Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

CLONAZEPAM 0.5 MG TABLET

Facility

$7.41

Service Code	NDC 60687086111
Hospital Charge Code	9637
Hospital Revenue Code	637
Min. Negotiated Rate	$2.91
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna Medicare	$3.71
Rate for Payer: Aetna New Business (MI Preferred)	$4.82
Rate for Payer: BCBS Complete	$2.96
Rate for Payer: Cash Price	$5.93
Rate for Payer: Cofinity Advantage	$5.19
Rate for Payer: Cofinity Commercial	$6.37
Rate for Payer: Encore Health Key Benefits Commercial	$5.93
Rate for Payer: Healthscope Commercial	$6.67
Rate for Payer: MI Amish Medical Board Commercial	$5.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.56
Rate for Payer: PHP Commercial	$6.30
Rate for Payer: Priority Health SBD	$4.67
Rate for Payer: UHC All Payor (Choice/PPO)	$4.82
Rate for Payer: UHC Core	$3.86
Rate for Payer: UHC Exchange	$2.91

CLONAZEPAM 0.5 MG TABLET

Facility

$49.00

Service Code	NDC 00093083201
Hospital Charge Code	9637
Hospital Revenue Code	637
Min. Negotiated Rate	$19.26
Max. Negotiated Rate	$44.10
Rate for Payer: Aetna Commercial	$41.65
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: Aetna New Business (MI Preferred)	$31.85
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cofinity Advantage	$34.30
Rate for Payer: Cofinity Commercial	$42.14
Rate for Payer: Encore Health Key Benefits Commercial	$39.20
Rate for Payer: Healthscope Commercial	$44.10
Rate for Payer: MI Amish Medical Board Commercial	$39.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$41.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75
Rate for Payer: PHP Commercial	$41.65
Rate for Payer: Priority Health SBD	$30.87
Rate for Payer: UHC All Payor (Choice/PPO)	$31.85
Rate for Payer: UHC Core	$25.53
Rate for Payer: UHC Exchange	$19.26

CLONAZEPAM 0.5 MG TABLET

Facility

$7.41

Service Code	NDC 60687086111
Hospital Charge Code	9637
Hospital Revenue Code	637
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$6.67
Rate for Payer: Aetna Commercial	$6.30
Rate for Payer: Aetna New Business (MI Preferred)	$4.82
Rate for Payer: Cash Price	$5.93
Rate for Payer: Cofinity Advantage	$5.19
Rate for Payer: Cofinity Commercial	$6.37
Rate for Payer: Encore Health Key Benefits Commercial	$5.93
Rate for Payer: Healthscope Commercial	$6.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.56
Rate for Payer: PHP Commercial	$6.30
Rate for Payer: Priority Health SBD	$4.67

CLONAZEPAM 1 MG TABLET

Facility

$701.75

Service Code	NDC 00904772861
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$275.79
Max. Negotiated Rate	$631.58
Rate for Payer: Aetna Commercial	$596.49
Rate for Payer: Aetna Medicare	$350.88
Rate for Payer: Aetna New Business (MI Preferred)	$456.14
Rate for Payer: BCBS Complete	$280.70
Rate for Payer: Cash Price	$561.40
Rate for Payer: Cofinity Advantage	$491.23
Rate for Payer: Cofinity Commercial	$603.50
Rate for Payer: Encore Health Key Benefits Commercial	$561.40
Rate for Payer: Healthscope Commercial	$631.58
Rate for Payer: MI Amish Medical Board Commercial	$561.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$596.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$526.31
Rate for Payer: PHP Commercial	$596.49
Rate for Payer: Priority Health SBD	$442.10
Rate for Payer: UHC All Payor (Choice/PPO)	$456.14
Rate for Payer: UHC Core	$365.61
Rate for Payer: UHC Exchange	$275.79

