Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$783.22
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Advantage	$870.24
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Encore Health Key Benefits Commercial	$994.56
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,056.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$932.40
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$978.58

Service Code	NDC 66993008096
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$384.58
Max. Negotiated Rate	$880.72
Rate for Payer: Aetna Commercial	$831.79
Rate for Payer: Aetna Medicare	$489.29
Rate for Payer: Aetna New Business (MI Preferred)	$636.08
Rate for Payer: BCBS Complete	$391.43
Rate for Payer: Cash Price	$782.86
Rate for Payer: Cofinity Advantage	$685.01
Rate for Payer: Cofinity Commercial	$841.58
Rate for Payer: Encore Health Key Benefits Commercial	$782.86
Rate for Payer: Healthscope Commercial	$880.72
Rate for Payer: MI Amish Medical Board Commercial	$782.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$831.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$733.93
Rate for Payer: PHP Commercial	$831.79
Rate for Payer: Priority Health SBD	$616.51
Rate for Payer: UHC All Payor (Choice/PPO)	$636.08
Rate for Payer: UHC Core	$509.84
Rate for Payer: UHC Exchange	$384.58

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$488.58
Max. Negotiated Rate	$1,118.88
Rate for Payer: Aetna Commercial	$1,056.72
Rate for Payer: Aetna Medicare	$621.60
Rate for Payer: Aetna New Business (MI Preferred)	$808.08
Rate for Payer: BCBS Complete	$497.28
Rate for Payer: Cash Price	$994.56
Rate for Payer: Cofinity Advantage	$870.24
Rate for Payer: Cofinity Commercial	$1,069.15
Rate for Payer: Encore Health Key Benefits Commercial	$994.56
Rate for Payer: Healthscope Commercial	$1,118.88
Rate for Payer: MI Amish Medical Board Commercial	$994.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,056.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$932.40
Rate for Payer: PHP Commercial	$1,056.72
Rate for Payer: Priority Health SBD	$783.22
Rate for Payer: UHC All Payor (Choice/PPO)	$808.08
Rate for Payer: UHC Core	$647.71
Rate for Payer: UHC Exchange	$488.58

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$26.07

Service Code	NDC 60505082901
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$16.42
Max. Negotiated Rate	$23.46
Rate for Payer: Aetna Commercial	$22.16
Rate for Payer: Aetna New Business (MI Preferred)	$16.95
Rate for Payer: Cash Price	$20.86
Rate for Payer: Cofinity Advantage	$18.25
Rate for Payer: Cofinity Commercial	$22.42
Rate for Payer: Encore Health Key Benefits Commercial	$20.86
Rate for Payer: Healthscope Commercial	$23.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.55
Rate for Payer: PHP Commercial	$22.16
Rate for Payer: Priority Health SBD	$16.42

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$26.07

Service Code	NDC 60505082901
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$10.25
Max. Negotiated Rate	$23.46
Rate for Payer: Aetna Commercial	$22.16
Rate for Payer: Aetna Medicare	$13.04
Rate for Payer: Aetna New Business (MI Preferred)	$16.95
Rate for Payer: BCBS Complete	$10.43
Rate for Payer: Cash Price	$20.86
Rate for Payer: Cofinity Advantage	$18.25
Rate for Payer: Cofinity Commercial	$22.42
Rate for Payer: Encore Health Key Benefits Commercial	$20.86
Rate for Payer: Healthscope Commercial	$23.46
Rate for Payer: MI Amish Medical Board Commercial	$20.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.55
Rate for Payer: PHP Commercial	$22.16
Rate for Payer: Priority Health SBD	$16.42
Rate for Payer: UHC All Payor (Choice/PPO)	$16.95
Rate for Payer: UHC Core	$13.58
Rate for Payer: UHC Exchange	$10.25

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$36.57

Service Code	NDC 00054327099
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$23.04
Max. Negotiated Rate	$32.91
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna New Business (MI Preferred)	$23.77
Rate for Payer: Cash Price	$29.26
Rate for Payer: Cofinity Advantage	$25.60
Rate for Payer: Cofinity Commercial	$31.45
Rate for Payer: Encore Health Key Benefits Commercial	$29.26
Rate for Payer: Healthscope Commercial	$32.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.43
Rate for Payer: PHP Commercial	$31.08
Rate for Payer: Priority Health SBD	$23.04

