Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SENNOSIDES 8.6 MG TABLET

Facility

$184.00

Service Code	NDC 70000044703
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$115.92
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna Commercial	$156.40
Rate for Payer: Aetna New Business (MI Preferred)	$119.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cofinity Commercial	$128.80
Rate for Payer: Cofinity Commercial	$158.24
Rate for Payer: Cofinity Medicare Advantage	$128.80
Rate for Payer: Encore Health Key Benefits Commercial	$147.20
Rate for Payer: Healthscope Commercial	$165.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.40
Rate for Payer: PHP Commercial	$156.40
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health SBD	$115.92

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$114.66
Rate for Payer: Cofinity Commercial	$140.87
Rate for Payer: Cofinity Medicare Advantage	$114.66
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: PHP Commercial	$139.23
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: Priority Health SBD	$103.19

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 57896045101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
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

$122.00

Service Code	NDC 96295013289
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$76.86
Max. Negotiated Rate	$109.80
Rate for Payer: Aetna Commercial	$103.70
Rate for Payer: Aetna New Business (MI Preferred)	$79.30
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

$132.00

Service Code	NDC 00904652261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$118.80
Rate for Payer: Aetna Commercial	$112.20
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: Aetna New Business (MI Preferred)	$85.80
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$113.52
Rate for Payer: Cofinity Commercial	$92.40
Rate for Payer: Cofinity Medicare Advantage	$92.40
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: PHP Commercial	$112.20
Rate for Payer: Priority Health Cigna Priority Health	$85.80
Rate for Payer: Priority Health SBD	$83.16

SENNOSIDES 8.6 MG TABLET

Facility

$184.00

Service Code	NDC 70000044703
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$165.60
Rate for Payer: Aetna Commercial	$156.40
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: Aetna New Business (MI Preferred)	$119.60
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cofinity Commercial	$128.80
Rate for Payer: Cofinity Commercial	$158.24
Rate for Payer: Cofinity Medicare Advantage	$128.80
Rate for Payer: Encore Health Key Benefits Commercial	$147.20
Rate for Payer: Healthscope Commercial	$165.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$156.40
Rate for Payer: PHP Commercial	$156.40
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health SBD	$115.92

SENNOSIDES 8.6 MG TABLET

Facility

$88.20

Service Code	NDC 96295013956
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
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

$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

$113.40

Service Code	NDC 49483008001
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
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

$132.30

Service Code	NDC 00904672559
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$83.35
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.46
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
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	$112.46
Rate for Payer: PHP Commercial	$112.46
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

SENNOSIDES 8.6 MG TABLET

Facility

$44.52

Service Code	NDC 67618030020
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$40.07
Rate for Payer: Aetna Commercial	$37.84
Rate for Payer: Aetna Medicare	$22.26
Rate for Payer: Aetna New Business (MI Preferred)	$28.94
Rate for Payer: BCBS Complete	$17.81
Rate for Payer: Cash Price	$35.62
Rate for Payer: Cofinity Commercial	$31.16
Rate for Payer: Cofinity Commercial	$38.29
Rate for Payer: Cofinity Medicare Advantage	$31.16
Rate for Payer: Encore Health Key Benefits Commercial	$35.62
Rate for Payer: Healthscope Commercial	$40.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.84
Rate for Payer: PHP Commercial	$37.84
Rate for Payer: Priority Health Cigna Priority Health	$28.94
Rate for Payer: Priority Health SBD	$28.05

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	$91.04
Rate for Payer: Aetna New Business (MI Preferred)	$69.62
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	$91.04
Rate for Payer: PHP Commercial	$91.04
Rate for Payer: Priority Health Cigna Priority Health	$69.62
Rate for Payer: Priority Health SBD	$67.47

SENNOSIDES 8.6 MG TABLET

Facility

$140.00

Service Code	NDC 00904725261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$119.00
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: Aetna New Business (MI Preferred)	$91.00
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$120.40
Rate for Payer: Cofinity Commercial	$98.00
Rate for Payer: Cofinity Medicare Advantage	$98.00
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: PHP Commercial	$119.00
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health SBD	$88.20

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
Rate for Payer: BCBS Complete	$65.52
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$114.66
Rate for Payer: Cofinity Commercial	$140.87
Rate for Payer: Cofinity Medicare Advantage	$114.66
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: PHP Commercial	$139.23
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: Priority Health SBD	$103.19