CLONAZEPAM 1 MG TABLET

Facility

$1,058.85

Service Code	NDC 00004005801
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$667.08
Max. Negotiated Rate	$952.97
Rate for Payer: Aetna Commercial	$900.02
Rate for Payer: Aetna New Business (MI Preferred)	$688.25
Rate for Payer: Cash Price	$847.08
Rate for Payer: Cofinity Advantage	$741.20
Rate for Payer: Cofinity Commercial	$910.61
Rate for Payer: Encore Health Key Benefits Commercial	$847.08
Rate for Payer: Healthscope Commercial	$952.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$900.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$794.14
Rate for Payer: PHP Commercial	$900.02
Rate for Payer: Priority Health SBD	$667.08

CLONAZEPAM 1 MG TABLET

Facility

$52.50

Service Code	NDC 43547040710
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$20.63
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Commercial	$44.62
Rate for Payer: Aetna Medicare	$26.25
Rate for Payer: Aetna New Business (MI Preferred)	$34.12
Rate for Payer: BCBS Complete	$21.00
Rate for Payer: Cash Price	$42.00
Rate for Payer: Cofinity Advantage	$36.75
Rate for Payer: Cofinity Commercial	$45.15
Rate for Payer: Encore Health Key Benefits Commercial	$42.00
Rate for Payer: Healthscope Commercial	$47.25
Rate for Payer: MI Amish Medical Board Commercial	$42.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.38
Rate for Payer: PHP Commercial	$44.62
Rate for Payer: Priority Health SBD	$33.08
Rate for Payer: UHC All Payor (Choice/PPO)	$34.12
Rate for Payer: UHC Core	$27.35
Rate for Payer: UHC Exchange	$20.63

CLONAZEPAM 1 MG TABLET

Facility

$56.00

Service Code	NDC 59651072301
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$22.01
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna Commercial	$47.60
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: Aetna New Business (MI Preferred)	$36.40
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cofinity Advantage	$39.20
Rate for Payer: Cofinity Commercial	$48.16
Rate for Payer: Encore Health Key Benefits Commercial	$44.80
Rate for Payer: Healthscope Commercial	$50.40
Rate for Payer: MI Amish Medical Board Commercial	$44.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: PHP Commercial	$47.60
Rate for Payer: Priority Health SBD	$35.28
Rate for Payer: UHC All Payor (Choice/PPO)	$36.40
Rate for Payer: UHC Core	$29.18
Rate for Payer: UHC Exchange	$22.01

CLONAZEPAM 1 MG TABLET

Facility

$52.50

Service Code	NDC 43547040710
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$33.08
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Commercial	$44.62
Rate for Payer: Aetna New Business (MI Preferred)	$34.12
Rate for Payer: Cash Price	$42.00
Rate for Payer: Cofinity Advantage	$36.75
Rate for Payer: Cofinity Commercial	$45.15
Rate for Payer: Encore Health Key Benefits Commercial	$42.00
Rate for Payer: Healthscope Commercial	$47.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$44.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.38
Rate for Payer: PHP Commercial	$44.62
Rate for Payer: Priority Health SBD	$33.08

CLONAZEPAM 1 MG TABLET

Facility

$1.47

Service Code	NDC 51079088201
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna Medicare	$0.74
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: BCBS Complete	$0.59
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Advantage	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: MI Amish Medical Board Commercial	$1.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.10
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health SBD	$0.93
Rate for Payer: UHC All Payor (Choice/PPO)	$0.96
Rate for Payer: UHC Core	$0.77
Rate for Payer: UHC Exchange	$0.58

CLONAZEPAM 1 MG TABLET

Facility

$1.47

Service Code	NDC 51079088201
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$1.32
Rate for Payer: Aetna Commercial	$1.25
Rate for Payer: Aetna New Business (MI Preferred)	$0.96
Rate for Payer: Cash Price	$1.18
Rate for Payer: Cofinity Advantage	$1.03
Rate for Payer: Cofinity Commercial	$1.26
Rate for Payer: Encore Health Key Benefits Commercial	$1.18
Rate for Payer: Healthscope Commercial	$1.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.10
Rate for Payer: PHP Commercial	$1.25
Rate for Payer: Priority Health SBD	$0.93

