Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AMITRIPTYLINE 100 MG TABLET

Facility

$3.66

Service Code	NDC 51079056301
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: Aetna Medicare	$1.83
Rate for Payer: Aetna New Business (MI Preferred)	$2.38
Rate for Payer: BCBS Complete	$1.46
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cofinity Advantage	$2.56
Rate for Payer: Cofinity Commercial	$3.15
Rate for Payer: Encore Health Key Benefits Commercial	$2.93
Rate for Payer: Healthscope Commercial	$3.29
Rate for Payer: MI Amish Medical Board Commercial	$2.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.75
Rate for Payer: PHP Commercial	$3.11
Rate for Payer: Priority Health SBD	$2.31
Rate for Payer: UHC All Payor (Choice/PPO)	$2.38
Rate for Payer: UHC Core	$1.91
Rate for Payer: UHC Exchange	$1.44

AMITRIPTYLINE 100 MG TABLET

Facility

$218.55

Service Code	NDC 16729017501
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$137.69
Max. Negotiated Rate	$196.69
Rate for Payer: Aetna Commercial	$185.77
Rate for Payer: Aetna New Business (MI Preferred)	$142.06
Rate for Payer: Cash Price	$174.84
Rate for Payer: Cofinity Advantage	$152.99
Rate for Payer: Cofinity Commercial	$187.95
Rate for Payer: Encore Health Key Benefits Commercial	$174.84
Rate for Payer: Healthscope Commercial	$196.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.91
Rate for Payer: PHP Commercial	$185.77
Rate for Payer: Priority Health SBD	$137.69

AMITRIPTYLINE 100 MG TABLET

Facility

$3.17

Service Code	NDC 50268004111
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna Medicare	$1.58
Rate for Payer: Aetna New Business (MI Preferred)	$2.06
Rate for Payer: BCBS Complete	$1.27
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Advantage	$2.22
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.85
Rate for Payer: MI Amish Medical Board Commercial	$2.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.38
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health SBD	$2.00
Rate for Payer: UHC All Payor (Choice/PPO)	$2.06
Rate for Payer: UHC Core	$1.65
Rate for Payer: UHC Exchange	$1.25

AMITRIPTYLINE 100 MG TABLET

Facility

$3.66

Service Code	NDC 51079056301
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$3.29
Rate for Payer: Aetna Commercial	$3.11
Rate for Payer: Aetna New Business (MI Preferred)	$2.38
Rate for Payer: Cash Price	$2.93
Rate for Payer: Cofinity Advantage	$2.56
Rate for Payer: Cofinity Commercial	$3.15
Rate for Payer: Encore Health Key Benefits Commercial	$2.93
Rate for Payer: Healthscope Commercial	$3.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.75
Rate for Payer: PHP Commercial	$3.11
Rate for Payer: Priority Health SBD	$2.31

AMITRIPTYLINE 100 MG TABLET

Facility

$158.40

Service Code	NDC 50268004115
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$99.79
Max. Negotiated Rate	$142.56
Rate for Payer: Aetna Commercial	$134.64
Rate for Payer: Aetna New Business (MI Preferred)	$102.96
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cofinity Advantage	$110.88
Rate for Payer: Cofinity Commercial	$136.22
Rate for Payer: Encore Health Key Benefits Commercial	$126.72
Rate for Payer: Healthscope Commercial	$142.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.80
Rate for Payer: PHP Commercial	$134.64
Rate for Payer: Priority Health SBD	$99.79

AMITRIPTYLINE 100 MG TABLET

Facility

$158.40

Service Code	NDC 50268004115
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$62.25
Max. Negotiated Rate	$142.56
Rate for Payer: Aetna Commercial	$134.64
Rate for Payer: Aetna Medicare	$79.20
Rate for Payer: Aetna New Business (MI Preferred)	$102.96
Rate for Payer: BCBS Complete	$63.36
Rate for Payer: Cash Price	$126.72
Rate for Payer: Cofinity Advantage	$110.88
Rate for Payer: Cofinity Commercial	$136.22
Rate for Payer: Encore Health Key Benefits Commercial	$126.72
Rate for Payer: Healthscope Commercial	$142.56
Rate for Payer: MI Amish Medical Board Commercial	$126.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.80
Rate for Payer: PHP Commercial	$134.64
Rate for Payer: Priority Health SBD	$99.79
Rate for Payer: UHC All Payor (Choice/PPO)	$102.96
Rate for Payer: UHC Core	$82.53
Rate for Payer: UHC Exchange	$62.25

