Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

GLYCOPYRROLATE 1 MG TABLET

Facility

$385.70

Service Code	NDC 69076047501
Hospital Charge Code	10130
Hospital Revenue Code	637
Min. Negotiated Rate	$242.99
Max. Negotiated Rate	$347.13
Rate for Payer: Aetna Commercial	$327.85
Rate for Payer: Aetna New Business (MI Preferred)	$250.71
Rate for Payer: Cash Price	$308.56
Rate for Payer: Cofinity Advantage	$269.99
Rate for Payer: Cofinity Commercial	$331.70
Rate for Payer: Encore Health Key Benefits Commercial	$308.56
Rate for Payer: Healthscope Commercial	$347.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$327.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$289.27
Rate for Payer: PHP Commercial	$327.85
Rate for Payer: Priority Health SBD	$242.99

GLYCOPYRROLATE 1 MG TABLET

Facility

$375.36

Service Code	NDC 00904670961
Hospital Charge Code	10130
Hospital Revenue Code	637
Min. Negotiated Rate	$147.52
Max. Negotiated Rate	$337.82
Rate for Payer: Aetna Commercial	$319.06
Rate for Payer: Aetna Medicare	$187.68
Rate for Payer: Aetna New Business (MI Preferred)	$243.98
Rate for Payer: BCBS Complete	$150.14
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Advantage	$262.75
Rate for Payer: Cofinity Commercial	$322.81
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$337.82
Rate for Payer: MI Amish Medical Board Commercial	$300.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$281.52
Rate for Payer: PHP Commercial	$319.06
Rate for Payer: Priority Health SBD	$236.48
Rate for Payer: UHC All Payor (Choice/PPO)	$243.98
Rate for Payer: UHC Core	$195.56
Rate for Payer: UHC Exchange	$147.52

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	$5.90
Max. Negotiated Rate	$5,610.93
Rate for Payer: Aetna Commercial	$5,299.21
Rate for Payer: Aetna Medicare	$11.74
Rate for Payer: Aetna New Business (MI Preferred)	$4,052.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$14.11
Rate for Payer: Amish Plain Church Group Commercial	$14.11
Rate for Payer: BCBS Complete	$6.20
Rate for Payer: BCBS MAPPO	$11.29
Rate for Payer: BCBS Trust/PPO	$29.18
Rate for Payer: BCN Commercial	$29.18
Rate for Payer: BCN Medicare Advantage	$11.29
Rate for Payer: Cash Price	$4,987.50
Rate for Payer: Cash Price	$4,987.50
Rate for Payer: Cofinity Advantage	$4,364.06
Rate for Payer: Cofinity Commercial	$5,361.56
Rate for Payer: Encore Health Key Benefits Commercial	$4,987.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$11.29
Rate for Payer: Healthscope Commercial	$5,610.93
Rate for Payer: Mclaren Medicaid	$5.90
Rate for Payer: Mclaren Medicare	$11.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$11.85
Rate for Payer: Meridian Medicaid	$11.85
Rate for Payer: MI Amish Medical Board Commercial	$12.98
Rate for Payer: Molina Medicare/Medicaid	$12.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,299.21
Rate for Payer: Nomi Health Commercial	$33.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,675.78
Rate for Payer: PACE Medicare	$10.73
Rate for Payer: PACE SWMI	$11.29
Rate for Payer: PHP Commercial	$5,299.21
Rate for Payer: PHP Medicare Advantage	$11.29
Rate for Payer: Priority Health Choice Medicaid	$5.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$34.83
Rate for Payer: Priority Health Medicare	$11.29
Rate for Payer: Priority Health SBD	$3,927.65
Rate for Payer: Priority Health Tiered Network	$27.86
Rate for Payer: Railroad Medicare Medicare	$11.29
Rate for Payer: UHC All Payor (Choice/PPO)	$19.19
Rate for Payer: UHC Core	$19.19
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$11.29
Rate for Payer: UHC Exchange	$19.19
Rate for Payer: UHC Medicaid	$5.90
Rate for Payer: UHCCP Medicaid	$5.90
Rate for Payer: VA VA	$11.29

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 Advantage	$4,364.06
Rate for Payer: Cofinity Commercial	$5,361.56
Rate for Payer: Encore Health Key Benefits Commercial	$4,987.50
Rate for Payer: Healthscope Commercial	$5,610.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5,299.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,675.78
Rate for Payer: PHP Commercial	$5,299.21
Rate for Payer: Priority Health SBD	$3,927.65