CLONAZEPAM 1 MG TABLET

Facility

$701.75

Service Code	NDC 00904772861
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$442.10
Max. Negotiated Rate	$631.58
Rate for Payer: Aetna Commercial	$596.49
Rate for Payer: Aetna New Business (MI Preferred)	$456.14
Rate for Payer: Cash Price	$561.40
Rate for Payer: Cofinity Advantage	$491.23
Rate for Payer: Cofinity Commercial	$603.50
Rate for Payer: Encore Health Key Benefits Commercial	$561.40
Rate for Payer: Healthscope Commercial	$631.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$596.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$526.31
Rate for Payer: PHP Commercial	$596.49
Rate for Payer: Priority Health SBD	$442.10

CLONAZEPAM 1 MG TABLET

Facility

$147.00

Service Code	NDC 51079088220
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$92.61
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Advantage	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health SBD	$92.61

CLONAZEPAM 1 MG TABLET

Facility

$147.00

Service Code	NDC 51079088220
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$57.77
Max. Negotiated Rate	$132.30
Rate for Payer: Aetna Commercial	$124.95
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: Aetna New Business (MI Preferred)	$95.55
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cofinity Advantage	$102.90
Rate for Payer: Cofinity Commercial	$126.42
Rate for Payer: Encore Health Key Benefits Commercial	$117.60
Rate for Payer: Healthscope Commercial	$132.30
Rate for Payer: MI Amish Medical Board Commercial	$117.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$124.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25
Rate for Payer: PHP Commercial	$124.95
Rate for Payer: Priority Health SBD	$92.61
Rate for Payer: UHC All Payor (Choice/PPO)	$95.55
Rate for Payer: UHC Core	$76.59
Rate for Payer: UHC Exchange	$57.77

CLONAZEPAM 1 MG TABLET

Facility

$1,058.85

Service Code	NDC 00004005801
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$416.13
Max. Negotiated Rate	$952.97
Rate for Payer: Aetna Commercial	$900.02
Rate for Payer: Aetna Medicare	$529.42
Rate for Payer: Aetna New Business (MI Preferred)	$688.25
Rate for Payer: BCBS Complete	$423.54
Rate for Payer: Cash Price	$847.08
Rate for Payer: Cofinity Advantage	$741.20
Rate for Payer: Cofinity Commercial	$910.61
Rate for Payer: Encore Health Key Benefits Commercial	$847.08
Rate for Payer: Healthscope Commercial	$952.97
Rate for Payer: MI Amish Medical Board Commercial	$847.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$900.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$794.14
Rate for Payer: PHP Commercial	$900.02
Rate for Payer: Priority Health SBD	$667.08
Rate for Payer: UHC All Payor (Choice/PPO)	$688.25
Rate for Payer: UHC Core	$551.66
Rate for Payer: UHC Exchange	$416.13

CLONAZEPAM 1 MG TABLET

Facility

$56.00

Service Code	NDC 59651072301
Hospital Charge Code	9638
Hospital Revenue Code	637
Min. Negotiated Rate	$35.28
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna Commercial	$47.60
Rate for Payer: Aetna New Business (MI Preferred)	$36.40
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cofinity Advantage	$39.20
Rate for Payer: Cofinity Commercial	$48.16
Rate for Payer: Encore Health Key Benefits Commercial	$44.80
Rate for Payer: Healthscope Commercial	$50.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$47.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: PHP Commercial	$47.60
Rate for Payer: Priority Health SBD	$35.28

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$91.18

Service Code	NDC 00378087116
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$57.44
Max. Negotiated Rate	$82.06
Rate for Payer: Aetna Commercial	$77.50
Rate for Payer: Aetna New Business (MI Preferred)	$59.27
Rate for Payer: Cash Price	$72.94
Rate for Payer: Cofinity Advantage	$63.83
Rate for Payer: Cofinity Commercial	$78.41
Rate for Payer: Encore Health Key Benefits Commercial	$72.94
Rate for Payer: Healthscope Commercial	$82.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.39
Rate for Payer: PHP Commercial	$77.50
Rate for Payer: Priority Health SBD	$57.44

