Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GLYCOPYRROLATE 0.2 MG/ML ORAL SOLN (CUSTOM)

Facility

$442.67

Service Code	NDC 0900-0002-30
Hospital Charge Code	158482
Hospital Revenue Code	250
Min. Negotiated Rate	$278.88
Max. Negotiated Rate	$398.40
Rate for Payer: Aetna Commercial	$376.27
Rate for Payer: Aetna New Business (MI Preferred)	$287.74
Rate for Payer: Cash Price	$354.14
Rate for Payer: Cofinity Commercial	$309.87
Rate for Payer: Cofinity Commercial	$380.70
Rate for Payer: Healthscope Commercial	$398.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$376.27
Rate for Payer: PHP Commercial	$376.27
Rate for Payer: Priority Health Cigna Priority Health	$309.87
Rate for Payer: Priority Health SBD	$278.88

GLYCOPYRROLATE 1 MG TABLET

Facility

$371.52

Service Code	NDC 0904-6709-61
Hospital Charge Code	10130
Hospital Revenue Code	637
Min. Negotiated Rate	$234.06
Max. Negotiated Rate	$334.37
Rate for Payer: Aetna Commercial	$315.79
Rate for Payer: Aetna New Business (MI Preferred)	$241.49
Rate for Payer: Cash Price	$297.22
Rate for Payer: Cofinity Commercial	$260.06
Rate for Payer: Cofinity Commercial	$319.51
Rate for Payer: Healthscope Commercial	$334.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$315.79
Rate for Payer: PHP Commercial	$315.79
Rate for Payer: Priority Health Cigna Priority Health	$260.06
Rate for Payer: Priority Health SBD	$234.06

GLYCOPYRROLATE 1 MG TABLET

Facility

$385.70

Service Code	NDC 69076-475-01
Hospital Charge Code	10130
Hospital Revenue Code	637
Min. Negotiated Rate	$242.99
Max. Negotiated Rate	$347.13
Rate for Payer: Aetna Commercial	$327.84
Rate for Payer: Aetna New Business (MI Preferred)	$250.70
Rate for Payer: Cash Price	$308.56
Rate for Payer: Cofinity Commercial	$269.99
Rate for Payer: Cofinity Commercial	$331.70
Rate for Payer: Healthscope Commercial	$347.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$327.84
Rate for Payer: PHP Commercial	$327.84
Rate for Payer: Priority Health Cigna Priority Health	$269.99
Rate for Payer: Priority Health SBD	$242.99

GLYCOPYRROLATE 1 MG TABLET

Facility

$244.40

Service Code	NDC 23155-606-01
Hospital Charge Code	10130
Hospital Revenue Code	637
Min. Negotiated Rate	$153.97
Max. Negotiated Rate	$219.96
Rate for Payer: Aetna Commercial	$207.74
Rate for Payer: Aetna New Business (MI Preferred)	$158.86
Rate for Payer: Cash Price	$195.52
Rate for Payer: Cofinity Commercial	$171.08
Rate for Payer: Cofinity Commercial	$210.18
Rate for Payer: Healthscope Commercial	$219.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.74
Rate for Payer: PHP Commercial	$207.74
Rate for Payer: Priority Health Cigna Priority Health	$171.08
Rate for Payer: Priority Health SBD	$153.97

GOLIMUMAB 12.5 MG/ML INTRAVENOUS SOLUTION

Facility

$6,234.37

Service Code	HCPCS J1602
Hospital Charge Code	167346
Hospital Revenue Code	636
Min. Negotiated Rate	$3,927.65
Max. Negotiated Rate	$5,610.93
Rate for Payer: Aetna Commercial	$5,299.21
Rate for Payer: Aetna New Business (MI Preferred)	$4,052.34
Rate for Payer: Cash Price	$4,987.50
Rate for Payer: Cofinity Commercial	$4,364.06
Rate for Payer: Cofinity Commercial	$5,361.56
Rate for Payer: Healthscope Commercial	$5,610.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5,299.21
Rate for Payer: PHP Commercial	$5,299.21
Rate for Payer: Priority Health Cigna Priority Health	$4,364.06
Rate for Payer: Priority Health SBD	$3,927.65

GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT

Facility

$3,028.61

Service Code	HCPCS J9202
Hospital Charge Code	10137
Hospital Revenue Code	636
Min. Negotiated Rate	$1,908.02
Max. Negotiated Rate	$2,725.75
Rate for Payer: Aetna Commercial	$2,574.32
Rate for Payer: Aetna New Business (MI Preferred)	$1,968.60
Rate for Payer: Cash Price	$2,422.89
Rate for Payer: Cofinity Commercial	$2,120.03
Rate for Payer: Cofinity Commercial	$2,604.60
Rate for Payer: Healthscope Commercial	$2,725.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,574.32
Rate for Payer: PHP Commercial	$2,574.32
Rate for Payer: Priority Health Cigna Priority Health	$2,120.03
Rate for Payer: Priority Health SBD	$1,908.02

GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT

Facility

$3,028.61

Service Code	HCPCS J9202
Hospital Charge Code	10137
Hospital Revenue Code	636
Min. Negotiated Rate	$333.13
Max. Negotiated Rate	$2,725.75
Rate for Payer: Aetna Commercial	$2,574.32
Rate for Payer: Aetna Medicare	$633.37
Rate for Payer: Aetna New Business (MI Preferred)	$1,968.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$761.26
Rate for Payer: Amish Plain Church Group Commercial	$761.26
Rate for Payer: BCBS Complete	$349.81
Rate for Payer: BCBS MAPPO	$609.01
Rate for Payer: BCBS Trust/PPO	$1,802.96
Rate for Payer: BCN Medicare Advantage	$609.01
Rate for Payer: Cash Price	$2,422.89
Rate for Payer: Cash Price	$2,422.89
Rate for Payer: Cofinity Commercial	$2,604.60
Rate for Payer: Cofinity Commercial	$2,120.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$609.01
Rate for Payer: Healthscope Commercial	$2,725.75
Rate for Payer: Mclaren Medicaid	$333.13
Rate for Payer: Mclaren Medicare	$609.01
Rate for Payer: Meridian Medicaid	$349.81
Rate for Payer: Meridian Wellcare - Medicare Advantage	$639.46
Rate for Payer: MI Amish Medical Board Commercial	$700.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,574.32
Rate for Payer: PACE Medicare	$578.56
Rate for Payer: PACE SWMI	$609.01
Rate for Payer: PHP Commercial	$2,574.32
Rate for Payer: PHP Medicare Advantage	$609.01
Rate for Payer: Priority Health Choice Medicaid	$333.13
Rate for Payer: Priority Health Cigna Priority Health	$2,120.03
Rate for Payer: Priority Health Medicare	$609.01
Rate for Payer: Priority Health SBD	$1,908.02
Rate for Payer: Railroad Medicare Medicare	$609.01
Rate for Payer: UHC Dual Complete DSNP	$609.01
Rate for Payer: UHC Medicare Advantage	$627.28
Rate for Payer: VA VA	$609.01

GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDES OBTAINING GRAFT)

Facility

$15,835.74

Service Code	CPT 21235
Hospital Revenue Code	360
Min. Negotiated Rate	$564.51
Max. Negotiated Rate	$15,835.74
Rate for Payer: Aetna Medicare	$5,419.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,513.48
Rate for Payer: Amish Plain Church Group Commercial	$6,513.48
Rate for Payer: BCBS Complete	$2,993.07
Rate for Payer: BCBS MAPPO	$5,210.78
Rate for Payer: BCBS Trust/PPO	$3,044.61
Rate for Payer: BCN Medicare Advantage	$5,210.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,210.78
Rate for Payer: Mclaren Medicaid	$2,850.30
Rate for Payer: Mclaren Medicare	$5,210.78
Rate for Payer: Meridian Medicaid	$2,993.07
Rate for Payer: Meridian Wellcare - Medicare Advantage	$5,471.32
Rate for Payer: MI Amish Medical Board Commercial	$5,992.40
Rate for Payer: PACE Medicare	$4,950.24
Rate for Payer: PACE SWMI	$5,210.78
Rate for Payer: PHP Medicare Advantage	$5,210.78
Rate for Payer: Priority Health Choice Medicaid	$2,850.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,835.74
Rate for Payer: Priority Health Medicare	$5,210.78
Rate for Payer: Priority Health Narrow Network	$12,668.59
Rate for Payer: Railroad Medicare Medicare	$5,210.78
Rate for Payer: UHC All Payor (Choice/PPO)	$620.96
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$5,210.78
Rate for Payer: UHC Exchange	$564.51
Rate for Payer: UHC Medicare Advantage	$5,367.10
Rate for Payer: VA VA	$5,210.78

GRAFTING OF AUTOLOGOUS SOFT TISSUE, OTHER, HARVESTED BY DIRECT EXCISION (EG, FAT, DERMIS, FASCIA)