GOSERELIN 10.8 MG SUBCUTANEOUS IMPLANT

Facility

$10,804.08

Service Code	HCPCS J9202
Hospital Charge Code	16254
Hospital Revenue Code	636
Min. Negotiated Rate	$1,282.88
Max. Negotiated Rate	$9,723.67
Rate for Payer: Aetna Commercial	$9,183.47
Rate for Payer: Aetna Medicare	$5,402.04
Rate for Payer: Aetna New Business (MI Preferred)	$7,022.65
Rate for Payer: BCBS Complete	$4,321.63
Rate for Payer: BCBS Trust/PPO	$1,914.52
Rate for Payer: BCN Commercial	$1,914.52
Rate for Payer: Cash Price	$8,643.26
Rate for Payer: Cash Price	$8,643.26
Rate for Payer: Cofinity Advantage	$7,562.86
Rate for Payer: Cofinity Commercial	$9,291.51
Rate for Payer: Encore Health Key Benefits Commercial	$8,643.26
Rate for Payer: Healthscope Commercial	$9,723.67
Rate for Payer: MI Amish Medical Board Commercial	$8,643.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9,183.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,103.06
Rate for Payer: PHP Commercial	$9,183.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,313.97
Rate for Payer: Priority Health SBD	$6,806.57
Rate for Payer: Priority Health Tiered Network	$1,851.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,282.88
Rate for Payer: UHC Core	$1,282.88
Rate for Payer: UHC Exchange	$1,282.88

GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT

Facility

$3,364.48

Service Code	HCPCS J9202
Hospital Charge Code	10137
Hospital Revenue Code	636
Min. Negotiated Rate	$1,282.88
Max. Negotiated Rate	$3,028.03
Rate for Payer: Aetna Commercial	$2,859.81
Rate for Payer: Aetna Medicare	$1,682.24
Rate for Payer: Aetna New Business (MI Preferred)	$2,186.91
Rate for Payer: BCBS Complete	$1,345.79
Rate for Payer: BCBS Trust/PPO	$1,914.52
Rate for Payer: BCN Commercial	$1,914.52
Rate for Payer: Cash Price	$2,691.58
Rate for Payer: Cash Price	$2,691.58
Rate for Payer: Cofinity Advantage	$2,355.14
Rate for Payer: Cofinity Commercial	$2,893.45
Rate for Payer: Encore Health Key Benefits Commercial	$2,691.58
Rate for Payer: Healthscope Commercial	$3,028.03
Rate for Payer: MI Amish Medical Board Commercial	$2,691.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,859.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,523.36
Rate for Payer: PHP Commercial	$2,859.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,313.97
Rate for Payer: Priority Health SBD	$2,119.62
Rate for Payer: Priority Health Tiered Network	$1,851.18
Rate for Payer: UHC All Payor (Choice/PPO)	$1,282.88
Rate for Payer: UHC Core	$1,282.88
Rate for Payer: UHC Exchange	$1,282.88

GOSERELIN 3.6 MG SUBCUTANEOUS IMPLANT

Facility

$3,364.48

Service Code	HCPCS J9202
Hospital Charge Code	10137
Hospital Revenue Code	636
Min. Negotiated Rate	$2,119.62
Max. Negotiated Rate	$3,028.03
Rate for Payer: Aetna Commercial	$2,859.81
Rate for Payer: Aetna New Business (MI Preferred)	$2,186.91
Rate for Payer: Cash Price	$2,691.58
Rate for Payer: Cofinity Advantage	$2,355.14
Rate for Payer: Cofinity Commercial	$2,893.45
Rate for Payer: Encore Health Key Benefits Commercial	$2,691.58
Rate for Payer: Healthscope Commercial	$3,028.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,859.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,523.36
Rate for Payer: PHP Commercial	$2,859.81
Rate for Payer: Priority Health SBD	$2,119.62