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$364.72

Service Code	NDC 00378087199
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$229.77
Max. Negotiated Rate	$328.25
Rate for Payer: Aetna Commercial	$310.01
Rate for Payer: Aetna New Business (MI Preferred)	$237.07
Rate for Payer: Cash Price	$291.78
Rate for Payer: Cofinity Advantage	$255.30
Rate for Payer: Cofinity Commercial	$313.66
Rate for Payer: Encore Health Key Benefits Commercial	$291.78
Rate for Payer: Healthscope Commercial	$328.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.54
Rate for Payer: PHP Commercial	$310.01
Rate for Payer: Priority Health SBD	$229.77

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$364.72

Service Code	NDC 00378087199
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$143.33
Max. Negotiated Rate	$328.25
Rate for Payer: Aetna Commercial	$310.01
Rate for Payer: Aetna Medicare	$182.36
Rate for Payer: Aetna New Business (MI Preferred)	$237.07
Rate for Payer: BCBS Complete	$145.89
Rate for Payer: Cash Price	$291.78
Rate for Payer: Cofinity Advantage	$255.30
Rate for Payer: Cofinity Commercial	$313.66
Rate for Payer: Encore Health Key Benefits Commercial	$291.78
Rate for Payer: Healthscope Commercial	$328.25
Rate for Payer: MI Amish Medical Board Commercial	$291.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$273.54
Rate for Payer: PHP Commercial	$310.01
Rate for Payer: Priority Health SBD	$229.77
Rate for Payer: UHC All Payor (Choice/PPO)	$237.07
Rate for Payer: UHC Core	$190.02
Rate for Payer: UHC Exchange	$143.33

CLONIDINE 0.1 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$91.18

Service Code	NDC 00378087116
Hospital Charge Code	27505
Hospital Revenue Code	637
Min. Negotiated Rate	$35.83
Max. Negotiated Rate	$82.06
Rate for Payer: Aetna Commercial	$77.50
Rate for Payer: Aetna Medicare	$45.59
Rate for Payer: Aetna New Business (MI Preferred)	$59.27
Rate for Payer: BCBS Complete	$36.47
Rate for Payer: Cash Price	$72.94
Rate for Payer: Cofinity Advantage	$63.83
Rate for Payer: Cofinity Commercial	$78.41
Rate for Payer: Encore Health Key Benefits Commercial	$72.94
Rate for Payer: Healthscope Commercial	$82.06
Rate for Payer: MI Amish Medical Board Commercial	$72.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$77.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$68.39
Rate for Payer: PHP Commercial	$77.50
Rate for Payer: Priority Health SBD	$57.44
Rate for Payer: UHC All Payor (Choice/PPO)	$59.27
Rate for Payer: UHC Core	$47.50
Rate for Payer: UHC Exchange	$35.83

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$153.52

Service Code	NDC 00378087216
Hospital Charge Code	27506
Hospital Revenue Code	637
Min. Negotiated Rate	$60.33
Max. Negotiated Rate	$138.17
Rate for Payer: Aetna Commercial	$130.49
Rate for Payer: Aetna Medicare	$76.76
Rate for Payer: Aetna New Business (MI Preferred)	$99.79
Rate for Payer: BCBS Complete	$61.41
Rate for Payer: Cash Price	$122.82
Rate for Payer: Cofinity Advantage	$107.46
Rate for Payer: Cofinity Commercial	$132.03
Rate for Payer: Encore Health Key Benefits Commercial	$122.82
Rate for Payer: Healthscope Commercial	$138.17
Rate for Payer: MI Amish Medical Board Commercial	$122.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.14
Rate for Payer: PHP Commercial	$130.49
Rate for Payer: Priority Health SBD	$96.72
Rate for Payer: UHC All Payor (Choice/PPO)	$99.79
Rate for Payer: UHC Core	$79.98
Rate for Payer: UHC Exchange	$60.33

