDC 49483008001
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: BCBS Complete	$45.36
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

SENNOSIDES 8.6 MG TABLET

Facility

$122.00

Service Code	NDC 96295013289
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$48.80
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna Commercial	$103.70
Rate for Payer: Aetna Medicare	$61.00
Rate for Payer: Aetna New Business (MI Preferred)	$79.30
Rate for Payer: BCBS Complete	$48.80
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cofinity Commercial	$104.92
Rate for Payer: Cofinity Commercial	$85.40
Rate for Payer: Cofinity Medicare Advantage	$85.40
Rate for Payer: Encore Health Key Benefits Commercial	$97.60
Rate for Payer: Healthscope Commercial	$109.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$103.70
Rate for Payer: PHP Commercial	$103.70
Rate for Payer: Priority Health Cigna Priority Health	$79.30
Rate for Payer: Priority Health SBD	$76.86

SENNOSIDES 8.6 MG TABLET

Facility

$107.10

Service Code	NDC 57896045401
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$67.47
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Commercial	$91.03
Rate for Payer: Aetna New Business (MI Preferred)	$69.61
Rate for Payer: Cash Price	$85.68
Rate for Payer: Cofinity Commercial	$74.97
Rate for Payer: Cofinity Commercial	$92.11
Rate for Payer: Cofinity Medicare Advantage	$74.97
Rate for Payer: Encore Health Key Benefits Commercial	$85.68
Rate for Payer: Healthscope Commercial	$96.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.03
Rate for Payer: PHP Commercial	$91.03
Rate for Payer: Priority Health Cigna Priority Health	$69.61
Rate for Payer: Priority Health SBD	$67.47

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 57896045101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Commercial	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Cofinity Medicare Advantage	$61.74
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health Cigna Priority Health	$57.33
Rate for Payer: Priority Health SBD	$55.57

SENNOSIDES 8.6 MG TABLET

Facility

$132.30

Service Code	NDC 00904672559
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.45
Rate for Payer: Aetna Medicare	$66.15
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
Rate for Payer: BCBS Complete	$52.92
Rate for Payer: Cash Price	$105.84
Rate for Payer: Cofinity Commercial	$113.78
Rate for Payer: Cofinity Commercial	$92.61
Rate for Payer: Cofinity Medicare Advantage	$92.61
Rate for Payer: Encore Health Key Benefits Commercial	$105.84
Rate for Payer: Healthscope Commercial	$119.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.45
Rate for Payer: PHP Commercial	$112.45
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT

Facility

$8,903.25

Service Code	CPT 30520
Hospital Revenue Code	360
Min. Negotiated Rate	$1,695.31
Max. Negotiated Rate	$8,903.25
Rate for Payer: Aetna Medicare	$3,289.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,953.62
Rate for Payer: Amish Plain Church Group Commercial	$3,953.62
Rate for Payer: BCBS Complete	$1,780.08
Rate for Payer: BCBS MAPPO	$3,162.90
Rate for Payer: BCN Medicare Advantage	$3,162.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,162.90
Rate for Payer: Mclaren Medicaid	$1,695.31
Rate for Payer: Mclaren Medicare	$3,162.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,321.05
Rate for Payer: Meridian Medicaid	$1,780.08
Rate for Payer: MI Amish Medical Board Commercial	$3,637.34
Rate for Payer: PACE Medicare	$3,004.76
Rate for Payer: PACE SWMI	$3,162.90
Rate for Payer: PHP Medicare Advantage	$3,162.90
Rate for Payer: Priority Health Choice Medicaid	$1,695.31
Rate for Payer: Priority Health Medicare	$3,162.90
Rate for Payer: Railroad Medicare Medicare	$3,162.90
Rate for Payer: UHC All Payor (Choice/PPO)	$8,903.25
Rate for Payer: UHC Dual Complete DSNP	$3,162.90
Rate for Payer: UHC Medicare Advantage	$3,162.90
Rate for Payer: UHCCP Medicaid	$1,780.71
Rate for Payer: VA VA	$3,162.90

