Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

ROSUVASTATIN 10 MG TABLET

Facility

$232.65

Service Code	NDC 68462026290
Hospital Charge Code	35134
Hospital Revenue Code	637
Min. Negotiated Rate	$151.22
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: ASR ASR	$225.67
Rate for Payer: ASR Commercial	$225.67
Rate for Payer: BCBS Trust/PPO	$189.59
Rate for Payer: BCN Commercial	$180.37
Rate for Payer: Cash Price	$186.12
Rate for Payer: Cofinity Commercial	$218.69
Rate for Payer: Encore Health Key Benefits Commercial	$186.12
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Healthscope Whirlpool	$225.67
Rate for Payer: Mclaren Commercial	$209.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.75
Rate for Payer: Nomi Health Commercial	$190.77
Rate for Payer: Priority Health Cigna Priority Health	$151.22
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$204.73

ROSUVASTATIN 10 MG TABLET

Facility

$232.65

Service Code	NDC 68462026290
Hospital Charge Code	35134
Hospital Revenue Code	637
Min. Negotiated Rate	$93.06
Max. Negotiated Rate	$232.65
Rate for Payer: Aetna Commercial	$209.38
Rate for Payer: Aetna Medicare	$116.32
Rate for Payer: ASR ASR	$225.67
Rate for Payer: ASR Commercial	$225.67
Rate for Payer: BCBS Complete	$93.06
Rate for Payer: BCBS Trust/PPO	$190.52
Rate for Payer: BCN Commercial	$180.37
Rate for Payer: Cash Price	$186.12
Rate for Payer: Cofinity Commercial	$218.69
Rate for Payer: Encore Health Key Benefits Commercial	$186.12
Rate for Payer: Healthscope Commercial	$232.65
Rate for Payer: Healthscope Whirlpool	$225.67
Rate for Payer: Mclaren Commercial	$209.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$197.75
Rate for Payer: Nomi Health Commercial	$190.77
Rate for Payer: Priority Health Cigna Priority Health	$151.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$203.85
Rate for Payer: Priority Health Narrow Network	$163.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$204.73

SACCHAROMYCES BOULARDII 250 MG CAPSULE

Facility

$125.76

Service Code	NDC 00904723006
Hospital Charge Code	37343
Hospital Revenue Code	637
Min. Negotiated Rate	$81.74
Max. Negotiated Rate	$125.76
Rate for Payer: Aetna Commercial	$113.18
Rate for Payer: ASR ASR	$121.99
Rate for Payer: ASR Commercial	$121.99
Rate for Payer: BCBS Trust/PPO	$102.48
Rate for Payer: BCN Commercial	$97.50
Rate for Payer: Cash Price	$100.61
Rate for Payer: Cofinity Commercial	$118.21
Rate for Payer: Encore Health Key Benefits Commercial	$100.61
Rate for Payer: Healthscope Commercial	$125.76
Rate for Payer: Healthscope Whirlpool	$121.99
Rate for Payer: Mclaren Commercial	$113.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.90
Rate for Payer: Nomi Health Commercial	$103.12
Rate for Payer: Priority Health Cigna Priority Health	$81.74
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.67

SACCHAROMYCES BOULARDII 250 MG CAPSULE

Facility

$125.76

Service Code	NDC 00904723006
Hospital Charge Code	37343
Hospital Revenue Code	637
Min. Negotiated Rate	$50.30
Max. Negotiated Rate	$125.76
Rate for Payer: Aetna Commercial	$113.18
Rate for Payer: Aetna Medicare	$62.88
Rate for Payer: ASR ASR	$121.99
Rate for Payer: ASR Commercial	$121.99
Rate for Payer: BCBS Complete	$50.30
Rate for Payer: BCBS Trust/PPO	$102.98
Rate for Payer: BCN Commercial	$97.50
Rate for Payer: Cash Price	$100.61
Rate for Payer: Cofinity Commercial	$118.21
Rate for Payer: Encore Health Key Benefits Commercial	$100.61
Rate for Payer: Healthscope Commercial	$125.76
Rate for Payer: Healthscope Whirlpool	$121.99
Rate for Payer: Mclaren Commercial	$113.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$106.90
Rate for Payer: Nomi Health Commercial	$103.12
Rate for Payer: Priority Health Cigna Priority Health	$81.74
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$110.19
Rate for Payer: Priority Health Narrow Network	$88.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$110.67

SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET

Facility

$2,367.41

Service Code	NDC 00078065920
Hospital Charge Code	174639
Hospital Revenue Code	637
Min. Negotiated Rate	$1,538.82
Max. Negotiated Rate	$2,367.41
Rate for Payer: Aetna Commercial	$2,130.67
Rate for Payer: ASR ASR	$2,296.39
Rate for Payer: ASR Commercial	$2,296.39
Rate for Payer: BCBS Trust/PPO	$1,929.20
Rate for Payer: BCN Commercial	$1,835.45
Rate for Payer: Cash Price	$1,893.93
Rate for Payer: Cofinity Commercial	$2,225.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,893.93
Rate for Payer: Healthscope Commercial	$2,367.41
Rate for Payer: Healthscope Whirlpool	$2,296.39
Rate for Payer: Mclaren Commercial	$2,130.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,012.30
Rate for Payer: Nomi Health Commercial	$1,941.28
Rate for Payer: Priority Health Cigna Priority Health	$1,538.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,083.32

SACUBITRIL 24 MG-VALSARTAN 26 MG TABLET

Facility

$2,367.41

Service Code	NDC 00078065920
Hospital Charge Code	174639
Hospital Revenue Code	637
Min. Negotiated Rate	$946.96
Max. Negotiated Rate	$2,367.41
Rate for Payer: Aetna Commercial	$2,130.67
Rate for Payer: Aetna Medicare	$1,183.70
Rate for Payer: ASR ASR	$2,296.39
Rate for Payer: ASR Commercial	$2,296.39
Rate for Payer: BCBS Complete	$946.96
Rate for Payer: BCBS Trust/PPO	$1,938.67
Rate for Payer: BCN Commercial	$1,835.45
Rate for Payer: Cash Price	$1,893.93
Rate for Payer: Cofinity Commercial	$2,225.37
Rate for Payer: Encore Health Key Benefits Commercial	$1,893.93
Rate for Payer: Healthscope Commercial	$2,367.41
Rate for Payer: Healthscope Whirlpool	$2,296.39
Rate for Payer: Mclaren Commercial	$2,130.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,012.30
Rate for Payer: Nomi Health Commercial	$1,941.28
Rate for Payer: Priority Health Cigna Priority Health	$1,538.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,074.32
Rate for Payer: Priority Health Narrow Network	$1,659.55
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,083.32

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$732.78

Service Code	NDC 10019055303
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$293.11
Max. Negotiated Rate	$732.78
Rate for Payer: Aetna Commercial	$659.50
Rate for Payer: Aetna Medicare	$366.39
Rate for Payer: ASR ASR	$710.80
Rate for Payer: ASR Commercial	$710.80
Rate for Payer: BCBS Complete	$293.11
Rate for Payer: BCBS Trust/PPO	$600.07
Rate for Payer: BCN Commercial	$568.12
Rate for Payer: Cash Price	$586.23
Rate for Payer: Cofinity Commercial	$688.81
Rate for Payer: Encore Health Key Benefits Commercial	$586.22
Rate for Payer: Healthscope Commercial	$732.78
Rate for Payer: Healthscope Whirlpool	$710.80
Rate for Payer: Mclaren Commercial	$659.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$622.86
Rate for Payer: Nomi Health Commercial	$600.88
Rate for Payer: Priority Health Cigna Priority Health	$476.31
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$642.06
Rate for Payer: Priority Health Narrow Network	$513.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$644.85

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$73.28

Service Code	NDC 10019055390
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$47.63
Max. Negotiated Rate	$73.28
Rate for Payer: Aetna Commercial	$65.95
Rate for Payer: ASR ASR	$71.08
Rate for Payer: ASR Commercial	$71.08
Rate for Payer: BCBS Trust/PPO	$59.72
Rate for Payer: BCN Commercial	$56.81
Rate for Payer: Cash Price	$58.62
Rate for Payer: Cofinity Commercial	$68.88
Rate for Payer: Encore Health Key Benefits Commercial	$58.62
Rate for Payer: Healthscope Commercial	$73.28
Rate for Payer: Healthscope Whirlpool	$71.08
Rate for Payer: Mclaren Commercial	$65.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.29
Rate for Payer: Nomi Health Commercial	$60.09
Rate for Payer: Priority Health Cigna Priority Health	$47.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.49