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$36.57

Service Code	NDC 00054327099
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$32.91
Rate for Payer: Aetna Commercial	$31.08
Rate for Payer: Aetna Medicare	$18.29
Rate for Payer: Aetna New Business (MI Preferred)	$23.77
Rate for Payer: BCBS Complete	$14.63
Rate for Payer: Cash Price	$29.26
Rate for Payer: Cofinity Advantage	$25.60
Rate for Payer: Cofinity Commercial	$31.45
Rate for Payer: Encore Health Key Benefits Commercial	$29.26
Rate for Payer: Healthscope Commercial	$32.91
Rate for Payer: MI Amish Medical Board Commercial	$29.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.43
Rate for Payer: PHP Commercial	$31.08
Rate for Payer: Priority Health SBD	$23.04
Rate for Payer: UHC All Payor (Choice/PPO)	$23.77
Rate for Payer: UHC Core	$19.05
Rate for Payer: UHC Exchange	$14.37

FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$234.60

Service Code	HCPCS 90662
Hospital Charge Code	212355
Hospital Revenue Code	636
Min. Negotiated Rate	$78.53
Max. Negotiated Rate	$212.33
Rate for Payer: Aetna Commercial	$199.41
Rate for Payer: Aetna Medicare	$117.30
Rate for Payer: Aetna New Business (MI Preferred)	$152.49
Rate for Payer: BCBS Complete	$93.84
Rate for Payer: BCBS Trust/PPO	$212.33
Rate for Payer: BCN Commercial	$212.33
Rate for Payer: Cash Price	$187.68
Rate for Payer: Cash Price	$187.68
Rate for Payer: Cofinity Advantage	$164.22
Rate for Payer: Cofinity Commercial	$201.76
Rate for Payer: Encore Health Key Benefits Commercial	$187.68
Rate for Payer: Healthscope Commercial	$211.14
Rate for Payer: MI Amish Medical Board Commercial	$187.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$199.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.95
Rate for Payer: PHP Commercial	$199.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$98.16
Rate for Payer: Priority Health SBD	$147.80
Rate for Payer: Priority Health Tiered Network	$78.53
Rate for Payer: UHC All Payor (Choice/PPO)	$161.96
Rate for Payer: UHC Core	$161.96
Rate for Payer: UHC Exchange	$161.96

FLU VACCINE TS2025-26(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$234.60

Service Code	HCPCS 90662
Hospital Charge Code	212355
Hospital Revenue Code	636
Min. Negotiated Rate	$147.80
Max. Negotiated Rate	$211.14
Rate for Payer: Aetna Commercial	$199.41
Rate for Payer: Aetna New Business (MI Preferred)	$152.49
Rate for Payer: Cash Price	$187.68
Rate for Payer: Cofinity Advantage	$164.22
Rate for Payer: Cofinity Commercial	$201.76
Rate for Payer: Encore Health Key Benefits Commercial	$187.68
Rate for Payer: Healthscope Commercial	$211.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$199.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.95
Rate for Payer: PHP Commercial	$199.41
Rate for Payer: Priority Health SBD	$147.80

FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE

Facility

$82.13

Service Code	HCPCS 90656
Hospital Charge Code	212359
Hospital Revenue Code	636
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$69.81
Rate for Payer: Aetna New Business (MI Preferred)	$53.38
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cofinity Advantage	$57.49
Rate for Payer: Cofinity Commercial	$70.63
Rate for Payer: Encore Health Key Benefits Commercial	$65.70
Rate for Payer: Healthscope Commercial	$73.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.60
Rate for Payer: PHP Commercial	$69.81
Rate for Payer: Priority Health SBD	$51.74