SERTRALINE 100 MG TABLET

Facility

$348.65

Service Code	NDC 60687025301
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$219.65
Max. Negotiated Rate	$313.79
Rate for Payer: Aetna Commercial	$296.35
Rate for Payer: Aetna New Business (MI Preferred)	$226.62
Rate for Payer: Cash Price	$278.92
Rate for Payer: Cofinity Commercial	$244.06
Rate for Payer: Cofinity Commercial	$299.84
Rate for Payer: Cofinity Medicare Advantage	$244.06
Rate for Payer: Encore Health Key Benefits Commercial	$278.92
Rate for Payer: Healthscope Commercial	$313.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.35
Rate for Payer: PHP Commercial	$296.35
Rate for Payer: Priority Health Cigna Priority Health	$226.62
Rate for Payer: Priority Health SBD	$219.65

SERTRALINE 100 MG TABLET

Facility

$88.83

Service Code	NDC 68180035309
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$79.95
Rate for Payer: Aetna Commercial	$75.51
Rate for Payer: Aetna New Business (MI Preferred)	$57.74
Rate for Payer: Cash Price	$71.06
Rate for Payer: Cofinity Commercial	$62.18
Rate for Payer: Cofinity Commercial	$76.39
Rate for Payer: Cofinity Medicare Advantage	$62.18
Rate for Payer: Encore Health Key Benefits Commercial	$71.06
Rate for Payer: Healthscope Commercial	$79.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.51
Rate for Payer: PHP Commercial	$75.51
Rate for Payer: Priority Health Cigna Priority Health	$57.74
Rate for Payer: Priority Health SBD	$55.96

SERTRALINE 100 MG TABLET

Facility

$195.05

Service Code	NDC 59762491003
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Commercial	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.53
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health Cigna Priority Health	$126.78
Rate for Payer: Priority Health SBD	$122.88

SERTRALINE 100 MG TABLET

Facility

$3.49

Service Code	NDC 60687025311
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$3.14
Rate for Payer: Aetna Commercial	$2.97
Rate for Payer: Aetna New Business (MI Preferred)	$2.27
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Commercial	$3.00
Rate for Payer: Cofinity Medicare Advantage	$2.44
Rate for Payer: Encore Health Key Benefits Commercial	$2.79
Rate for Payer: Healthscope Commercial	$3.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.97
Rate for Payer: PHP Commercial	$2.97
Rate for Payer: Priority Health Cigna Priority Health	$2.27
Rate for Payer: Priority Health SBD	$2.20

SERTRALINE 100 MG TABLET

Facility

$3.49

Service Code	NDC 60687025311
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.14
Rate for Payer: Aetna Commercial	$2.97
Rate for Payer: Aetna Medicare	$1.75
Rate for Payer: Aetna New Business (MI Preferred)	$2.27
Rate for Payer: BCBS Complete	$1.40
Rate for Payer: Cash Price	$2.79
Rate for Payer: Cofinity Commercial	$2.44
Rate for Payer: Cofinity Commercial	$3.00
Rate for Payer: Cofinity Medicare Advantage	$2.44
Rate for Payer: Encore Health Key Benefits Commercial	$2.79
Rate for Payer: Healthscope Commercial	$3.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.97
Rate for Payer: PHP Commercial	$2.97
Rate for Payer: Priority Health Cigna Priority Health	$2.27
Rate for Payer: Priority Health SBD	$2.20

SERTRALINE 100 MG TABLET

Facility

$195.05

Service Code	NDC 59762491003
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$78.02
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna Medicare	$97.53
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: BCBS Complete	$78.02
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Commercial	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.53
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health Cigna Priority Health	$126.78
Rate for Payer: Priority Health SBD	$122.88

SERTRALINE 100 MG TABLET

Facility

$88.83

Service Code	NDC 68180035309
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$35.53
Max. Negotiated Rate	$79.95
Rate for Payer: Aetna Commercial	$75.51
Rate for Payer: Aetna Medicare	$44.41
Rate for Payer: Aetna New Business (MI Preferred)	$57.74
Rate for Payer: BCBS Complete	$35.53
Rate for Payer: Cash Price	$71.06
Rate for Payer: Cofinity Commercial	$62.18
Rate for Payer: Cofinity Commercial	$76.39
Rate for Payer: Cofinity Medicare Advantage	$62.18
Rate for Payer: Encore Health Key Benefits Commercial	$71.06
Rate for Payer: Healthscope Commercial	$79.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$75.51
Rate for Payer: PHP Commercial	$75.51
Rate for Payer: Priority Health Cigna Priority Health	$57.74
Rate for Payer: Priority Health SBD	$55.96

