Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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	$334.78
Max. Negotiated Rate	$766.67
Rate for Payer: Aetna Commercial	$724.08
Rate for Payer: Aetna Medicare	$425.93
Rate for Payer: Aetna New Business (MI Preferred)	$553.71
Rate for Payer: BCBS Complete	$340.74
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: MI Amish Medical Board Commercial	$681.49
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
Rate for Payer: UHC All Payor (Choice/PPO)	$553.71
Rate for Payer: UHC Core	$443.82
Rate for Payer: UHC Exchange	$334.78

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

CLONIDINE HCL 0.1 MG TABLET

Facility

$262.20

Service Code	NDC 00904744261
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$103.04
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna Medicare	$131.10
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: BCBS Complete	$104.88
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: MI Amish Medical Board Commercial	$209.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19
Rate for Payer: UHC All Payor (Choice/PPO)	$170.43
Rate for Payer: UHC Core	$136.61
Rate for Payer: UHC Exchange	$103.04

CLONIDINE HCL 0.1 MG TABLET

Facility

$84.60

Service Code	NDC 228212710
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna Medicare	$42.30
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: BCBS Complete	$33.84
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Advantage	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Encore Health Key Benefits Commercial	$67.68
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: MI Amish Medical Board Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.45
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health SBD	$53.30
Rate for Payer: UHC All Payor (Choice/PPO)	$54.99
Rate for Payer: UHC Core	$44.08
Rate for Payer: UHC Exchange	$33.25

CLONIDINE HCL 0.1 MG TABLET

Facility

$82.25

Service Code	NDC 58657064701
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$51.82
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Advantage	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.69
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health SBD	$51.82

CLONIDINE HCL 0.1 MG TABLET

Facility

$2.88

Service Code	NDC 60687011311
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: Priority Health SBD	$1.81

CLONIDINE HCL 0.1 MG TABLET

Facility

$82.25

Service Code	NDC 58657064701
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$32.32
Max. Negotiated Rate	$74.03
Rate for Payer: Aetna Commercial	$69.91
Rate for Payer: Aetna Medicare	$41.12
Rate for Payer: Aetna New Business (MI Preferred)	$53.46
Rate for Payer: BCBS Complete	$32.90
Rate for Payer: Cash Price	$65.80
Rate for Payer: Cofinity Advantage	$57.58
Rate for Payer: Cofinity Commercial	$70.73
Rate for Payer: Encore Health Key Benefits Commercial	$65.80
Rate for Payer: Healthscope Commercial	$74.03
Rate for Payer: MI Amish Medical Board Commercial	$65.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.69
Rate for Payer: PHP Commercial	$69.91
Rate for Payer: Priority Health SBD	$51.82
Rate for Payer: UHC All Payor (Choice/PPO)	$53.46
Rate for Payer: UHC Core	$42.85
Rate for Payer: UHC Exchange	$32.32

CLONIDINE HCL 0.1 MG TABLET

Facility

$2.88

Service Code	NDC 60687011311
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$1.13
Max. Negotiated Rate	$2.59
Rate for Payer: Aetna Commercial	$2.45
Rate for Payer: Aetna Medicare	$1.44
Rate for Payer: Aetna New Business (MI Preferred)	$1.87
Rate for Payer: BCBS Complete	$1.15
Rate for Payer: Cash Price	$2.30
Rate for Payer: Cofinity Advantage	$2.02
Rate for Payer: Cofinity Commercial	$2.48
Rate for Payer: Encore Health Key Benefits Commercial	$2.30
Rate for Payer: Healthscope Commercial	$2.59
Rate for Payer: MI Amish Medical Board Commercial	$2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.16
Rate for Payer: PHP Commercial	$2.45
Rate for Payer: Priority Health SBD	$1.81
Rate for Payer: UHC All Payor (Choice/PPO)	$1.87
Rate for Payer: UHC Core	$1.50
Rate for Payer: UHC Exchange	$1.13

CLONIDINE HCL 0.1 MG TABLET

Facility

$84.60

Service Code	NDC 00228212710
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$33.25
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna Medicare	$42.30
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: BCBS Complete	$33.84
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Advantage	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Encore Health Key Benefits Commercial	$67.68
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: MI Amish Medical Board Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.45
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health SBD	$53.30
Rate for Payer: UHC All Payor (Choice/PPO)	$54.99
Rate for Payer: UHC Core	$44.08
Rate for Payer: UHC Exchange	$33.25

