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	$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

$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	$808.78
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	$808.78
Rate for Payer: PHP Commercial	$808.78
Rate for Payer: Priority Health Cigna Priority Health	$618.48
Rate for Payer: Priority Health SBD	$599.44

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 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	$18.28
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

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

$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

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	$66.79
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: BCBS Trust/PPO	$199.79
Rate for Payer: BCN Commercial	$199.79
Rate for Payer: Cash Price	$182.27
Rate for Payer: Cash Price	$182.27
Rate for Payer: Cofinity Commercial	$195.94
Rate for Payer: Cofinity Commercial	$159.49
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 HMO/PPO/Tiered Network	$83.49
Rate for Payer: Priority Health Narrow Network	$66.79
Rate for Payer: Priority Health SBD	$143.54
Rate for Payer: UHC All Payor (Choice/PPO)	$71.18

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 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	$56.94
Rate for Payer: Cofinity Commercial	$69.96
Rate for Payer: Cofinity Medicare Advantage	$56.94
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	$17.88
Max. Negotiated Rate	$73.22
Rate for Payer: Aetna Commercial	$69.15
Rate for Payer: Aetna Medicare	$40.68
Rate for Payer: Aetna New Business (MI Preferred)	$52.88
Rate for Payer: BCBS Complete	$32.54
Rate for Payer: BCBS Trust/PPO	$58.56
Rate for Payer: BCN Commercial	$58.56
Rate for Payer: Cash Price	$65.08
Rate for Payer: Cash Price	$65.08
Rate for Payer: Cofinity Commercial	$69.96
Rate for Payer: Cofinity Commercial	$56.94
Rate for Payer: Cofinity Medicare Advantage	$56.94
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 HMO/PPO/Tiered Network	$22.35
Rate for Payer: Priority Health Narrow Network	$17.88
Rate for Payer: Priority Health SBD	$51.25
Rate for Payer: UHC All Payor (Choice/PPO)	$19.79

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	$135.86
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
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	$194.08
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

$4.15

Service Code	NDC 51079099301
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.74
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 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	$3.74
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

$4.15

Service Code	NDC 51079099301
Hospital Charge Code	10084
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.74
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	$3.74
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	$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

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	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna Medicare	$107.82
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	$194.08
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 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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

FLUVOXAMINE 50 MG TABLET

Facility

$378.35

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$238.36
Max. Negotiated Rate	$340.52
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Commercial	$264.84
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Cofinity Medicare Advantage	$264.84
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health Cigna Priority Health	$245.93
Rate for Payer: Priority Health SBD	$238.36

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	$318.16
Rate for Payer: Aetna New Business (MI Preferred)	$243.30
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Cofinity Medicare Advantage	$262.01
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	$318.16
Rate for Payer: PHP Commercial	$318.16
Rate for Payer: Priority Health Cigna Priority Health	$243.30
Rate for Payer: Priority Health SBD	$235.81

FLUVOXAMINE 50 MG TABLET

Facility

$3.75

Service Code	NDC 51079099201
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
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 Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Medicare Advantage	$2.62
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: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

FLUVOXAMINE 50 MG TABLET

Facility

$378.35

Service Code	NDC 62559015901
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$151.34
Max. Negotiated Rate	$340.52
Rate for Payer: Aetna Commercial	$321.60
Rate for Payer: Aetna Medicare	$189.18
Rate for Payer: Aetna New Business (MI Preferred)	$245.93
Rate for Payer: BCBS Complete	$151.34
Rate for Payer: Cash Price	$302.68
Rate for Payer: Cofinity Commercial	$264.84
Rate for Payer: Cofinity Commercial	$325.38
Rate for Payer: Cofinity Medicare Advantage	$264.84
Rate for Payer: Encore Health Key Benefits Commercial	$302.68
Rate for Payer: Healthscope Commercial	$340.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.60
Rate for Payer: PHP Commercial	$321.60
Rate for Payer: Priority Health Cigna Priority Health	$245.93
Rate for Payer: Priority Health SBD	$238.36

FLUVOXAMINE 50 MG TABLET

Facility

$374.30

Service Code	NDC 51079099220
Hospital Charge Code	10085
Hospital Revenue Code	637
Min. Negotiated Rate	$149.72
Max. Negotiated Rate	$336.87
Rate for Payer: Aetna Commercial	$318.16
Rate for Payer: Aetna Medicare	$187.15
Rate for Payer: Aetna New Business (MI Preferred)	$243.30
Rate for Payer: BCBS Complete	$149.72
Rate for Payer: Cash Price	$299.44
Rate for Payer: Cofinity Commercial	$262.01
Rate for Payer: Cofinity Commercial	$321.90
Rate for Payer: Cofinity Medicare Advantage	$262.01
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	$318.16
Rate for Payer: PHP Commercial	$318.16
Rate for Payer: Priority Health Cigna Priority Health	$243.30
Rate for Payer: Priority Health SBD	$235.81

FOLIC ACID 1 MG TABLET

Facility

$164.00

Service Code	NDC 69315012701
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$147.60
Rate for Payer: Aetna Commercial	$139.40
Rate for Payer: Aetna Medicare	$82.00
Rate for Payer: Aetna New Business (MI Preferred)	$106.60
Rate for Payer: BCBS Complete	$65.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cofinity Commercial	$114.80
Rate for Payer: Cofinity Commercial	$141.04
Rate for Payer: Cofinity Medicare Advantage	$114.80
Rate for Payer: Encore Health Key Benefits Commercial	$131.20
Rate for Payer: Healthscope Commercial	$147.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.40
Rate for Payer: PHP Commercial	$139.40
Rate for Payer: Priority Health Cigna Priority Health	$106.60
Rate for Payer: Priority Health SBD	$103.32

FOLIC ACID 1 MG TABLET

Facility

$1.50

Service Code	NDC 62584089711
Hospital Charge Code	3233
Hospital Revenue Code	637
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.35
Rate for Payer: Aetna Commercial	$1.28
Rate for Payer: Aetna Medicare	$0.75
Rate for Payer: Aetna New Business (MI Preferred)	$0.98
Rate for Payer: BCBS Complete	$0.60
Rate for Payer: Cash Price	$1.20
Rate for Payer: Cofinity Commercial	$1.05
Rate for Payer: Cofinity Commercial	$1.29
Rate for Payer: Cofinity Medicare Advantage	$1.05
Rate for Payer: Encore Health Key Benefits Commercial	$1.20
Rate for Payer: Healthscope Commercial	$1.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.28
Rate for Payer: PHP Commercial	$1.28
Rate for Payer: Priority Health Cigna Priority Health	$0.98
Rate for Payer: Priority Health SBD	$0.95

Know your out-of-pocket cost for care.

All Charges