SERTRALINE 100 MG TABLET

Facility

$348.65

Service Code	NDC 60687025301
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$139.46
Max. Negotiated Rate	$313.79
Rate for Payer: Aetna Commercial	$296.35
Rate for Payer: Aetna Medicare	$174.32
Rate for Payer: Aetna New Business (MI Preferred)	$226.62
Rate for Payer: BCBS Complete	$139.46
Rate for Payer: Cash Price	$278.92
Rate for Payer: Cofinity Commercial	$244.06
Rate for Payer: Cofinity Commercial	$299.84
Rate for Payer: Cofinity Medicare Advantage	$244.06
Rate for Payer: Encore Health Key Benefits Commercial	$278.92
Rate for Payer: Healthscope Commercial	$313.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$296.35
Rate for Payer: PHP Commercial	$296.35
Rate for Payer: Priority Health Cigna Priority Health	$226.62
Rate for Payer: Priority Health SBD	$219.65

SERTRALINE 25 MG TABLET

Facility

$267.90

Service Code	NDC 60687023101
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$107.16
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna Medicare	$133.95
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: BCBS Complete	$107.16
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

SERTRALINE 25 MG TABLET

Facility

$4.56

Service Code	NDC 51079014901
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna Medicare	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$2.96
Rate for Payer: BCBS Complete	$1.82
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cofinity Commercial	$3.19
Rate for Payer: Cofinity Commercial	$3.92
Rate for Payer: Cofinity Medicare Advantage	$3.19
Rate for Payer: Encore Health Key Benefits Commercial	$3.65
Rate for Payer: Healthscope Commercial	$4.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.88
Rate for Payer: PHP Commercial	$3.88
Rate for Payer: Priority Health Cigna Priority Health	$2.96
Rate for Payer: Priority Health SBD	$2.87

SERTRALINE 25 MG TABLET

Facility

$455.90

Service Code	NDC 51079014920
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$287.22
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$387.51
Rate for Payer: Aetna New Business (MI Preferred)	$296.33
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$319.13
Rate for Payer: Cofinity Commercial	$392.07
Rate for Payer: Cofinity Medicare Advantage	$319.13
Rate for Payer: Encore Health Key Benefits Commercial	$364.72
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$387.51
Rate for Payer: PHP Commercial	$387.51
Rate for Payer: Priority Health Cigna Priority Health	$296.33
Rate for Payer: Priority Health SBD	$287.22

SERTRALINE 25 MG TABLET

Facility

$59.22

Service Code	NDC 68180035109
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$37.31
Max. Negotiated Rate	$53.30
Rate for Payer: Aetna Commercial	$50.34
Rate for Payer: Aetna New Business (MI Preferred)	$38.49
Rate for Payer: Cash Price	$47.38
Rate for Payer: Cofinity Commercial	$41.45
Rate for Payer: Cofinity Commercial	$50.93
Rate for Payer: Cofinity Medicare Advantage	$41.45
Rate for Payer: Encore Health Key Benefits Commercial	$47.38
Rate for Payer: Healthscope Commercial	$53.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.34
Rate for Payer: PHP Commercial	$50.34
Rate for Payer: Priority Health Cigna Priority Health	$38.49
Rate for Payer: Priority Health SBD	$37.31

SERTRALINE 25 MG TABLET

Facility

$2.68

Service Code	NDC 60687023111
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.69

SERTRALINE 25 MG TABLET

Facility

$2.68

Service Code	NDC 60687023111
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare	$1.34
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: BCBS Complete	$1.07
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health Cigna Priority Health	$1.74
Rate for Payer: Priority Health SBD	$1.69