CLONIDINE HCL 0.1 MG TABLET

Facility

$287.85

Service Code	NDC 60687011301
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$113.13
Max. Negotiated Rate	$259.06
Rate for Payer: Aetna Commercial	$244.67
Rate for Payer: Aetna Medicare	$143.93
Rate for Payer: Aetna New Business (MI Preferred)	$187.10
Rate for Payer: BCBS Complete	$115.14
Rate for Payer: Cash Price	$230.28
Rate for Payer: Cofinity Advantage	$201.50
Rate for Payer: Cofinity Commercial	$247.55
Rate for Payer: Encore Health Key Benefits Commercial	$230.28
Rate for Payer: Healthscope Commercial	$259.06
Rate for Payer: MI Amish Medical Board Commercial	$230.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.89
Rate for Payer: PHP Commercial	$244.67
Rate for Payer: Priority Health SBD	$181.35
Rate for Payer: UHC All Payor (Choice/PPO)	$187.10
Rate for Payer: UHC Core	$149.97
Rate for Payer: UHC Exchange	$113.13

CLONIDINE HCL 0.1 MG TABLET

Facility

$262.20

Service Code	NDC 00904744261
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$165.19
Max. Negotiated Rate	$235.98
Rate for Payer: Aetna Commercial	$222.87
Rate for Payer: Aetna New Business (MI Preferred)	$170.43
Rate for Payer: Cash Price	$209.76
Rate for Payer: Cofinity Advantage	$183.54
Rate for Payer: Cofinity Commercial	$225.49
Rate for Payer: Encore Health Key Benefits Commercial	$209.76
Rate for Payer: Healthscope Commercial	$235.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$222.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.65
Rate for Payer: PHP Commercial	$222.87
Rate for Payer: Priority Health SBD	$165.19

CLONIDINE HCL 0.1 MG TABLET

Facility

$287.85

Service Code	NDC 60687011301
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$181.35
Max. Negotiated Rate	$259.06
Rate for Payer: Aetna Commercial	$244.67
Rate for Payer: Aetna New Business (MI Preferred)	$187.10
Rate for Payer: Cash Price	$230.28
Rate for Payer: Cofinity Advantage	$201.50
Rate for Payer: Cofinity Commercial	$247.55
Rate for Payer: Encore Health Key Benefits Commercial	$230.28
Rate for Payer: Healthscope Commercial	$259.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$244.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.89
Rate for Payer: PHP Commercial	$244.67
Rate for Payer: Priority Health SBD	$181.35

CLONIDINE HCL 0.1 MG TABLET

Facility

$84.60

Service Code	NDC 00228212710
Hospital Charge Code	1755
Hospital Revenue Code	637
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$76.14
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna New Business (MI Preferred)	$54.99
Rate for Payer: Cash Price	$67.68
Rate for Payer: Cofinity Advantage	$59.22
Rate for Payer: Cofinity Commercial	$72.76
Rate for Payer: Encore Health Key Benefits Commercial	$67.68
Rate for Payer: Healthscope Commercial	$76.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.45
Rate for Payer: PHP Commercial	$71.91
Rate for Payer: Priority Health SBD	$53.30

CLONIDINE HCL 0.2 MG TABLET

Facility

$126.90

Service Code	NDC 29300013601
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$114.21
Rate for Payer: Aetna Commercial	$107.86
Rate for Payer: Aetna New Business (MI Preferred)	$82.48
Rate for Payer: Cash Price	$101.52
Rate for Payer: Cofinity Advantage	$88.83
Rate for Payer: Cofinity Commercial	$109.13
Rate for Payer: Encore Health Key Benefits Commercial	$101.52
Rate for Payer: Healthscope Commercial	$114.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.17
Rate for Payer: PHP Commercial	$107.86
Rate for Payer: Priority Health SBD	$79.95

CLONIDINE HCL 0.2 MG TABLET

Facility

$2.73

Service Code	NDC 60687012411
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna Medicare	$1.36
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: BCBS Complete	$1.09
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: MI Amish Medical Board Commercial	$2.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72
Rate for Payer: UHC All Payor (Choice/PPO)	$1.77
Rate for Payer: UHC Core	$1.42
Rate for Payer: UHC Exchange	$1.07

