Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$42.09

Service Code	NDC 69339016001
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$16.84
Max. Negotiated Rate	$37.88
Rate for Payer: Aetna Commercial	$35.78
Rate for Payer: Aetna Medicare	$21.05
Rate for Payer: Aetna New Business (MI Preferred)	$27.36
Rate for Payer: BCBS Complete	$16.84
Rate for Payer: Cash Price	$33.67
Rate for Payer: Cofinity Commercial	$29.46
Rate for Payer: Cofinity Commercial	$36.20
Rate for Payer: Cofinity Medicare Advantage	$29.46
Rate for Payer: Encore Health Key Benefits Commercial	$33.67
Rate for Payer: Healthscope Commercial	$37.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.78
Rate for Payer: PHP Commercial	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$27.36
Rate for Payer: Priority Health SBD	$26.52

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$35.72

Service Code	NDC 69339016017
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$32.15
Rate for Payer: Aetna Commercial	$30.36
Rate for Payer: Aetna New Business (MI Preferred)	$23.22
Rate for Payer: Cash Price	$28.58
Rate for Payer: Cofinity Commercial	$25.00
Rate for Payer: Cofinity Commercial	$30.72
Rate for Payer: Cofinity Medicare Advantage	$25.00
Rate for Payer: Encore Health Key Benefits Commercial	$28.58
Rate for Payer: Healthscope Commercial	$32.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.36
Rate for Payer: PHP Commercial	$30.36
Rate for Payer: Priority Health Cigna Priority Health	$23.22
Rate for Payer: Priority Health SBD	$22.50

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$35.72

Service Code	NDC 69339016017
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$14.29
Max. Negotiated Rate	$32.15
Rate for Payer: Aetna Commercial	$30.36
Rate for Payer: Aetna Medicare	$17.86
Rate for Payer: Aetna New Business (MI Preferred)	$23.22
Rate for Payer: BCBS Complete	$14.29
Rate for Payer: Cash Price	$28.58
Rate for Payer: Cofinity Commercial	$25.00
Rate for Payer: Cofinity Commercial	$30.72
Rate for Payer: Cofinity Medicare Advantage	$25.00
Rate for Payer: Encore Health Key Benefits Commercial	$28.58
Rate for Payer: Healthscope Commercial	$32.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.36
Rate for Payer: PHP Commercial	$30.36
Rate for Payer: Priority Health Cigna Priority Health	$23.22
Rate for Payer: Priority Health SBD	$22.50

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$44.65

Service Code	NDC 00121477640
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$42.09

Service Code	NDC 69339016001
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$37.88
Rate for Payer: Aetna Commercial	$35.78
Rate for Payer: Aetna New Business (MI Preferred)	$27.36
Rate for Payer: Cash Price	$33.67
Rate for Payer: Cofinity Commercial	$29.46
Rate for Payer: Cofinity Commercial	$36.20
Rate for Payer: Cofinity Medicare Advantage	$29.46
Rate for Payer: Encore Health Key Benefits Commercial	$33.67
Rate for Payer: Healthscope Commercial	$37.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$35.78
Rate for Payer: PHP Commercial	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$27.36
Rate for Payer: Priority Health SBD	$26.52

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$44.65

Service Code	NDC 00121477640
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna Medicare	$22.32
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: BCBS Complete	$17.86
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSPENSION

Facility

$31.73

Service Code	NDC 00121477610
Hospital Charge Code	162543
Hospital Revenue Code	637
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Commercial	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Cofinity Medicare Advantage	$22.21
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.97
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health Cigna Priority Health	$20.62
Rate for Payer: Priority Health SBD	$19.99

MEGESTROL 40 MG TABLET

Facility

$427.70

Service Code	NDC 00904357161
Hospital Charge Code	4871
Hospital Revenue Code	637
Min. Negotiated Rate	$269.45
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

