Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

FLUTICASONE 110 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$794.31

Service Code	NDC 66993007996
Hospital Charge Code	300060
Hospital Revenue Code	637
Min. Negotiated Rate	$317.72
Max. Negotiated Rate	$714.88
Rate for Payer: Aetna Commercial	$675.16
Rate for Payer: Aetna Medicare	$397.15
Rate for Payer: Aetna New Business (MI Preferred)	$516.30
Rate for Payer: BCBS Complete	$317.72
Rate for Payer: Cash Price	$635.45
Rate for Payer: Cofinity Commercial	$556.02
Rate for Payer: Cofinity Commercial	$683.11
Rate for Payer: Cofinity Medicare Advantage	$556.02
Rate for Payer: Encore Health Key Benefits Commercial	$635.45
Rate for Payer: Healthscope Commercial	$714.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.16
Rate for Payer: PHP Commercial	$675.16
Rate for Payer: Priority Health Cigna Priority Health	$516.30
Rate for Payer: Priority Health SBD	$500.42

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$951.50

Service Code	NDC 66993008096
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$599.45
Max. Negotiated Rate	$856.35
Rate for Payer: Aetna Commercial	$808.77
Rate for Payer: Aetna New Business (MI Preferred)	$618.48
Rate for Payer: Cash Price	$761.20
Rate for Payer: Cofinity Commercial	$666.05
Rate for Payer: Cofinity Commercial	$818.29
Rate for Payer: Cofinity Medicare Advantage	$666.05
Rate for Payer: Encore Health Key Benefits Commercial	$761.20
Rate for Payer: Healthscope Commercial	$856.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$808.77
Rate for Payer: PHP Commercial	$808.77
Rate for Payer: Priority Health Cigna Priority Health	$618.48
Rate for Payer: Priority Health SBD	$599.45

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$951.50

Service Code	NDC 66993008096
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$380.60
Max. Negotiated Rate	$856.35
Rate for Payer: Aetna Commercial	$808.77
Rate for Payer: Aetna Medicare	$475.75
Rate for Payer: Aetna New Business (MI Preferred)	$618.48
Rate for Payer: BCBS Complete	$380.60
Rate for Payer: Cash Price	$761.20
Rate for Payer: Cofinity Commercial	$666.05
Rate for Payer: Cofinity Commercial	$818.29
Rate for Payer: Cofinity Medicare Advantage	$666.05
Rate for Payer: Encore Health Key Benefits Commercial	$761.20
Rate for Payer: Healthscope Commercial	$856.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$808.77
Rate for Payer: PHP Commercial	$808.77
Rate for Payer: Priority Health Cigna Priority Health	$618.48
Rate for Payer: Priority Health SBD	$599.45

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	300061
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 Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Cofinity Medicare Advantage	$870.24
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: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$808.08
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE 220 MCG/ACTUATION HFA AEROSOL COMMON CANISTER INHALER

Facility

$1,243.20

Service Code	NDC 00173072020
Hospital Charge Code	300061
Hospital Revenue Code	637
Min. Negotiated Rate	$497.28
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 Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Cofinity Medicare Advantage	$870.24
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: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$808.08
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$794.31

Service Code	NDC 66993007996
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$500.42
Max. Negotiated Rate	$714.88
Rate for Payer: Aetna Commercial	$675.16
Rate for Payer: Aetna New Business (MI Preferred)	$516.30
Rate for Payer: Cash Price	$635.45
Rate for Payer: Cofinity Commercial	$556.02
Rate for Payer: Cofinity Commercial	$683.11
Rate for Payer: Cofinity Medicare Advantage	$556.02
Rate for Payer: Encore Health Key Benefits Commercial	$635.45
Rate for Payer: Healthscope Commercial	$714.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.16
Rate for Payer: PHP Commercial	$675.16
Rate for Payer: Priority Health Cigna Priority Health	$516.30
Rate for Payer: Priority Health SBD	$500.42

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$658.63
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Commercial	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Cofinity Medicare Advantage	$731.81
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health Cigna Priority Health	$679.54
Rate for Payer: Priority Health SBD	$658.63