Facility

$5,427.00

Service Code	CPT 15769
Hospital Revenue Code	360
Min. Negotiated Rate	$474.14
Max. Negotiated Rate	$5,427.00
Rate for Payer: Aetna Medicare	$3,319.93
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,990.30
Rate for Payer: Amish Plain Church Group Commercial	$3,990.30
Rate for Payer: BCBS Complete	$1,833.62
Rate for Payer: BCBS MAPPO	$3,192.24
Rate for Payer: BCBS Trust/PPO	$1,450.73
Rate for Payer: BCN Medicare Advantage	$3,192.24
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,192.24
Rate for Payer: Mclaren Medicaid	$1,746.16
Rate for Payer: Mclaren Medicare	$3,192.24
Rate for Payer: Meridian Medicaid	$1,833.62
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,351.85
Rate for Payer: MI Amish Medical Board Commercial	$3,671.08
Rate for Payer: PACE Medicare	$3,032.63
Rate for Payer: PACE SWMI	$3,192.24
Rate for Payer: PHP Medicare Advantage	$3,192.24
Rate for Payer: Priority Health Choice Medicaid	$1,746.16
Rate for Payer: Priority Health Medicare	$3,192.24
Rate for Payer: Railroad Medicare Medicare	$3,192.24
Rate for Payer: UHC All Payor (Choice/PPO)	$521.55
Rate for Payer: UHC Core	$5,427.00
Rate for Payer: UHC Dual Complete DSNP	$3,192.24
Rate for Payer: UHC Exchange	$474.14
Rate for Payer: UHC Medicare Advantage	$3,288.01
Rate for Payer: VA VA	$3,192.24

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.01

Service Code	NDC 0121-1488-10
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$6.31
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna New Business (MI Preferred)	$4.56
Rate for Payer: Cash Price	$5.61
Rate for Payer: Cofinity Commercial	$4.91
Rate for Payer: Cofinity Commercial	$6.03
Rate for Payer: Healthscope Commercial	$6.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.96
Rate for Payer: PHP Commercial	$5.96
Rate for Payer: Priority Health Cigna Priority Health	$4.91
Rate for Payer: Priority Health SBD	$4.42

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.14

Service Code	NDC 50383-063-12
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: BCBS Complete	$1.26
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$1.98

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.01

Service Code	NDC 0121-1488-00
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$6.31
Rate for Payer: Aetna Commercial	$5.96
Rate for Payer: Aetna New Business (MI Preferred)	$4.56
Rate for Payer: Cash Price	$5.61
Rate for Payer: Cofinity Commercial	$4.91
Rate for Payer: Cofinity Commercial	$6.03
Rate for Payer: Healthscope Commercial	$6.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.96
Rate for Payer: PHP Commercial	$5.96
Rate for Payer: Priority Health Cigna Priority Health	$4.91
Rate for Payer: Priority Health SBD	$4.42

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.14

Service Code	NDC 50383-063-12
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.83
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.04
Rate for Payer: Cash Price	$2.51
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.70
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$1.98

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.80

Service Code	NDC 0121-1744-10
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$3.42
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna New Business (MI Preferred)	$2.47
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cofinity Commercial	$2.66
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Healthscope Commercial	$3.42
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.23
Rate for Payer: PHP Commercial	$3.23
Rate for Payer: Priority Health Cigna Priority Health	$2.66
Rate for Payer: Priority Health SBD	$2.39

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$269.80

Service Code	NDC 63824-008-15
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$169.97
Max. Negotiated Rate	$242.82
Rate for Payer: Aetna Commercial	$229.33
Rate for Payer: Aetna New Business (MI Preferred)	$175.37
Rate for Payer: Cash Price	$215.84
Rate for Payer: Cofinity Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$229.33
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$188.86
Rate for Payer: Priority Health SBD	$169.97

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$115.90

Service Code	NDC 63824-008-34
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$73.02
Max. Negotiated Rate	$104.31
Rate for Payer: Aetna Commercial	$98.52
Rate for Payer: Aetna New Business (MI Preferred)	$75.34
Rate for Payer: Cash Price	$92.72
Rate for Payer: Cofinity Commercial	$81.13
Rate for Payer: Cofinity Commercial	$99.67
Rate for Payer: Healthscope Commercial	$104.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$98.52
Rate for Payer: PHP Commercial	$98.52
Rate for Payer: Priority Health Cigna Priority Health	$81.13
Rate for Payer: Priority Health SBD	$73.02

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$126.20

Service Code	NDC 96295-12390
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$79.51
Max. Negotiated Rate	$113.58
Rate for Payer: Aetna Commercial	$107.27
Rate for Payer: Aetna New Business (MI Preferred)	$82.03
Rate for Payer: Cash Price	$100.96
Rate for Payer: Cofinity Commercial	$108.53
Rate for Payer: Cofinity Commercial	$88.34
Rate for Payer: Healthscope Commercial	$113.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$107.27
Rate for Payer: PHP Commercial	$107.27
Rate for Payer: Priority Health Cigna Priority Health	$88.34
Rate for Payer: Priority Health SBD	$79.51