FLU VACCINE TS 2025-26(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE

Facility

$82.13

Service Code	HCPCS 90656
Hospital Charge Code	212359
Hospital Revenue Code	636
Min. Negotiated Rate	$18.58
Max. Negotiated Rate	$73.92
Rate for Payer: Aetna Commercial	$69.81
Rate for Payer: Aetna Medicare	$41.06
Rate for Payer: Aetna New Business (MI Preferred)	$53.38
Rate for Payer: BCBS Complete	$32.85
Rate for Payer: BCBS Trust/PPO	$50.45
Rate for Payer: BCN Commercial	$50.45
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cofinity Advantage	$57.49
Rate for Payer: Cofinity Commercial	$70.63
Rate for Payer: Encore Health Key Benefits Commercial	$65.70
Rate for Payer: Healthscope Commercial	$73.92
Rate for Payer: MI Amish Medical Board Commercial	$65.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.60
Rate for Payer: PHP Commercial	$69.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$23.22
Rate for Payer: Priority Health SBD	$51.74
Rate for Payer: Priority Health Tiered Network	$18.58
Rate for Payer: UHC All Payor (Choice/PPO)	$38.31
Rate for Payer: UHC Core	$38.31
Rate for Payer: UHC Exchange	$38.31

FLUVOXAMINE 100 MG TABLET

Facility

$218.50

Service Code	NDC 62559016001
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$85.87
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna Medicare	$109.25
Rate for Payer: Aetna New Business (MI Preferred)	$142.03
Rate for Payer: BCBS Complete	$87.40
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Advantage	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: MI Amish Medical Board Commercial	$174.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.88
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health SBD	$137.66
Rate for Payer: UHC All Payor (Choice/PPO)	$142.03
Rate for Payer: UHC Core	$113.84
Rate for Payer: UHC Exchange	$85.87

FLUVOXAMINE 100 MG TABLET

Facility

$218.50

Service Code	NDC 62559016001
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$137.66
Max. Negotiated Rate	$196.65
Rate for Payer: Aetna Commercial	$185.72
Rate for Payer: Aetna New Business (MI Preferred)	$142.03
Rate for Payer: Cash Price	$174.80
Rate for Payer: Cofinity Advantage	$152.95
Rate for Payer: Cofinity Commercial	$187.91
Rate for Payer: Encore Health Key Benefits Commercial	$174.80
Rate for Payer: Healthscope Commercial	$196.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$163.88
Rate for Payer: PHP Commercial	$185.72
Rate for Payer: Priority Health SBD	$137.66

FLUVOXAMINE 100 MG TABLET

Facility

$414.20

Service Code	NDC 51079099320
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$162.78
Max. Negotiated Rate	$372.78
Rate for Payer: Aetna Commercial	$352.07
Rate for Payer: Aetna Medicare	$207.10
Rate for Payer: Aetna New Business (MI Preferred)	$269.23
Rate for Payer: BCBS Complete	$165.68
Rate for Payer: Cash Price	$331.36
Rate for Payer: Cofinity Advantage	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Encore Health Key Benefits Commercial	$331.36
Rate for Payer: Healthscope Commercial	$372.78
Rate for Payer: MI Amish Medical Board Commercial	$331.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$352.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.65
Rate for Payer: PHP Commercial	$352.07
Rate for Payer: Priority Health SBD	$260.95
Rate for Payer: UHC All Payor (Choice/PPO)	$269.23
Rate for Payer: UHC Core	$215.80
Rate for Payer: UHC Exchange	$162.78

FLUVOXAMINE 100 MG TABLET

Facility

$4.15

Service Code	NDC 51079099301
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61

FLUVOXAMINE 100 MG TABLET

Facility

$414.20

Service Code	NDC 51079099320
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$260.95
Max. Negotiated Rate	$372.78
Rate for Payer: Aetna Commercial	$352.07
Rate for Payer: Aetna New Business (MI Preferred)	$269.23
Rate for Payer: Cash Price	$331.36
Rate for Payer: Cofinity Advantage	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Encore Health Key Benefits Commercial	$331.36
Rate for Payer: Healthscope Commercial	$372.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$352.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.65
Rate for Payer: PHP Commercial	$352.07
Rate for Payer: Priority Health SBD	$260.95