CLONIDINE HCL 0.2 MG TABLET

Facility

$126.90

Service Code	NDC 29300013601
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$49.87
Max. Negotiated Rate	$114.21
Rate for Payer: Aetna Commercial	$107.86
Rate for Payer: Aetna Medicare	$63.45
Rate for Payer: Aetna New Business (MI Preferred)	$82.48
Rate for Payer: BCBS Complete	$50.76
Rate for Payer: Cash Price	$101.52
Rate for Payer: Cofinity Advantage	$88.83
Rate for Payer: Cofinity Commercial	$109.13
Rate for Payer: Encore Health Key Benefits Commercial	$101.52
Rate for Payer: Healthscope Commercial	$114.21
Rate for Payer: MI Amish Medical Board Commercial	$101.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.17
Rate for Payer: PHP Commercial	$107.86
Rate for Payer: Priority Health SBD	$79.95
Rate for Payer: UHC All Payor (Choice/PPO)	$82.48
Rate for Payer: UHC Core	$66.11
Rate for Payer: UHC Exchange	$49.87

CLONIDINE HCL 0.2 MG TABLET

Facility

$2.73

Service Code	NDC 60687012411
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$1.72
Max. Negotiated Rate	$2.46
Rate for Payer: Aetna Commercial	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$1.77
Rate for Payer: Cash Price	$2.18
Rate for Payer: Cofinity Advantage	$1.91
Rate for Payer: Cofinity Commercial	$2.35
Rate for Payer: Encore Health Key Benefits Commercial	$2.18
Rate for Payer: Healthscope Commercial	$2.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.05
Rate for Payer: PHP Commercial	$2.32
Rate for Payer: Priority Health SBD	$1.72

CLONIDINE HCL 0.2 MG TABLET

Facility

$272.65

Service Code	NDC 60687012401
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$171.77
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.75
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: Cash Price	$218.12
Rate for Payer: Cofinity Advantage	$190.85
Rate for Payer: Cofinity Commercial	$234.48
Rate for Payer: Encore Health Key Benefits Commercial	$218.12
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.49
Rate for Payer: PHP Commercial	$231.75
Rate for Payer: Priority Health SBD	$171.77

CLONIDINE HCL 0.2 MG TABLET

Facility

$126.90

Service Code	NDC 52817018110
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$49.87
Max. Negotiated Rate	$114.21
Rate for Payer: Aetna Commercial	$107.86
Rate for Payer: Aetna Medicare	$63.45
Rate for Payer: Aetna New Business (MI Preferred)	$82.48
Rate for Payer: BCBS Complete	$50.76
Rate for Payer: Cash Price	$101.52
Rate for Payer: Cofinity Advantage	$88.83
Rate for Payer: Cofinity Commercial	$109.13
Rate for Payer: Encore Health Key Benefits Commercial	$101.52
Rate for Payer: Healthscope Commercial	$114.21
Rate for Payer: MI Amish Medical Board Commercial	$101.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.17
Rate for Payer: PHP Commercial	$107.86
Rate for Payer: Priority Health SBD	$79.95
Rate for Payer: UHC All Payor (Choice/PPO)	$82.48
Rate for Payer: UHC Core	$66.11
Rate for Payer: UHC Exchange	$49.87

CLONIDINE HCL 0.2 MG TABLET

Facility

$126.90

Service Code	NDC 52817018110
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$79.95
Max. Negotiated Rate	$114.21
Rate for Payer: Aetna Commercial	$107.86
Rate for Payer: Aetna New Business (MI Preferred)	$82.48
Rate for Payer: Cash Price	$101.52
Rate for Payer: Cofinity Advantage	$88.83
Rate for Payer: Cofinity Commercial	$109.13
Rate for Payer: Encore Health Key Benefits Commercial	$101.52
Rate for Payer: Healthscope Commercial	$114.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.17
Rate for Payer: PHP Commercial	$107.86
Rate for Payer: Priority Health SBD	$79.95