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$794.31

Service Code	NDC 66993007996
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$317.72
Max. Negotiated Rate	$714.88
Rate for Payer: Aetna Commercial	$675.16
Rate for Payer: Aetna Medicare	$397.15
Rate for Payer: Aetna New Business (MI Preferred)	$516.30
Rate for Payer: BCBS Complete	$317.72
Rate for Payer: Cash Price	$635.45
Rate for Payer: Cofinity Commercial	$556.02
Rate for Payer: Cofinity Commercial	$683.11
Rate for Payer: Cofinity Medicare Advantage	$556.02
Rate for Payer: Encore Health Key Benefits Commercial	$635.45
Rate for Payer: Healthscope Commercial	$714.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$675.16
Rate for Payer: PHP Commercial	$675.16
Rate for Payer: Priority Health Cigna Priority Health	$516.30
Rate for Payer: Priority Health SBD	$500.42

FLUTICASONE PROPIONATE 110 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$1,045.44

Service Code	NDC 00173071920
Hospital Charge Code	40698
Hospital Revenue Code	637
Min. Negotiated Rate	$418.18
Max. Negotiated Rate	$940.90
Rate for Payer: Aetna Commercial	$888.62
Rate for Payer: Aetna Medicare	$522.72
Rate for Payer: Aetna New Business (MI Preferred)	$679.54
Rate for Payer: BCBS Complete	$418.18
Rate for Payer: Cash Price	$836.35
Rate for Payer: Cofinity Commercial	$731.81
Rate for Payer: Cofinity Commercial	$899.08
Rate for Payer: Cofinity Medicare Advantage	$731.81
Rate for Payer: Encore Health Key Benefits Commercial	$836.35
Rate for Payer: Healthscope Commercial	$940.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$888.62
Rate for Payer: PHP Commercial	$888.62
Rate for Payer: Priority Health Cigna Priority Health	$679.54
Rate for Payer: Priority Health SBD	$658.63

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	$497.28
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 Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Cofinity Medicare Advantage	$870.24
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: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$808.08
Rate for Payer: Priority Health SBD	$783.22

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 Commercial	$1,069.15
Rate for Payer: Cofinity Commercial	$870.24
Rate for Payer: Cofinity Medicare Advantage	$870.24
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: PHP Commercial	$1,056.72
Rate for Payer: Priority Health Cigna Priority Health	$808.08
Rate for Payer: Priority Health SBD	$783.22

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$951.50

Service Code	NDC 66993008096
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$380.60
Max. Negotiated Rate	$856.35
Rate for Payer: Aetna Commercial	$808.77
Rate for Payer: Aetna Medicare	$475.75
Rate for Payer: Aetna New Business (MI Preferred)	$618.48
Rate for Payer: BCBS Complete	$380.60
Rate for Payer: Cash Price	$761.20
Rate for Payer: Cofinity Commercial	$666.05
Rate for Payer: Cofinity Commercial	$818.29
Rate for Payer: Cofinity Medicare Advantage	$666.05
Rate for Payer: Encore Health Key Benefits Commercial	$761.20
Rate for Payer: Healthscope Commercial	$856.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$808.77
Rate for Payer: PHP Commercial	$808.77
Rate for Payer: Priority Health Cigna Priority Health	$618.48
Rate for Payer: Priority Health SBD	$599.45

FLUTICASONE PROPIONATE 220 MCG/ACTUATION HFA AEROSOL INHALER

Facility

$951.50

Service Code	NDC 66993008096
Hospital Charge Code	40699
Hospital Revenue Code	637
Min. Negotiated Rate	$599.45
Max. Negotiated Rate	$856.35
Rate for Payer: Aetna Commercial	$808.77
Rate for Payer: Aetna New Business (MI Preferred)	$618.48
Rate for Payer: Cash Price	$761.20
Rate for Payer: Cofinity Commercial	$666.05
Rate for Payer: Cofinity Commercial	$818.29
Rate for Payer: Cofinity Medicare Advantage	$666.05
Rate for Payer: Encore Health Key Benefits Commercial	$761.20
Rate for Payer: Healthscope Commercial	$856.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$808.77
Rate for Payer: PHP Commercial	$808.77
Rate for Payer: Priority Health Cigna Priority Health	$618.48
Rate for Payer: Priority Health SBD	$599.45