AMITRIPTYLINE 100 MG TABLET

Facility

$3.17

Service Code	NDC 50268004111
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.85
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.06
Rate for Payer: Cash Price	$2.54
Rate for Payer: Cofinity Advantage	$2.22
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Encore Health Key Benefits Commercial	$2.54
Rate for Payer: Healthscope Commercial	$2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.38
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health SBD	$2.00

AMITRIPTYLINE 100 MG TABLET

Facility

$365.28

Service Code	NDC 51079056320
Hospital Charge Code	433
Hospital Revenue Code	637
Min. Negotiated Rate	$230.13
Max. Negotiated Rate	$328.75
Rate for Payer: Aetna Commercial	$310.49
Rate for Payer: Aetna New Business (MI Preferred)	$237.43
Rate for Payer: Cash Price	$292.22
Rate for Payer: Cofinity Advantage	$255.70
Rate for Payer: Cofinity Commercial	$314.14
Rate for Payer: Encore Health Key Benefits Commercial	$292.22
Rate for Payer: Healthscope Commercial	$328.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.96
Rate for Payer: PHP Commercial	$310.49
Rate for Payer: Priority Health SBD	$230.13

AMITRIPTYLINE 10 MG TABLET

Facility

$136.30

Service Code	NDC 16729017101
Hospital Charge Code	432
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87

AMITRIPTYLINE 10 MG TABLET

Facility

$136.30

Service Code	NDC 16729017101
Hospital Charge Code	432
Hospital Revenue Code	637
Min. Negotiated Rate	$53.57
Max. Negotiated Rate	$122.67
Rate for Payer: Aetna Commercial	$115.86
Rate for Payer: Aetna Medicare	$68.15
Rate for Payer: Aetna New Business (MI Preferred)	$88.59
Rate for Payer: BCBS Complete	$54.52
Rate for Payer: Cash Price	$109.04
Rate for Payer: Cofinity Advantage	$95.41
Rate for Payer: Cofinity Commercial	$117.22
Rate for Payer: Encore Health Key Benefits Commercial	$109.04
Rate for Payer: Healthscope Commercial	$122.67
Rate for Payer: MI Amish Medical Board Commercial	$109.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$115.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.22
Rate for Payer: PHP Commercial	$115.86
Rate for Payer: Priority Health SBD	$85.87
Rate for Payer: UHC All Payor (Choice/PPO)	$88.59
Rate for Payer: UHC Core	$71.01
Rate for Payer: UHC Exchange	$53.57

AMITRIPTYLINE 25 MG TABLET

Facility

$230.30

Service Code	NDC 00781148701
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$145.09
Max. Negotiated Rate	$207.27
Rate for Payer: Aetna Commercial	$195.75
Rate for Payer: Aetna New Business (MI Preferred)	$149.69
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Advantage	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$172.72
Rate for Payer: PHP Commercial	$195.75
Rate for Payer: Priority Health SBD	$145.09

AMITRIPTYLINE 25 MG TABLET

Facility

$336.30

Service Code	NDC 60687043301
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$211.87
Max. Negotiated Rate	$302.67
Rate for Payer: Aetna Commercial	$285.86
Rate for Payer: Aetna New Business (MI Preferred)	$218.59
Rate for Payer: Cash Price	$269.04
Rate for Payer: Cofinity Advantage	$235.41
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Encore Health Key Benefits Commercial	$269.04
Rate for Payer: Healthscope Commercial	$302.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.22
Rate for Payer: PHP Commercial	$285.86
Rate for Payer: Priority Health SBD	$211.87

AMITRIPTYLINE 25 MG TABLET

Facility

$230.30

Service Code	NDC 00781148701
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$90.51
Max. Negotiated Rate	$207.27
Rate for Payer: Aetna Commercial	$195.75
Rate for Payer: Aetna Medicare	$115.15
Rate for Payer: Aetna New Business (MI Preferred)	$149.69
Rate for Payer: BCBS Complete	$92.12
Rate for Payer: Cash Price	$184.24
Rate for Payer: Cofinity Advantage	$161.21
Rate for Payer: Cofinity Commercial	$198.06
Rate for Payer: Encore Health Key Benefits Commercial	$184.24
Rate for Payer: Healthscope Commercial	$207.27
Rate for Payer: MI Amish Medical Board Commercial	$184.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$195.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$172.72
Rate for Payer: PHP Commercial	$195.75
Rate for Payer: Priority Health SBD	$145.09
Rate for Payer: UHC All Payor (Choice/PPO)	$149.69
Rate for Payer: UHC Core	$119.99
Rate for Payer: UHC Exchange	$90.51