SERTRALINE 25 MG TABLET

Facility

$4.56

Service Code	NDC 51079014901
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$4.10
Rate for Payer: Aetna Commercial	$3.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.96
Rate for Payer: Cash Price	$3.65
Rate for Payer: Cofinity Commercial	$3.19
Rate for Payer: Cofinity Commercial	$3.92
Rate for Payer: Cofinity Medicare Advantage	$3.19
Rate for Payer: Encore Health Key Benefits Commercial	$3.65
Rate for Payer: Healthscope Commercial	$4.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.88
Rate for Payer: PHP Commercial	$3.88
Rate for Payer: Priority Health Cigna Priority Health	$2.96
Rate for Payer: Priority Health SBD	$2.87

SERTRALINE 25 MG TABLET

Facility

$267.90

Service Code	NDC 60687023101
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$168.78
Max. Negotiated Rate	$241.11
Rate for Payer: Aetna Commercial	$227.72
Rate for Payer: Aetna New Business (MI Preferred)	$174.13
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$187.53
Rate for Payer: Cofinity Commercial	$230.39
Rate for Payer: Cofinity Medicare Advantage	$187.53
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.72
Rate for Payer: PHP Commercial	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$174.13
Rate for Payer: Priority Health SBD	$168.78

SERTRALINE 25 MG TABLET

Facility

$455.90

Service Code	NDC 51079014920
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$182.36
Max. Negotiated Rate	$410.31
Rate for Payer: Aetna Commercial	$387.51
Rate for Payer: Aetna Medicare	$227.95
Rate for Payer: Aetna New Business (MI Preferred)	$296.33
Rate for Payer: BCBS Complete	$182.36
Rate for Payer: Cash Price	$364.72
Rate for Payer: Cofinity Commercial	$319.13
Rate for Payer: Cofinity Commercial	$392.07
Rate for Payer: Cofinity Medicare Advantage	$319.13
Rate for Payer: Encore Health Key Benefits Commercial	$364.72
Rate for Payer: Healthscope Commercial	$410.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$387.51
Rate for Payer: PHP Commercial	$387.51
Rate for Payer: Priority Health Cigna Priority Health	$296.33
Rate for Payer: Priority Health SBD	$287.22

SERTRALINE 25 MG TABLET

Facility

$59.22

Service Code	NDC 68180035109
Hospital Charge Code	19882
Hospital Revenue Code	637
Min. Negotiated Rate	$23.69
Max. Negotiated Rate	$53.30
Rate for Payer: Aetna Commercial	$50.34
Rate for Payer: Aetna Medicare	$29.61
Rate for Payer: Aetna New Business (MI Preferred)	$38.49
Rate for Payer: BCBS Complete	$23.69
Rate for Payer: Cash Price	$47.38
Rate for Payer: Cofinity Commercial	$41.45
Rate for Payer: Cofinity Commercial	$50.93
Rate for Payer: Cofinity Medicare Advantage	$41.45
Rate for Payer: Encore Health Key Benefits Commercial	$47.38
Rate for Payer: Healthscope Commercial	$53.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$50.34
Rate for Payer: PHP Commercial	$50.34
Rate for Payer: Priority Health Cigna Priority Health	$38.49
Rate for Payer: Priority Health SBD	$37.31

SERTRALINE 50 MG TABLET

Facility

$225.60

Service Code	NDC 59762490003
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$90.24
Max. Negotiated Rate	$203.04
Rate for Payer: Aetna Commercial	$191.76
Rate for Payer: Aetna Medicare	$112.80
Rate for Payer: Aetna New Business (MI Preferred)	$146.64
Rate for Payer: BCBS Complete	$90.24
Rate for Payer: Cash Price	$180.48
Rate for Payer: Cofinity Commercial	$157.92
Rate for Payer: Cofinity Commercial	$194.02
Rate for Payer: Cofinity Medicare Advantage	$157.92
Rate for Payer: Encore Health Key Benefits Commercial	$180.48
Rate for Payer: Healthscope Commercial	$203.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.76
Rate for Payer: PHP Commercial	$191.76
Rate for Payer: Priority Health Cigna Priority Health	$146.64
Rate for Payer: Priority Health SBD	$142.13

Know your out-of-pocket cost for care.

All Charges