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$96.91

Service Code	NDC 50742050504
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$38.76
Max. Negotiated Rate	$96.91
Rate for Payer: Aetna Commercial	$87.22
Rate for Payer: Aetna Medicare	$48.46
Rate for Payer: ASR ASR	$94.00
Rate for Payer: ASR Commercial	$94.00
Rate for Payer: BCBS Complete	$38.76
Rate for Payer: BCBS Trust/PPO	$79.36
Rate for Payer: BCN Commercial	$75.13
Rate for Payer: Cash Price	$77.53
Rate for Payer: Cofinity Commercial	$91.10
Rate for Payer: Encore Health Key Benefits Commercial	$77.53
Rate for Payer: Healthscope Commercial	$96.91
Rate for Payer: Healthscope Whirlpool	$94.00
Rate for Payer: Mclaren Commercial	$87.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.37
Rate for Payer: Nomi Health Commercial	$79.47
Rate for Payer: Priority Health Cigna Priority Health	$62.99
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.91
Rate for Payer: Priority Health Narrow Network	$67.93
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$85.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$96.91

Service Code	NDC 50742050504
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$62.99
Max. Negotiated Rate	$96.91
Rate for Payer: Aetna Commercial	$87.22
Rate for Payer: ASR ASR	$94.00
Rate for Payer: ASR Commercial	$94.00
Rate for Payer: BCBS Trust/PPO	$78.97
Rate for Payer: BCN Commercial	$75.13
Rate for Payer: Cash Price	$77.53
Rate for Payer: Cofinity Commercial	$91.10
Rate for Payer: Encore Health Key Benefits Commercial	$77.53
Rate for Payer: Healthscope Commercial	$96.91
Rate for Payer: Healthscope Whirlpool	$94.00
Rate for Payer: Mclaren Commercial	$87.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.37
Rate for Payer: Nomi Health Commercial	$79.47
Rate for Payer: Priority Health Cigna Priority Health	$62.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$85.28

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$73.28

Service Code	NDC 10019055390
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$73.28
Rate for Payer: Aetna Commercial	$65.95
Rate for Payer: Aetna Medicare	$36.64
Rate for Payer: ASR ASR	$71.08
Rate for Payer: ASR Commercial	$71.08
Rate for Payer: BCBS Complete	$29.31
Rate for Payer: BCBS Trust/PPO	$60.01
Rate for Payer: BCN Commercial	$56.81
Rate for Payer: Cash Price	$58.62
Rate for Payer: Cofinity Commercial	$68.88
Rate for Payer: Encore Health Key Benefits Commercial	$58.62
Rate for Payer: Healthscope Commercial	$73.28
Rate for Payer: Healthscope Whirlpool	$71.08
Rate for Payer: Mclaren Commercial	$65.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$62.29
Rate for Payer: Nomi Health Commercial	$60.09
Rate for Payer: Priority Health Cigna Priority Health	$47.63
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$64.21
Rate for Payer: Priority Health Narrow Network	$51.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$64.49

SCOPOLAMINE 1 MG OVER 3 DAYS TRANSDERMAL PATCH

Facility

$732.78

Service Code	NDC 10019055303
Hospital Charge Code	27696
Hospital Revenue Code	637
Min. Negotiated Rate	$476.31
Max. Negotiated Rate	$732.78
Rate for Payer: Aetna Commercial	$659.50
Rate for Payer: ASR ASR	$710.80
Rate for Payer: ASR Commercial	$710.80
Rate for Payer: BCBS Trust/PPO	$597.14
Rate for Payer: BCN Commercial	$568.12
Rate for Payer: Cash Price	$586.23
Rate for Payer: Cofinity Commercial	$688.81
Rate for Payer: Encore Health Key Benefits Commercial	$586.22
Rate for Payer: Healthscope Commercial	$732.78
Rate for Payer: Healthscope Whirlpool	$710.80
Rate for Payer: Mclaren Commercial	$659.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$622.86
Rate for Payer: Nomi Health Commercial	$600.88
Rate for Payer: Priority Health Cigna Priority Health	$476.31
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$644.85