CLONIDINE HCL 0.2 MG TABLET

Facility

$272.65

Service Code	NDC 60687012401
Hospital Charge Code	1756
Hospital Revenue Code	637
Min. Negotiated Rate	$107.15
Max. Negotiated Rate	$245.38
Rate for Payer: Aetna Commercial	$231.75
Rate for Payer: Aetna Medicare	$136.32
Rate for Payer: Aetna New Business (MI Preferred)	$177.22
Rate for Payer: BCBS Complete	$109.06
Rate for Payer: Cash Price	$218.12
Rate for Payer: Cofinity Advantage	$190.85
Rate for Payer: Cofinity Commercial	$234.48
Rate for Payer: Encore Health Key Benefits Commercial	$218.12
Rate for Payer: Healthscope Commercial	$245.38
Rate for Payer: MI Amish Medical Board Commercial	$218.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$231.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$204.49
Rate for Payer: PHP Commercial	$231.75
Rate for Payer: Priority Health SBD	$171.77
Rate for Payer: UHC All Payor (Choice/PPO)	$177.22
Rate for Payer: UHC Core	$142.05
Rate for Payer: UHC Exchange	$107.15

CLONIDINE HCL 0.3 MG TABLET

Facility

$155.10

Service Code	NDC 52817018210
Hospital Charge Code	1757
Hospital Revenue Code	637
Min. Negotiated Rate	$97.71
Max. Negotiated Rate	$139.59
Rate for Payer: Aetna Commercial	$131.84
Rate for Payer: Aetna New Business (MI Preferred)	$100.81
Rate for Payer: Cash Price	$124.08
Rate for Payer: Cofinity Advantage	$108.57
Rate for Payer: Cofinity Commercial	$133.39
Rate for Payer: Encore Health Key Benefits Commercial	$124.08
Rate for Payer: Healthscope Commercial	$139.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$131.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$116.33
Rate for Payer: PHP Commercial	$131.84
Rate for Payer: Priority Health SBD	$97.71

CLONIDINE HCL 0.3 MG TABLET

Facility

$138.65

Service Code	NDC 00228212910
Hospital Charge Code	1757
Hospital Revenue Code	637
Min. Negotiated Rate	$87.35
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Advantage	$97.06
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.99
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health SBD	$87.35

CLONIDINE HCL 0.3 MG TABLET

Facility

$3.20

Service Code	NDC 50268019411
Hospital Charge Code	1757
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.88
Rate for Payer: Aetna Commercial	$2.72
Rate for Payer: Aetna Medicare	$1.60
Rate for Payer: Aetna New Business (MI Preferred)	$2.08
Rate for Payer: BCBS Complete	$1.28
Rate for Payer: Cash Price	$2.56
Rate for Payer: Cofinity Advantage	$2.24
Rate for Payer: Cofinity Commercial	$2.75
Rate for Payer: Encore Health Key Benefits Commercial	$2.56
Rate for Payer: Healthscope Commercial	$2.88
Rate for Payer: MI Amish Medical Board Commercial	$2.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.40
Rate for Payer: PHP Commercial	$2.72
Rate for Payer: Priority Health SBD	$2.02
Rate for Payer: UHC All Payor (Choice/PPO)	$2.08
Rate for Payer: UHC Core	$1.67
Rate for Payer: UHC Exchange	$1.26

CLONIDINE HCL 0.3 MG TABLET

Facility

$138.65

Service Code	NDC 00228212910
Hospital Charge Code	1757
Hospital Revenue Code	637
Min. Negotiated Rate	$54.49
Max. Negotiated Rate	$124.78
Rate for Payer: Aetna Commercial	$117.85
Rate for Payer: Aetna Medicare	$69.33
Rate for Payer: Aetna New Business (MI Preferred)	$90.12
Rate for Payer: BCBS Complete	$55.46
Rate for Payer: Cash Price	$110.92
Rate for Payer: Cofinity Advantage	$97.06
Rate for Payer: Cofinity Commercial	$119.24
Rate for Payer: Encore Health Key Benefits Commercial	$110.92
Rate for Payer: Healthscope Commercial	$124.78
Rate for Payer: MI Amish Medical Board Commercial	$110.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.99
Rate for Payer: PHP Commercial	$117.85
Rate for Payer: Priority Health SBD	$87.35
Rate for Payer: UHC All Payor (Choice/PPO)	$90.12
Rate for Payer: UHC Core	$72.24
Rate for Payer: UHC Exchange	$54.49

Know your out-of-pocket cost for care.

All Charges