AMITRIPTYLINE 25 MG TABLET

Facility

$3.37

Service Code	NDC 60687043311
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna Medicare	$1.69
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: BCBS Complete	$1.35
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Advantage	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: MI Amish Medical Board Commercial	$2.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.53
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health SBD	$2.12
Rate for Payer: UHC All Payor (Choice/PPO)	$2.19
Rate for Payer: UHC Core	$1.76
Rate for Payer: UHC Exchange	$1.32

AMITRIPTYLINE 25 MG TABLET

Facility

$336.30

Service Code	NDC 60687043301
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$132.17
Max. Negotiated Rate	$302.67
Rate for Payer: Aetna Commercial	$285.86
Rate for Payer: Aetna Medicare	$168.15
Rate for Payer: Aetna New Business (MI Preferred)	$218.59
Rate for Payer: BCBS Complete	$134.52
Rate for Payer: Cash Price	$269.04
Rate for Payer: Cofinity Advantage	$235.41
Rate for Payer: Cofinity Commercial	$289.22
Rate for Payer: Encore Health Key Benefits Commercial	$269.04
Rate for Payer: Healthscope Commercial	$302.67
Rate for Payer: MI Amish Medical Board Commercial	$269.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$285.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.22
Rate for Payer: PHP Commercial	$285.86
Rate for Payer: Priority Health SBD	$211.87
Rate for Payer: UHC All Payor (Choice/PPO)	$218.59
Rate for Payer: UHC Core	$175.21
Rate for Payer: UHC Exchange	$132.17

AMITRIPTYLINE 25 MG TABLET

Facility

$3.37

Service Code	NDC 60687043311
Hospital Charge Code	435
Hospital Revenue Code	637
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$3.03
Rate for Payer: Aetna Commercial	$2.86
Rate for Payer: Aetna New Business (MI Preferred)	$2.19
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cofinity Advantage	$2.36
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Encore Health Key Benefits Commercial	$2.70
Rate for Payer: Healthscope Commercial	$3.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.53
Rate for Payer: PHP Commercial	$2.86
Rate for Payer: Priority Health SBD	$2.12

AMITRIPTYLINE 50 MG TABLET

Facility

$3.32

Service Code	NDC 51079013301
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$1.66
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: BCBS Complete	$1.33
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Advantage	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: MI Amish Medical Board Commercial	$2.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health SBD	$2.09
Rate for Payer: UHC All Payor (Choice/PPO)	$2.16
Rate for Payer: UHC Core	$1.73
Rate for Payer: UHC Exchange	$1.30

AMITRIPTYLINE 50 MG TABLET

Facility

$141.12

Service Code	NDC 50268003915
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$127.01
Rate for Payer: Aetna Commercial	$119.95
Rate for Payer: Aetna New Business (MI Preferred)	$91.73
Rate for Payer: Cash Price	$112.90
Rate for Payer: Cofinity Advantage	$98.78
Rate for Payer: Cofinity Commercial	$121.36
Rate for Payer: Encore Health Key Benefits Commercial	$112.90
Rate for Payer: Healthscope Commercial	$127.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.84
Rate for Payer: PHP Commercial	$119.95
Rate for Payer: Priority Health SBD	$88.91

AMITRIPTYLINE 50 MG TABLET

Facility

$331.55

Service Code	NDC 51079013320
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$130.30
Max. Negotiated Rate	$298.39
Rate for Payer: Aetna Commercial	$281.82
Rate for Payer: Aetna Medicare	$165.78
Rate for Payer: Aetna New Business (MI Preferred)	$215.51
Rate for Payer: BCBS Complete	$132.62
Rate for Payer: Cash Price	$265.24
Rate for Payer: Cofinity Advantage	$232.09
Rate for Payer: Cofinity Commercial	$285.13
Rate for Payer: Encore Health Key Benefits Commercial	$265.24
Rate for Payer: Healthscope Commercial	$298.39
Rate for Payer: MI Amish Medical Board Commercial	$265.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$248.66
Rate for Payer: PHP Commercial	$281.82
Rate for Payer: Priority Health SBD	$208.88
Rate for Payer: UHC All Payor (Choice/PPO)	$215.51
Rate for Payer: UHC Core	$172.74
Rate for Payer: UHC Exchange	$130.30