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

Facility

$19,075.37

Service Code	CPT 21235
Hospital Revenue Code	360
Min. Negotiated Rate	$3,084.94
Max. Negotiated Rate	$19,075.37
Rate for Payer: Aetna Medicare	$6,134.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,373.18
Rate for Payer: Amish Plain Church Group Commercial	$7,373.18
Rate for Payer: BCBS Complete	$3,239.48
Rate for Payer: BCBS MAPPO	$5,898.54
Rate for Payer: BCBS Trust/PPO	$4,015.81
Rate for Payer: BCN Commercial	$4,015.81
Rate for Payer: BCN Medicare Advantage	$5,898.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,898.54
Rate for Payer: Mclaren Medicaid	$3,084.94
Rate for Payer: Mclaren Medicare	$5,898.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,193.47
Rate for Payer: Meridian Medicaid	$6,193.47
Rate for Payer: MI Amish Medical Board Commercial	$6,783.32
Rate for Payer: Molina Medicare/Medicaid	$6,488.39
Rate for Payer: Nomi Health Commercial	$17,695.62
Rate for Payer: PACE Medicare	$5,603.61
Rate for Payer: PACE SWMI	$5,898.54
Rate for Payer: PHP Medicare Advantage	$5,898.54
Rate for Payer: Priority Health Choice Medicaid	$3,084.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$19,075.37
Rate for Payer: Priority Health Medicare	$5,898.54
Rate for Payer: Priority Health Tiered Network	$15,260.30
Rate for Payer: Railroad Medicare Medicare	$5,898.54
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$5,898.54
Rate for Payer: UHC Medicaid	$3,084.94
Rate for Payer: UHCCP Medicaid	$3,084.94
Rate for Payer: VA VA	$5,898.54

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

Facility

$11,418.88

Service Code	CPT 15769
Hospital Revenue Code	360
Min. Negotiated Rate	$1,846.70
Max. Negotiated Rate	$11,418.88
Rate for Payer: Aetna Medicare	$3,672.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,413.73
Rate for Payer: Amish Plain Church Group Commercial	$4,413.73
Rate for Payer: BCBS Complete	$1,939.21
Rate for Payer: BCBS MAPPO	$3,530.98
Rate for Payer: BCBS Trust/PPO	$1,913.49
Rate for Payer: BCN Commercial	$1,913.49
Rate for Payer: BCN Medicare Advantage	$3,530.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,530.98
Rate for Payer: Mclaren Medicaid	$1,846.70
Rate for Payer: Mclaren Medicare	$3,530.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,707.53
Rate for Payer: Meridian Medicaid	$3,707.53
Rate for Payer: MI Amish Medical Board Commercial	$4,060.63
Rate for Payer: Molina Medicare/Medicaid	$3,884.08
Rate for Payer: Nomi Health Commercial	$10,592.94
Rate for Payer: PACE Medicare	$3,354.43
Rate for Payer: PACE SWMI	$3,530.98
Rate for Payer: PHP Medicare Advantage	$3,530.98
Rate for Payer: Priority Health Choice Medicaid	$1,846.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$11,418.88
Rate for Payer: Priority Health Medicare	$3,530.98
Rate for Payer: Priority Health Tiered Network	$9,135.10
Rate for Payer: Railroad Medicare Medicare	$3,530.98
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$3,530.98
Rate for Payer: UHC Medicaid	$1,846.70
Rate for Payer: UHCCP Medicaid	$1,846.70
Rate for Payer: VA VA	$3,530.98

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.80

Service Code	NDC 00121174410
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$3.42
Rate for Payer: Aetna Commercial	$3.23
Rate for Payer: Aetna Medicare	$1.90
Rate for Payer: Aetna New Business (MI Preferred)	$2.47
Rate for Payer: BCBS Complete	$1.52
Rate for Payer: Cash Price	$3.04
Rate for Payer: Cofinity Advantage	$2.66
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.04
Rate for Payer: Healthscope Commercial	$3.42
Rate for Payer: MI Amish Medical Board Commercial	$3.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.85
Rate for Payer: PHP Commercial	$3.23
Rate for Payer: Priority Health SBD	$2.39
Rate for Payer: UHC All Payor (Choice/PPO)	$2.47
Rate for Payer: UHC Core	$1.98
Rate for Payer: UHC Exchange	$1.49

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.88

Service Code	NDC 00121148810
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$7.09
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna New Business (MI Preferred)	$5.12
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cofinity Advantage	$5.52
Rate for Payer: Cofinity Commercial	$6.78
Rate for Payer: Encore Health Key Benefits Commercial	$6.30
Rate for Payer: Healthscope Commercial	$7.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.91
Rate for Payer: PHP Commercial	$6.70
Rate for Payer: Priority Health SBD	$4.96