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$3.69

Service Code	NDC 68084-572-11
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Healthscope Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.58
Rate for Payer: Priority Health SBD	$2.32

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$1,178.00

Service Code	NDC 0904-6986-40
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$742.14
Max. Negotiated Rate	$1,060.20
Rate for Payer: Aetna Commercial	$1,001.30
Rate for Payer: Aetna New Business (MI Preferred)	$765.70
Rate for Payer: Cash Price	$942.40
Rate for Payer: Cofinity Commercial	$1,013.08
Rate for Payer: Cofinity Commercial	$824.60
Rate for Payer: Healthscope Commercial	$1,060.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,001.30
Rate for Payer: PHP Commercial	$1,001.30
Rate for Payer: Priority Health Cigna Priority Health	$824.60
Rate for Payer: Priority Health SBD	$742.14

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$368.16

Service Code	NDC 68084-572-01
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$231.94
Max. Negotiated Rate	$331.34
Rate for Payer: Aetna Commercial	$312.94
Rate for Payer: Aetna New Business (MI Preferred)	$239.30
Rate for Payer: Cash Price	$294.53
Rate for Payer: Cofinity Commercial	$257.71
Rate for Payer: Cofinity Commercial	$316.62
Rate for Payer: Healthscope Commercial	$331.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$312.94
Rate for Payer: PHP Commercial	$312.94
Rate for Payer: Priority Health Cigna Priority Health	$257.71
Rate for Payer: Priority Health SBD	$231.94

GUANFACINE 1 MG TABLET

Facility

$190.95

Service Code	NDC 68084-748-25
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$171.86
Rate for Payer: Aetna Commercial	$162.31
Rate for Payer: Aetna New Business (MI Preferred)	$124.12
Rate for Payer: Cash Price	$152.76
Rate for Payer: Cofinity Commercial	$133.66
Rate for Payer: Cofinity Commercial	$164.22
Rate for Payer: Healthscope Commercial	$171.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$162.31
Rate for Payer: PHP Commercial	$162.31
Rate for Payer: Priority Health Cigna Priority Health	$133.66
Rate for Payer: Priority Health SBD	$120.30

GUANFACINE 1 MG TABLET

Facility

$189.65

Service Code	NDC 68094-019-62
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$119.48
Max. Negotiated Rate	$170.68
Rate for Payer: Aetna Commercial	$161.20
Rate for Payer: Aetna New Business (MI Preferred)	$123.27
Rate for Payer: Cash Price	$151.72
Rate for Payer: Cofinity Commercial	$132.76
Rate for Payer: Cofinity Commercial	$163.10
Rate for Payer: Healthscope Commercial	$170.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$161.20
Rate for Payer: PHP Commercial	$161.20
Rate for Payer: Priority Health Cigna Priority Health	$132.76
Rate for Payer: Priority Health SBD	$119.48

GUANFACINE 1 MG TABLET

Facility

$446.50

Service Code	NDC 0591-0444-01
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$281.30
Max. Negotiated Rate	$401.85
Rate for Payer: Aetna Commercial	$379.52
Rate for Payer: Aetna New Business (MI Preferred)	$290.22
Rate for Payer: Cash Price	$357.20
Rate for Payer: Cofinity Commercial	$312.55
Rate for Payer: Cofinity Commercial	$383.99
Rate for Payer: Healthscope Commercial	$401.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$379.52
Rate for Payer: PHP Commercial	$379.52
Rate for Payer: Priority Health Cigna Priority Health	$312.55
Rate for Payer: Priority Health SBD	$281.30

GUANFACINE 1 MG TABLET

Facility

$6.37

Service Code	NDC 68084-748-95
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.14
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$4.46
Rate for Payer: Cofinity Commercial	$5.48
Rate for Payer: Healthscope Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.46
Rate for Payer: Priority Health SBD	$4.01

GUANFACINE 1 MG TABLET

Facility

$210.96

Service Code	NDC 0904-7140-04
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$132.90
Max. Negotiated Rate	$189.86
Rate for Payer: Aetna Commercial	$179.32
Rate for Payer: Aetna New Business (MI Preferred)	$137.12
Rate for Payer: Cash Price	$168.77
Rate for Payer: Cofinity Commercial	$147.67
Rate for Payer: Cofinity Commercial	$181.43
Rate for Payer: Healthscope Commercial	$189.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$179.32
Rate for Payer: PHP Commercial	$179.32
Rate for Payer: Priority Health Cigna Priority Health	$147.67
Rate for Payer: Priority Health SBD	$132.90

Know your out-of-pocket cost for care.

All Charges