SENNOSIDES 8.6 MG TABLET

Facility

$149.10

Service Code	NDC 67618030010
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$134.19
Rate for Payer: Aetna Commercial	$126.74
Rate for Payer: Aetna Medicare	$74.55
Rate for Payer: Aetna New Business (MI Preferred)	$96.92
Rate for Payer: BCBS Complete	$59.64
Rate for Payer: Cash Price	$119.28
Rate for Payer: Cofinity Commercial	$104.37
Rate for Payer: Cofinity Commercial	$128.23
Rate for Payer: Cofinity Medicare Advantage	$104.37
Rate for Payer: Encore Health Key Benefits Commercial	$119.28
Rate for Payer: Healthscope Commercial	$134.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.74
Rate for Payer: PHP Commercial	$126.74
Rate for Payer: Priority Health Cigna Priority Health	$96.92
Rate for Payer: Priority Health SBD	$93.93

SENNOSIDES 8.6 MG TABLET

Facility

$299.25

Service Code	NDC 96295013519
Hospital Charge Code	11349
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 Commercial	$209.48
Rate for Payer: Cofinity Commercial	$257.36
Rate for Payer: Cofinity Medicare Advantage	$209.48
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: PHP Commercial	$254.36
Rate for Payer: Priority Health Cigna Priority Health	$194.51
Rate for Payer: Priority Health SBD	$188.53

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	$112.46
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	$112.46
Rate for Payer: PHP Commercial	$112.46
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

SENNOSIDES 8.6 MG TABLET

Facility

$567.00

Service Code	NDC 49483008010
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$357.21
Max. Negotiated Rate	$510.30
Rate for Payer: Aetna Commercial	$481.95
Rate for Payer: Aetna New Business (MI Preferred)	$368.55
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cofinity Commercial	$396.90
Rate for Payer: Cofinity Commercial	$487.62
Rate for Payer: Cofinity Medicare Advantage	$396.90
Rate for Payer: Encore Health Key Benefits Commercial	$453.60
Rate for Payer: Healthscope Commercial	$510.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.95
Rate for Payer: PHP Commercial	$481.95
Rate for Payer: Priority Health Cigna Priority Health	$368.55
Rate for Payer: Priority Health SBD	$357.21

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

Facility

$9,986.81

Service Code	CPT 30520
Hospital Revenue Code	360
Min. Negotiated Rate	$702.66
Max. Negotiated Rate	$9,986.81
Rate for Payer: Aetna Medicare	$3,304.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,971.88
Rate for Payer: Amish Plain Church Group Commercial	$3,971.88
Rate for Payer: BCBS Complete	$1,788.30
Rate for Payer: BCBS MAPPO	$3,177.50
Rate for Payer: BCBS Trust/PPO	$1,894.08
Rate for Payer: BCN Commercial	$1,894.08
Rate for Payer: BCN Medicare Advantage	$3,177.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,177.50
Rate for Payer: Mclaren Medicaid	$1,703.14
Rate for Payer: Mclaren Medicare	$3,177.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,336.38
Rate for Payer: Meridian Medicaid	$1,788.30
Rate for Payer: MI Amish Medical Board Commercial	$3,654.12
Rate for Payer: Nomi Health Commercial	$6,672.75
Rate for Payer: PACE Medicare	$3,018.62
Rate for Payer: PACE SWMI	$3,177.50
Rate for Payer: PHP Medicare Advantage	$3,177.50
Rate for Payer: Priority Health Choice Medicaid	$1,703.14
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,986.81
Rate for Payer: Priority Health Medicare	$3,177.50
Rate for Payer: Priority Health Narrow Network	$7,989.45
Rate for Payer: Railroad Medicare Medicare	$3,177.50
Rate for Payer: UHC All Payor (Choice/PPO)	$702.66
Rate for Payer: UHC Core	$4,155.00
Rate for Payer: UHC Dual Complete DSNP	$3,177.50
Rate for Payer: UHC Exchange	$4,450.00
Rate for Payer: UHC Medicare Advantage	$3,177.50
Rate for Payer: UHCCP Medicaid	$1,788.93
Rate for Payer: VA VA	$3,177.50

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	$136.54
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.54
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

$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	$97.52
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	$136.54
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Cofinity Medicare Advantage	$136.54
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

$348.65

Service Code	NDC 60687025301
Hospital Charge Code	11350
Hospital Revenue Code	637
Min. Negotiated Rate	$139.46
Max. Negotiated Rate	$313.78
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	$313.78
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	$35.53
Max. Negotiated Rate	$79.95
Rate for Payer: Aetna Commercial	$75.51
Rate for Payer: Aetna Medicare	$44.42
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

$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

$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	$1.74
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

Know your out-of-pocket cost for care.

All Charges