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$614.06

Service Code	NDC 00378087299
Hospital Charge Code	27506
Hospital Revenue Code	637
Min. Negotiated Rate	$241.33
Max. Negotiated Rate	$552.65
Rate for Payer: Aetna Commercial	$521.95
Rate for Payer: Aetna Medicare	$307.03
Rate for Payer: Aetna New Business (MI Preferred)	$399.14
Rate for Payer: BCBS Complete	$245.62
Rate for Payer: Cash Price	$491.25
Rate for Payer: Cofinity Advantage	$429.84
Rate for Payer: Cofinity Commercial	$528.09
Rate for Payer: Encore Health Key Benefits Commercial	$491.25
Rate for Payer: Healthscope Commercial	$552.65
Rate for Payer: MI Amish Medical Board Commercial	$491.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$521.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$460.55
Rate for Payer: PHP Commercial	$521.95
Rate for Payer: Priority Health SBD	$386.86
Rate for Payer: UHC All Payor (Choice/PPO)	$399.14
Rate for Payer: UHC Core	$319.93
Rate for Payer: UHC Exchange	$241.33

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$153.52

Service Code	NDC 00378087216
Hospital Charge Code	27506
Hospital Revenue Code	637
Min. Negotiated Rate	$96.72
Max. Negotiated Rate	$138.17
Rate for Payer: Aetna Commercial	$130.49
Rate for Payer: Aetna New Business (MI Preferred)	$99.79
Rate for Payer: Cash Price	$122.82
Rate for Payer: Cofinity Advantage	$107.46
Rate for Payer: Cofinity Commercial	$132.03
Rate for Payer: Encore Health Key Benefits Commercial	$122.82
Rate for Payer: Healthscope Commercial	$138.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$130.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$115.14
Rate for Payer: PHP Commercial	$130.49
Rate for Payer: Priority Health SBD	$96.72

CLONIDINE 0.2 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$614.06

Service Code	NDC 00378087299
Hospital Charge Code	27506
Hospital Revenue Code	637
Min. Negotiated Rate	$386.86
Max. Negotiated Rate	$552.65
Rate for Payer: Aetna Commercial	$521.95
Rate for Payer: Aetna New Business (MI Preferred)	$399.14
Rate for Payer: Cash Price	$491.25
Rate for Payer: Cofinity Advantage	$429.84
Rate for Payer: Cofinity Commercial	$528.09
Rate for Payer: Encore Health Key Benefits Commercial	$491.25
Rate for Payer: Healthscope Commercial	$552.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$521.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$460.55
Rate for Payer: PHP Commercial	$521.95
Rate for Payer: Priority Health SBD	$386.86

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$851.86

Service Code	NDC 00378087399
Hospital Charge Code	27507
Hospital Revenue Code	637
Min. Negotiated Rate	$536.67
Max. Negotiated Rate	$766.67
Rate for Payer: Aetna Commercial	$724.08
Rate for Payer: Aetna New Business (MI Preferred)	$553.71
Rate for Payer: Cash Price	$681.49
Rate for Payer: Cofinity Advantage	$596.30
Rate for Payer: Cofinity Commercial	$732.60
Rate for Payer: Encore Health Key Benefits Commercial	$681.49
Rate for Payer: Healthscope Commercial	$766.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$724.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$638.89
Rate for Payer: PHP Commercial	$724.08
Rate for Payer: Priority Health SBD	$536.67

CLONIDINE 0.3 MG/24 HR WEEKLY TRANSDERMAL PATCH

Facility

$212.97

Service Code	NDC 00378087316
Hospital Charge Code	27507
Hospital Revenue Code	637
Min. Negotiated Rate	$83.70
Max. Negotiated Rate	$191.67
Rate for Payer: Aetna Commercial	$181.02
Rate for Payer: Aetna Medicare	$106.48
Rate for Payer: Aetna New Business (MI Preferred)	$138.43
Rate for Payer: BCBS Complete	$85.19
Rate for Payer: Cash Price	$170.38
Rate for Payer: Cofinity Advantage	$149.08
Rate for Payer: Cofinity Commercial	$183.15
Rate for Payer: Encore Health Key Benefits Commercial	$170.38
Rate for Payer: Healthscope Commercial	$191.67
Rate for Payer: MI Amish Medical Board Commercial	$170.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.73
Rate for Payer: PHP Commercial	$181.02
Rate for Payer: Priority Health SBD	$134.17
Rate for Payer: UHC All Payor (Choice/PPO)	$138.43
Rate for Payer: UHC Core	$110.96
Rate for Payer: UHC Exchange	$83.70

Know your out-of-pocket cost for care.

All Charges