MEGESTROL 40 MG TABLET

Facility

$427.70

Service Code	NDC 00904357161
Hospital Charge Code	4871
Hospital Revenue Code	637
Min. Negotiated Rate	$171.08
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna Medicare	$213.85
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: BCBS Complete	$171.08
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

MELATONIN 3 MG TABLET

Facility

$2.43

Service Code	NDC 50268052411
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna Medicare	$1.22
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: BCBS Complete	$0.97
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Medicare Advantage	$1.70
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.58
Rate for Payer: Priority Health SBD	$1.53

MELATONIN 3 MG TABLET

Facility

$28.20

Service Code	NDC 80681008600
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$17.77
Max. Negotiated Rate	$25.38
Rate for Payer: Aetna Commercial	$23.97
Rate for Payer: Aetna New Business (MI Preferred)	$18.33
Rate for Payer: Cash Price	$22.56
Rate for Payer: Cofinity Commercial	$19.74
Rate for Payer: Cofinity Commercial	$24.25
Rate for Payer: Cofinity Medicare Advantage	$19.74
Rate for Payer: Encore Health Key Benefits Commercial	$22.56
Rate for Payer: Healthscope Commercial	$25.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.97
Rate for Payer: PHP Commercial	$23.97
Rate for Payer: Priority Health Cigna Priority Health	$18.33
Rate for Payer: Priority Health SBD	$17.77

MELATONIN 3 MG TABLET

Facility

$28.20

Service Code	NDC 80681008600
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$11.28
Max. Negotiated Rate	$25.38
Rate for Payer: Aetna Commercial	$23.97
Rate for Payer: Aetna Medicare	$14.10
Rate for Payer: Aetna New Business (MI Preferred)	$18.33
Rate for Payer: BCBS Complete	$11.28
Rate for Payer: Cash Price	$22.56
Rate for Payer: Cofinity Commercial	$19.74
Rate for Payer: Cofinity Commercial	$24.25
Rate for Payer: Cofinity Medicare Advantage	$19.74
Rate for Payer: Encore Health Key Benefits Commercial	$22.56
Rate for Payer: Healthscope Commercial	$25.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.97
Rate for Payer: PHP Commercial	$23.97
Rate for Payer: Priority Health Cigna Priority Health	$18.33
Rate for Payer: Priority Health SBD	$17.77

MELATONIN 3 MG TABLET

Facility

$4.00

Service Code	NDC 77333051625
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: Aetna New Business (MI Preferred)	$2.60
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Cofinity Commercial	$3.44
Rate for Payer: Cofinity Medicare Advantage	$2.80
Rate for Payer: Encore Health Key Benefits Commercial	$3.20
Rate for Payer: Healthscope Commercial	$3.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.40
Rate for Payer: PHP Commercial	$3.40
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: Priority Health SBD	$2.52

MELATONIN 3 MG TABLET

Facility

$658.00

Service Code	NDC 80681014800
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$263.20
Max. Negotiated Rate	$592.20
Rate for Payer: Aetna Commercial	$559.30
Rate for Payer: Aetna Medicare	$329.00
Rate for Payer: Aetna New Business (MI Preferred)	$427.70
Rate for Payer: BCBS Complete	$263.20
Rate for Payer: Cash Price	$526.40
Rate for Payer: Cofinity Commercial	$460.60
Rate for Payer: Cofinity Commercial	$565.88
Rate for Payer: Cofinity Medicare Advantage	$460.60
Rate for Payer: Encore Health Key Benefits Commercial	$526.40
Rate for Payer: Healthscope Commercial	$592.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$559.30
Rate for Payer: PHP Commercial	$559.30
Rate for Payer: Priority Health Cigna Priority Health	$427.70
Rate for Payer: Priority Health SBD	$414.54