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.88

Service Code	NDC 00121148810
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.09
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna Medicare	$3.94
Rate for Payer: Aetna New Business (MI Preferred)	$5.12
Rate for Payer: BCBS Complete	$3.15
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cofinity Advantage	$5.52
Rate for Payer: Cofinity Commercial	$6.78
Rate for Payer: Encore Health Key Benefits Commercial	$6.30
Rate for Payer: Healthscope Commercial	$7.09
Rate for Payer: MI Amish Medical Board Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.91
Rate for Payer: PHP Commercial	$6.70
Rate for Payer: Priority Health SBD	$4.96
Rate for Payer: UHC All Payor (Choice/PPO)	$5.12
Rate for Payer: UHC Core	$4.11
Rate for Payer: UHC Exchange	$3.10

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.88

Service Code	NDC 00121148800
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.09
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna Medicare	$3.94
Rate for Payer: Aetna New Business (MI Preferred)	$5.12
Rate for Payer: BCBS Complete	$3.15
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cofinity Advantage	$5.52
Rate for Payer: Cofinity Commercial	$6.78
Rate for Payer: Encore Health Key Benefits Commercial	$6.30
Rate for Payer: Healthscope Commercial	$7.09
Rate for Payer: MI Amish Medical Board Commercial	$6.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.91
Rate for Payer: PHP Commercial	$6.70
Rate for Payer: Priority Health SBD	$4.96
Rate for Payer: UHC All Payor (Choice/PPO)	$5.12
Rate for Payer: UHC Core	$4.11
Rate for Payer: UHC Exchange	$3.10

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.80

Service Code	NDC 00121174410
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 Advantage	$2.66
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Encore Health Key Benefits Commercial	$3.04
Rate for Payer: Healthscope Commercial	$3.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.85
Rate for Payer: PHP Commercial	$3.23
Rate for Payer: Priority Health SBD	$2.39

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.88

Service Code	NDC 00121148800
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.96
Max. Negotiated Rate	$7.09
Rate for Payer: Aetna Commercial	$6.70
Rate for Payer: Aetna New Business (MI Preferred)	$5.12
Rate for Payer: Cash Price	$6.30
Rate for Payer: Cofinity Advantage	$5.52
Rate for Payer: Cofinity Commercial	$6.78
Rate for Payer: Encore Health Key Benefits Commercial	$6.30
Rate for Payer: Healthscope Commercial	$7.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.91
Rate for Payer: PHP Commercial	$6.70
Rate for Payer: Priority Health SBD	$4.96

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$1,168.50

Service Code	NDC 00904698640
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$459.22
Max. Negotiated Rate	$1,051.65
Rate for Payer: Aetna Commercial	$993.23
Rate for Payer: Aetna Medicare	$584.25
Rate for Payer: Aetna New Business (MI Preferred)	$759.52
Rate for Payer: BCBS Complete	$467.40
Rate for Payer: Cash Price	$934.80
Rate for Payer: Cofinity Advantage	$817.95
Rate for Payer: Cofinity Commercial	$1,004.91
Rate for Payer: Encore Health Key Benefits Commercial	$934.80
Rate for Payer: Healthscope Commercial	$1,051.65
Rate for Payer: MI Amish Medical Board Commercial	$934.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$993.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$876.38
Rate for Payer: PHP Commercial	$993.23
Rate for Payer: Priority Health SBD	$736.15
Rate for Payer: UHC All Payor (Choice/PPO)	$759.52
Rate for Payer: UHC Core	$608.79
Rate for Payer: UHC Exchange	$459.22

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$115.90

Service Code	NDC 63824000834
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)	$75.33
Rate for Payer: Cash Price	$92.72
Rate for Payer: Cofinity Advantage	$81.13
Rate for Payer: Cofinity Commercial	$99.67
Rate for Payer: Encore Health Key Benefits Commercial	$92.72
Rate for Payer: Healthscope Commercial	$104.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.92
Rate for Payer: PHP Commercial	$98.52
Rate for Payer: Priority Health SBD	$73.02