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$26.14

Service Code	NDC 60505082901
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$10.46
Max. Negotiated Rate	$23.53
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna Medicare	$13.07
Rate for Payer: Aetna New Business (MI Preferred)	$16.99
Rate for Payer: BCBS Complete	$10.46
Rate for Payer: Cash Price	$20.91
Rate for Payer: Cofinity Commercial	$18.30
Rate for Payer: Cofinity Commercial	$22.48
Rate for Payer: Cofinity Medicare Advantage	$18.30
Rate for Payer: Encore Health Key Benefits Commercial	$20.91
Rate for Payer: Healthscope Commercial	$23.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.22
Rate for Payer: PHP Commercial	$22.22
Rate for Payer: Priority Health Cigna Priority Health	$16.99
Rate for Payer: Priority Health SBD	$16.47

FLUTICASONE PROPIONATE 50 MCG/ACTUATION NASAL SPRAY,SUSPENSION

Facility

$26.14

Service Code	NDC 60505082901
Hospital Charge Code	70536
Hospital Revenue Code	637
Min. Negotiated Rate	$16.47
Max. Negotiated Rate	$23.53
Rate for Payer: Aetna Commercial	$22.22
Rate for Payer: Aetna New Business (MI Preferred)	$16.99
Rate for Payer: Cash Price	$20.91
Rate for Payer: Cofinity Commercial	$18.30
Rate for Payer: Cofinity Commercial	$22.48
Rate for Payer: Cofinity Medicare Advantage	$18.30
Rate for Payer: Encore Health Key Benefits Commercial	$20.91
Rate for Payer: Healthscope Commercial	$23.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.22
Rate for Payer: PHP Commercial	$22.22
Rate for Payer: Priority Health Cigna Priority Health	$16.99
Rate for Payer: Priority Health SBD	$16.47

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 Commercial	$25.60
Rate for Payer: Cofinity Commercial	$31.45
Rate for Payer: Cofinity Medicare Advantage	$25.60
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: PHP Commercial	$31.08
Rate for Payer: Priority Health Cigna Priority Health	$23.77
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	$14.63
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 Commercial	$25.60
Rate for Payer: Cofinity Commercial	$31.45
Rate for Payer: Cofinity Medicare Advantage	$25.60
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: PHP Commercial	$31.08
Rate for Payer: Priority Health Cigna Priority Health	$23.77
Rate for Payer: Priority Health SBD	$23.04

FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$227.84

Service Code	HCPCS 90662
Hospital Charge Code	207828
Hospital Revenue Code	636
Min. Negotiated Rate	$143.54
Max. Negotiated Rate	$205.06
Rate for Payer: Aetna Commercial	$193.66
Rate for Payer: Aetna New Business (MI Preferred)	$148.10
Rate for Payer: Cash Price	$182.27
Rate for Payer: Cofinity Commercial	$159.49
Rate for Payer: Cofinity Commercial	$195.94
Rate for Payer: Cofinity Medicare Advantage	$159.49
Rate for Payer: Encore Health Key Benefits Commercial	$182.27
Rate for Payer: Healthscope Commercial	$205.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.66
Rate for Payer: PHP Commercial	$193.66
Rate for Payer: Priority Health Cigna Priority Health	$148.10
Rate for Payer: Priority Health SBD	$143.54