MELATONIN 3 MG TABLET

Facility

$109.28

Service Code	NDC 20555003600
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$68.85
Max. Negotiated Rate	$98.35
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna New Business (MI Preferred)	$71.03
Rate for Payer: Cash Price	$87.42
Rate for Payer: Cofinity Commercial	$76.50
Rate for Payer: Cofinity Commercial	$93.98
Rate for Payer: Cofinity Medicare Advantage	$76.50
Rate for Payer: Encore Health Key Benefits Commercial	$87.42
Rate for Payer: Healthscope Commercial	$98.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.89
Rate for Payer: PHP Commercial	$92.89
Rate for Payer: Priority Health Cigna Priority Health	$71.03
Rate for Payer: Priority Health SBD	$68.85

MELATONIN 3 MG TABLET

Facility

$109.28

Service Code	NDC 20555003600
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$43.71
Max. Negotiated Rate	$98.35
Rate for Payer: Aetna Commercial	$92.89
Rate for Payer: Aetna Medicare	$54.64
Rate for Payer: Aetna New Business (MI Preferred)	$71.03
Rate for Payer: BCBS Complete	$43.71
Rate for Payer: Cash Price	$87.42
Rate for Payer: Cofinity Commercial	$76.50
Rate for Payer: Cofinity Commercial	$93.98
Rate for Payer: Cofinity Medicare Advantage	$76.50
Rate for Payer: Encore Health Key Benefits Commercial	$87.42
Rate for Payer: Healthscope Commercial	$98.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$92.89
Rate for Payer: PHP Commercial	$92.89
Rate for Payer: Priority Health Cigna Priority Health	$71.03
Rate for Payer: Priority Health SBD	$68.85

MELATONIN 3 MG TABLET

Facility

$2.43

Service Code	NDC 50268052411
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Medicare Advantage	$1.70
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.58
Rate for Payer: Priority Health SBD	$1.53

MELATONIN 3 MG TABLET

Facility

$4.00

Service Code	NDC 77333051625
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$3.60
Rate for Payer: Aetna Commercial	$3.40
Rate for Payer: Aetna New Business (MI Preferred)	$2.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cofinity Commercial	$2.80
Rate for Payer: Cofinity Commercial	$3.44
Rate for Payer: Cofinity Medicare Advantage	$2.80
Rate for Payer: Encore Health Key Benefits Commercial	$3.20
Rate for Payer: Healthscope Commercial	$3.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.40
Rate for Payer: PHP Commercial	$3.40
Rate for Payer: Priority Health Cigna Priority Health	$2.60
Rate for Payer: Priority Health SBD	$2.52

MELATONIN 3 MG TABLET

Facility

$121.03

Service Code	NDC 50268052415
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$108.93
Rate for Payer: Aetna Commercial	$102.88
Rate for Payer: Aetna New Business (MI Preferred)	$78.67
Rate for Payer: Cash Price	$96.82
Rate for Payer: Cofinity Commercial	$104.09
Rate for Payer: Cofinity Commercial	$84.72
Rate for Payer: Cofinity Medicare Advantage	$84.72
Rate for Payer: Encore Health Key Benefits Commercial	$96.82
Rate for Payer: Healthscope Commercial	$108.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.88
Rate for Payer: PHP Commercial	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$78.67
Rate for Payer: Priority Health SBD	$76.25

MELATONIN 3 MG TABLET

Facility

$121.03

Service Code	NDC 50268052415
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$48.41
Max. Negotiated Rate	$108.93
Rate for Payer: Aetna Commercial	$102.88
Rate for Payer: Aetna Medicare	$60.52
Rate for Payer: Aetna New Business (MI Preferred)	$78.67
Rate for Payer: BCBS Complete	$48.41
Rate for Payer: Cash Price	$96.82
Rate for Payer: Cofinity Commercial	$104.09
Rate for Payer: Cofinity Commercial	$84.72
Rate for Payer: Cofinity Medicare Advantage	$84.72
Rate for Payer: Encore Health Key Benefits Commercial	$96.82
Rate for Payer: Healthscope Commercial	$108.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$102.88
Rate for Payer: PHP Commercial	$102.88
Rate for Payer: Priority Health Cigna Priority Health	$78.67
Rate for Payer: Priority Health SBD	$76.25