SCREENING OF A PATIENT

Professional

Both

$15.00

Service Code	HCPCS D0190
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$20.16
Rate for Payer: Aetna Commercial	$13.35
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$20.16
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Meridian Medicaid	$20.16
Rate for Payer: Priority Health Choice Medicaid	$19.20
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.97
Rate for Payer: UHC Exchange	$14.97
Rate for Payer: UHCCP Medicaid	$19.20

SENNOSIDES 8.6 MG TABLET

Facility

$132.00

Service Code	NDC 00904652261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: ASR ASR	$128.04
Rate for Payer: ASR Commercial	$128.04
Rate for Payer: BCBS Trust/PPO	$107.57
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: Nomi Health Commercial	$108.24
Rate for Payer: Priority Health Cigna Priority Health	$85.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna Commercial	$147.42
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: ASR ASR	$158.89
Rate for Payer: ASR Commercial	$158.89
Rate for Payer: BCBS Complete	$65.52
Rate for Payer: BCBS Trust/PPO	$134.14
Rate for Payer: BCN Commercial	$126.99
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$153.97
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$163.80
Rate for Payer: Healthscope Whirlpool	$158.89
Rate for Payer: Mclaren Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: Nomi Health Commercial	$134.32
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$143.52
Rate for Payer: Priority Health Narrow Network	$114.82
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$144.14

SENNOSIDES 8.6 MG TABLET

Facility

$140.00

Service Code	NDC 00904725261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: ASR ASR	$135.80
Rate for Payer: ASR Commercial	$135.80
Rate for Payer: BCBS Trust/PPO	$114.09
Rate for Payer: BCN Commercial	$108.54
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$140.00
Rate for Payer: Healthscope Whirlpool	$135.80
Rate for Payer: Mclaren Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: Nomi Health Commercial	$114.80
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$123.20

SENNOSIDES 8.6 MG TABLET

Facility

$163.80

Service Code	NDC 51645085101
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$106.47
Max. Negotiated Rate	$163.80
Rate for Payer: Aetna Commercial	$147.42
Rate for Payer: ASR ASR	$158.89
Rate for Payer: ASR Commercial	$158.89
Rate for Payer: BCBS Trust/PPO	$133.48
Rate for Payer: BCN Commercial	$126.99
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Commercial	$153.97
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$163.80
Rate for Payer: Healthscope Whirlpool	$158.89
Rate for Payer: Mclaren Commercial	$147.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: Nomi Health Commercial	$134.32
Rate for Payer: Priority Health Cigna Priority Health	$106.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$144.14

SENNOSIDES 8.6 MG TABLET

Facility

$113.40

Service Code	NDC 49483008001
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$73.71
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna Commercial	$102.06
Rate for Payer: ASR ASR	$110.00
Rate for Payer: ASR Commercial	$110.00
Rate for Payer: BCBS Trust/PPO	$92.41
Rate for Payer: BCN Commercial	$87.92
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$106.60
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$113.40
Rate for Payer: Healthscope Whirlpool	$110.00
Rate for Payer: Mclaren Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: Nomi Health Commercial	$92.99
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$99.79

SENNOSIDES 8.6 MG TABLET

Facility

$140.00

Service Code	NDC 00904725261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$56.00
Max. Negotiated Rate	$140.00
Rate for Payer: Aetna Commercial	$126.00
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: ASR ASR	$135.80
Rate for Payer: ASR Commercial	$135.80
Rate for Payer: BCBS Complete	$56.00
Rate for Payer: BCBS Trust/PPO	$114.65
Rate for Payer: BCN Commercial	$108.54
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$112.00
Rate for Payer: Healthscope Commercial	$140.00
Rate for Payer: Healthscope Whirlpool	$135.80
Rate for Payer: Mclaren Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$119.00
Rate for Payer: Nomi Health Commercial	$114.80
Rate for Payer: Priority Health Cigna Priority Health	$91.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$122.67
Rate for Payer: Priority Health Narrow Network	$98.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$123.20

SENNOSIDES 8.6 MG TABLET

Facility

$132.00

Service Code	NDC 00904652261
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: ASR ASR	$128.04
Rate for Payer: ASR Commercial	$128.04
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCBS Trust/PPO	$108.09
Rate for Payer: BCN Commercial	$102.34
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cofinity Commercial	$124.08
Rate for Payer: Encore Health Key Benefits Commercial	$105.60
Rate for Payer: Healthscope Commercial	$132.00
Rate for Payer: Healthscope Whirlpool	$128.04
Rate for Payer: Mclaren Commercial	$118.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.20
Rate for Payer: Nomi Health Commercial	$108.24
Rate for Payer: Priority Health Cigna Priority Health	$85.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.66
Rate for Payer: Priority Health Narrow Network	$92.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$116.16