AMITRIPTYLINE 50 MG TABLET

Facility

$3.32

Service Code	NDC 51079013301
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Advantage	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health SBD	$2.09

AMITRIPTYLINE 50 MG TABLET

Facility

$2.83

Service Code	NDC 50268003911
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$2.55
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna New Business (MI Preferred)	$1.84
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Advantage	$1.98
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.12
Rate for Payer: PHP Commercial	$2.41
Rate for Payer: Priority Health SBD	$1.78

AMITRIPTYLINE 50 MG TABLET

Facility

$2.83

Service Code	NDC 50268003911
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$2.55
Rate for Payer: Aetna Commercial	$2.41
Rate for Payer: Aetna Medicare	$1.42
Rate for Payer: Aetna New Business (MI Preferred)	$1.84
Rate for Payer: BCBS Complete	$1.13
Rate for Payer: Cash Price	$2.26
Rate for Payer: Cofinity Advantage	$1.98
Rate for Payer: Cofinity Commercial	$2.43
Rate for Payer: Encore Health Key Benefits Commercial	$2.26
Rate for Payer: Healthscope Commercial	$2.55
Rate for Payer: MI Amish Medical Board Commercial	$2.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.12
Rate for Payer: PHP Commercial	$2.41
Rate for Payer: Priority Health SBD	$1.78
Rate for Payer: UHC All Payor (Choice/PPO)	$1.84
Rate for Payer: UHC Core	$1.47
Rate for Payer: UHC Exchange	$1.11

AMITRIPTYLINE 50 MG TABLET

Facility

$452.20

Service Code	NDC 00904741161
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$284.89
Max. Negotiated Rate	$406.98
Rate for Payer: Aetna Commercial	$384.37
Rate for Payer: Aetna New Business (MI Preferred)	$293.93
Rate for Payer: Cash Price	$361.76
Rate for Payer: Cofinity Advantage	$316.54
Rate for Payer: Cofinity Commercial	$388.89
Rate for Payer: Encore Health Key Benefits Commercial	$361.76
Rate for Payer: Healthscope Commercial	$406.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$384.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.15
Rate for Payer: PHP Commercial	$384.37
Rate for Payer: Priority Health SBD	$284.89

AMITRIPTYLINE 50 MG TABLET

Facility

$331.55

Service Code	NDC 51079013320
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$208.88
Max. Negotiated Rate	$298.39
Rate for Payer: Aetna Commercial	$281.82
Rate for Payer: Aetna New Business (MI Preferred)	$215.51
Rate for Payer: Cash Price	$265.24
Rate for Payer: Cofinity Advantage	$232.09
Rate for Payer: Cofinity Commercial	$285.13
Rate for Payer: Encore Health Key Benefits Commercial	$265.24
Rate for Payer: Healthscope Commercial	$298.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$281.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$248.66
Rate for Payer: PHP Commercial	$281.82
Rate for Payer: Priority Health SBD	$208.88

AMITRIPTYLINE 50 MG TABLET

Facility

$452.20

Service Code	NDC 00904741161
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$177.71
Max. Negotiated Rate	$406.98
Rate for Payer: Aetna Commercial	$384.37
Rate for Payer: Aetna Medicare	$226.10
Rate for Payer: Aetna New Business (MI Preferred)	$293.93
Rate for Payer: BCBS Complete	$180.88
Rate for Payer: Cash Price	$361.76
Rate for Payer: Cofinity Advantage	$316.54
Rate for Payer: Cofinity Commercial	$388.89
Rate for Payer: Encore Health Key Benefits Commercial	$361.76
Rate for Payer: Healthscope Commercial	$406.98
Rate for Payer: MI Amish Medical Board Commercial	$361.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$384.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.15
Rate for Payer: PHP Commercial	$384.37
Rate for Payer: Priority Health SBD	$284.89
Rate for Payer: UHC All Payor (Choice/PPO)	$293.93
Rate for Payer: UHC Core	$235.60
Rate for Payer: UHC Exchange	$177.71

Know your out-of-pocket cost for care.

All Charges