FLUVOXAMINE 100 MG TABLET

Facility

$4.15

Service Code	NDC 51079099301
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: BCBS Complete	$1.66
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: MI Amish Medical Board Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61
Rate for Payer: UHC All Payor (Choice/PPO)	$2.70
Rate for Payer: UHC Core	$2.16
Rate for Payer: UHC Exchange	$1.63

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079099220
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$147.10
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna Medicare	$187.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: BCBS Complete	$149.72
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: MI Amish Medical Board Commercial	$299.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81
Rate for Payer: UHC All Payor (Choice/PPO)	$243.29
Rate for Payer: UHC Core	$195.01
Rate for Payer: UHC Exchange	$147.10

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079099201
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Advantage	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: MI Amish Medical Board Commercial	$3.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.81
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health SBD	$2.36
Rate for Payer: UHC All Payor (Choice/PPO)	$2.44
Rate for Payer: UHC Core	$1.95
Rate for Payer: UHC Exchange	$1.47

FLUVOXAMINE 50 MG TABLET

Facility

$206.15

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$81.02
Max. Negotiated Rate	$185.53
Rate for Payer: Aetna Commercial	$175.23
Rate for Payer: Aetna Medicare	$103.08
Rate for Payer: Aetna New Business (MI Preferred)	$134.00
Rate for Payer: BCBS Complete	$82.46
Rate for Payer: Cash Price	$164.92
Rate for Payer: Cofinity Advantage	$144.31
Rate for Payer: Cofinity Commercial	$177.29
Rate for Payer: Encore Health Key Benefits Commercial	$164.92
Rate for Payer: Healthscope Commercial	$185.53
Rate for Payer: MI Amish Medical Board Commercial	$164.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.61
Rate for Payer: PHP Commercial	$175.23
Rate for Payer: Priority Health SBD	$129.87
Rate for Payer: UHC All Payor (Choice/PPO)	$134.00
Rate for Payer: UHC Core	$107.40
Rate for Payer: UHC Exchange	$81.02

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079099201
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Advantage	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.81
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health SBD	$2.36

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079099220
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$235.81
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.29
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Advantage	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Encore Health Key Benefits Commercial	$299.44
Rate for Payer: Healthscope Commercial	$336.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.73
Rate for Payer: PHP Commercial	$318.15
Rate for Payer: Priority Health SBD	$235.81

FLUVOXAMINE 50 MG TABLET

Facility

$206.15

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$129.87
Max. Negotiated Rate	$185.53
Rate for Payer: Aetna Commercial	$175.23
Rate for Payer: Aetna New Business (MI Preferred)	$134.00
Rate for Payer: Cash Price	$164.92
Rate for Payer: Cofinity Advantage	$144.31
Rate for Payer: Cofinity Commercial	$177.29
Rate for Payer: Encore Health Key Benefits Commercial	$164.92
Rate for Payer: Healthscope Commercial	$185.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$175.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.61
Rate for Payer: PHP Commercial	$175.23
Rate for Payer: Priority Health SBD	$129.87

FOLIC ACID 1 MG TABLET

Facility

$188.00

Service Code	NDC 65162036110
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44

FOLIC ACID 1 MG TABLET

Facility

$168.00

Service Code	NDC 69315012701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$66.02
Max. Negotiated Rate	$151.20
Rate for Payer: Aetna Commercial	$142.80
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: Aetna New Business (MI Preferred)	$109.20
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cofinity Advantage	$117.60
Rate for Payer: Cofinity Commercial	$144.48
Rate for Payer: Encore Health Key Benefits Commercial	$134.40
Rate for Payer: Healthscope Commercial	$151.20
Rate for Payer: MI Amish Medical Board Commercial	$134.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.00
Rate for Payer: PHP Commercial	$142.80
Rate for Payer: Priority Health SBD	$105.84
Rate for Payer: UHC All Payor (Choice/PPO)	$109.20
Rate for Payer: UHC Core	$87.53
Rate for Payer: UHC Exchange	$66.02

Know your out-of-pocket cost for care.

All Charges