SENNOSIDES 8.6 MG TABLET

Facility

$113.40

Service Code	NDC 49483008001
Hospital Charge Code	11349
Hospital Revenue Code	637
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$113.40
Rate for Payer: Aetna Commercial	$102.06
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: ASR ASR	$110.00
Rate for Payer: ASR Commercial	$110.00
Rate for Payer: BCBS Complete	$45.36
Rate for Payer: BCBS Trust/PPO	$92.86
Rate for Payer: BCN Commercial	$87.92
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$106.60
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$113.40
Rate for Payer: Healthscope Whirlpool	$110.00
Rate for Payer: Mclaren Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: Nomi Health Commercial	$92.99
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$99.36
Rate for Payer: Priority Health Narrow Network	$79.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$99.79

SERTRALINE 50 MG TABLET

Facility

$3.05

Service Code	NDC 60687024211
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.74
Rate for Payer: ASR ASR	$2.96
Rate for Payer: ASR Commercial	$2.96
Rate for Payer: BCBS Trust/PPO	$2.49
Rate for Payer: BCN Commercial	$2.36
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.87
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: Healthscope Whirlpool	$2.96
Rate for Payer: Mclaren Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: Nomi Health Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.68

SERTRALINE 50 MG TABLET

Facility

$4,976.87

Service Code	NDC 00049490041
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$3,234.97
Max. Negotiated Rate	$4,976.87
Rate for Payer: Aetna Commercial	$4,479.18
Rate for Payer: ASR ASR	$4,827.56
Rate for Payer: ASR Commercial	$4,827.56
Rate for Payer: BCBS Trust/PPO	$4,055.65
Rate for Payer: BCN Commercial	$3,858.57
Rate for Payer: Cash Price	$3,981.50
Rate for Payer: Cofinity Commercial	$4,678.26
Rate for Payer: Encore Health Key Benefits Commercial	$3,981.50
Rate for Payer: Healthscope Commercial	$4,976.87
Rate for Payer: Healthscope Whirlpool	$4,827.56
Rate for Payer: Mclaren Commercial	$4,479.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,230.34
Rate for Payer: Nomi Health Commercial	$4,081.03
Rate for Payer: Priority Health Cigna Priority Health	$3,234.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4,379.65

SERTRALINE 50 MG TABLET

Facility

$3.05

Service Code	NDC 60687024211
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.74
Rate for Payer: Aetna Medicare	$1.52
Rate for Payer: ASR ASR	$2.96
Rate for Payer: ASR Commercial	$2.96
Rate for Payer: BCBS Complete	$1.22
Rate for Payer: BCBS Trust/PPO	$2.50
Rate for Payer: BCN Commercial	$2.36
Rate for Payer: Cash Price	$2.44
Rate for Payer: Cofinity Commercial	$2.87
Rate for Payer: Encore Health Key Benefits Commercial	$2.44
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: Healthscope Whirlpool	$2.96
Rate for Payer: Mclaren Commercial	$2.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.59
Rate for Payer: Nomi Health Commercial	$2.50
Rate for Payer: Priority Health Cigna Priority Health	$1.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.67
Rate for Payer: Priority Health Narrow Network	$2.14
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2.68

SERTRALINE 50 MG TABLET

Facility

$31.73

Service Code	NDC 68180035206
Hospital Charge Code	11351
Hospital Revenue Code	637
Min. Negotiated Rate	$20.62
Max. Negotiated Rate	$31.73
Rate for Payer: Aetna Commercial	$28.56
Rate for Payer: ASR ASR	$30.78
Rate for Payer: ASR Commercial	$30.78
Rate for Payer: BCBS Trust/PPO	$25.86
Rate for Payer: BCN Commercial	$24.60
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Commercial	$29.83
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$31.73
Rate for Payer: Healthscope Whirlpool	$30.78
Rate for Payer: Mclaren Commercial	$28.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.97
Rate for Payer: Nomi Health Commercial	$26.02
Rate for Payer: Priority Health Cigna Priority Health	$20.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$27.92

Know your out-of-pocket cost for care.

All Charges