MELATONIN 3 MG TABLET

Facility

$399.50

Service Code	NDC 77333051610
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$251.69
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.57
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.57
Rate for Payer: PHP Commercial	$339.57
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.69

MELATONIN 3 MG TABLET

Facility

$399.50

Service Code	NDC 77333051610
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$159.80
Max. Negotiated Rate	$359.55
Rate for Payer: Aetna Commercial	$339.57
Rate for Payer: Aetna Medicare	$199.75
Rate for Payer: Aetna New Business (MI Preferred)	$259.68
Rate for Payer: BCBS Complete	$159.80
Rate for Payer: Cash Price	$319.60
Rate for Payer: Cofinity Commercial	$279.65
Rate for Payer: Cofinity Commercial	$343.57
Rate for Payer: Cofinity Medicare Advantage	$279.65
Rate for Payer: Encore Health Key Benefits Commercial	$319.60
Rate for Payer: Healthscope Commercial	$359.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$339.57
Rate for Payer: PHP Commercial	$339.57
Rate for Payer: Priority Health Cigna Priority Health	$259.68
Rate for Payer: Priority Health SBD	$251.69

MELATONIN 3 MG TABLET

Facility

$658.00

Service Code	NDC 80681014800
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$414.54
Max. Negotiated Rate	$592.20
Rate for Payer: Aetna Commercial	$559.30
Rate for Payer: Aetna New Business (MI Preferred)	$427.70
Rate for Payer: Cash Price	$526.40
Rate for Payer: Cofinity Commercial	$460.60
Rate for Payer: Cofinity Commercial	$565.88
Rate for Payer: Cofinity Medicare Advantage	$460.60
Rate for Payer: Encore Health Key Benefits Commercial	$526.40
Rate for Payer: Healthscope Commercial	$592.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$559.30
Rate for Payer: PHP Commercial	$559.30
Rate for Payer: Priority Health Cigna Priority Health	$427.70
Rate for Payer: Priority Health SBD	$414.54

MELATONIN 3 MG TABLET

Facility

$118.44

Service Code	NDC 96295013723
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$47.38
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$100.67
Rate for Payer: Aetna Medicare	$59.22
Rate for Payer: Aetna New Business (MI Preferred)	$76.99
Rate for Payer: BCBS Complete	$47.38
Rate for Payer: Cash Price	$94.75
Rate for Payer: Cofinity Commercial	$101.86
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Cofinity Medicare Advantage	$82.91
Rate for Payer: Encore Health Key Benefits Commercial	$94.75
Rate for Payer: Healthscope Commercial	$106.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.67
Rate for Payer: PHP Commercial	$100.67
Rate for Payer: Priority Health Cigna Priority Health	$76.99
Rate for Payer: Priority Health SBD	$74.62

MELATONIN 3 MG TABLET

Facility

$118.44

Service Code	NDC 96295013723
Hospital Charge Code	16830
Hospital Revenue Code	637
Min. Negotiated Rate	$74.62
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Commercial	$100.67
Rate for Payer: Aetna New Business (MI Preferred)	$76.99
Rate for Payer: Cash Price	$94.75
Rate for Payer: Cofinity Commercial	$101.86
Rate for Payer: Cofinity Commercial	$82.91
Rate for Payer: Cofinity Medicare Advantage	$82.91
Rate for Payer: Encore Health Key Benefits Commercial	$94.75
Rate for Payer: Healthscope Commercial	$106.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$100.67
Rate for Payer: PHP Commercial	$100.67
Rate for Payer: Priority Health Cigna Priority Health	$76.99
Rate for Payer: Priority Health SBD	$74.62

Know your out-of-pocket cost for care.

All Charges