FLU VACCINE TS2024-25(65YR UP)(PF)180 MCG/0.5 ML INTRAMUSCULAR SYRINGE

Facility

$227.84

Service Code	HCPCS 90662
Hospital Charge Code	207828
Hospital Revenue Code	636
Min. Negotiated Rate	$91.14
Max. Negotiated Rate	$205.06
Rate for Payer: Aetna Commercial	$193.66
Rate for Payer: Aetna Medicare	$113.92
Rate for Payer: Aetna New Business (MI Preferred)	$148.10
Rate for Payer: BCBS Complete	$91.14
Rate for Payer: Cash Price	$182.27
Rate for Payer: Cofinity Commercial	$159.49
Rate for Payer: Cofinity Commercial	$195.94
Rate for Payer: Cofinity Medicare Advantage	$159.49
Rate for Payer: Encore Health Key Benefits Commercial	$182.27
Rate for Payer: Healthscope Commercial	$205.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.66
Rate for Payer: PHP Commercial	$193.66
Rate for Payer: Priority Health Cigna Priority Health	$148.10
Rate for Payer: Priority Health SBD	$143.54

FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE

Facility

$81.35

Service Code	HCPCS 90656
Hospital Charge Code	207827
Hospital Revenue Code	636
Min. Negotiated Rate	$51.25
Max. Negotiated Rate	$73.22
Rate for Payer: Aetna Commercial	$69.15
Rate for Payer: Aetna New Business (MI Preferred)	$52.88
Rate for Payer: Cash Price	$65.08
Rate for Payer: Cofinity Commercial	$56.95
Rate for Payer: Cofinity Commercial	$69.96
Rate for Payer: Cofinity Medicare Advantage	$56.95
Rate for Payer: Encore Health Key Benefits Commercial	$65.08
Rate for Payer: Healthscope Commercial	$73.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.15
Rate for Payer: PHP Commercial	$69.15
Rate for Payer: Priority Health Cigna Priority Health	$52.88
Rate for Payer: Priority Health SBD	$51.25

FLU VACCINE TS 2024-25(6MOS UP)(PF) 45 MCG(15MCG X3)/0.5 ML IM SYRINGE

Facility

$81.35

Service Code	HCPCS 90656
Hospital Charge Code	207827
Hospital Revenue Code	636
Min. Negotiated Rate	$32.54
Max. Negotiated Rate	$73.22
Rate for Payer: Aetna Commercial	$69.15
Rate for Payer: Aetna Medicare	$40.67
Rate for Payer: Aetna New Business (MI Preferred)	$52.88
Rate for Payer: BCBS Complete	$32.54
Rate for Payer: Cash Price	$65.08
Rate for Payer: Cofinity Commercial	$56.95
Rate for Payer: Cofinity Commercial	$69.96
Rate for Payer: Cofinity Medicare Advantage	$56.95
Rate for Payer: Encore Health Key Benefits Commercial	$65.08
Rate for Payer: Healthscope Commercial	$73.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.15
Rate for Payer: PHP Commercial	$69.15
Rate for Payer: Priority Health Cigna Priority Health	$52.88
Rate for Payer: Priority Health SBD	$51.25

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 Commercial	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Cofinity Medicare Advantage	$2.90
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: PHP Commercial	$3.53
Rate for Payer: Priority Health Cigna Priority Health	$2.70
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 Commercial	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Cofinity Medicare Advantage	$289.94
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: PHP Commercial	$352.07
Rate for Payer: Priority Health Cigna Priority Health	$269.23
Rate for Payer: Priority Health SBD	$260.95

FLUVOXAMINE 100 MG TABLET

Facility

$215.65

Service Code	NDC 62559016001
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$86.26
Max. Negotiated Rate	$194.09
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna Medicare	$107.83
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: BCBS Complete	$86.26
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Cofinity Medicare Advantage	$150.96
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$140.17
Rate for Payer: Priority Health SBD	$135.86

FLUVOXAMINE 100 MG TABLET

Facility

$414.20

Service Code	NDC 51079099320
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$165.68
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 Commercial	$289.94
Rate for Payer: Cofinity Commercial	$356.21
Rate for Payer: Cofinity Medicare Advantage	$289.94
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: PHP Commercial	$352.07
Rate for Payer: Priority Health Cigna Priority Health	$269.23
Rate for Payer: Priority Health SBD	$260.95

Know your out-of-pocket cost for care.

All Charges