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$269.80

Service Code	NDC 63824000815
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$106.03
Max. Negotiated Rate	$242.82
Rate for Payer: Aetna Commercial	$229.33
Rate for Payer: Aetna Medicare	$134.90
Rate for Payer: Aetna New Business (MI Preferred)	$175.37
Rate for Payer: BCBS Complete	$107.92
Rate for Payer: Cash Price	$215.84
Rate for Payer: Cofinity Advantage	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Encore Health Key Benefits Commercial	$215.84
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: MI Amish Medical Board Commercial	$215.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$202.35
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health SBD	$169.97
Rate for Payer: UHC All Payor (Choice/PPO)	$175.37
Rate for Payer: UHC Core	$140.57
Rate for Payer: UHC Exchange	$106.03

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$115.90

Service Code	NDC 63824000834
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$45.55
Max. Negotiated Rate	$104.31
Rate for Payer: Aetna Commercial	$98.52
Rate for Payer: Aetna Medicare	$57.95
Rate for Payer: Aetna New Business (MI Preferred)	$75.33
Rate for Payer: BCBS Complete	$46.36
Rate for Payer: Cash Price	$92.72
Rate for Payer: Cofinity Advantage	$81.13
Rate for Payer: Cofinity Commercial	$99.67
Rate for Payer: Encore Health Key Benefits Commercial	$92.72
Rate for Payer: Healthscope Commercial	$104.31
Rate for Payer: MI Amish Medical Board Commercial	$92.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$98.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.92
Rate for Payer: PHP Commercial	$98.52
Rate for Payer: Priority Health SBD	$73.02
Rate for Payer: UHC All Payor (Choice/PPO)	$75.33
Rate for Payer: UHC Core	$60.38
Rate for Payer: UHC Exchange	$45.55

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$5.81

Service Code	NDC 68084057211
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$5.23
Rate for Payer: Aetna Commercial	$4.94
Rate for Payer: Aetna New Business (MI Preferred)	$3.78
Rate for Payer: Cash Price	$4.65
Rate for Payer: Cofinity Advantage	$4.07
Rate for Payer: Cofinity Commercial	$5.00
Rate for Payer: Encore Health Key Benefits Commercial	$4.65
Rate for Payer: Healthscope Commercial	$5.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.36
Rate for Payer: PHP Commercial	$4.94
Rate for Payer: Priority Health SBD	$3.66

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$580.80

Service Code	NDC 68084057201
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$228.25
Max. Negotiated Rate	$522.72
Rate for Payer: Aetna Commercial	$493.68
Rate for Payer: Aetna Medicare	$290.40
Rate for Payer: Aetna New Business (MI Preferred)	$377.52
Rate for Payer: BCBS Complete	$232.32
Rate for Payer: Cash Price	$464.64
Rate for Payer: Cofinity Advantage	$406.56
Rate for Payer: Cofinity Commercial	$499.49
Rate for Payer: Encore Health Key Benefits Commercial	$464.64
Rate for Payer: Healthscope Commercial	$522.72
Rate for Payer: MI Amish Medical Board Commercial	$464.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$493.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$435.60
Rate for Payer: PHP Commercial	$493.68
Rate for Payer: Priority Health SBD	$365.90
Rate for Payer: UHC All Payor (Choice/PPO)	$377.52
Rate for Payer: UHC Core	$302.60
Rate for Payer: UHC Exchange	$228.25

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$126.20

Service Code	NDC 96295012390
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$49.60
Max. Negotiated Rate	$113.58
Rate for Payer: Aetna Commercial	$107.27
Rate for Payer: Aetna Medicare	$63.10
Rate for Payer: Aetna New Business (MI Preferred)	$82.03
Rate for Payer: BCBS Complete	$50.48
Rate for Payer: Cash Price	$100.96
Rate for Payer: Cofinity Advantage	$88.34
Rate for Payer: Cofinity Commercial	$108.53
Rate for Payer: Encore Health Key Benefits Commercial	$100.96
Rate for Payer: Healthscope Commercial	$113.58
Rate for Payer: MI Amish Medical Board Commercial	$100.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.65
Rate for Payer: PHP Commercial	$107.27
Rate for Payer: Priority Health SBD	$79.51
Rate for Payer: UHC All Payor (Choice/PPO)	$82.03
Rate for Payer: UHC Core	$65.75
Rate for Payer: UHC Exchange	$49.60

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$269.80

Service Code	NDC 63824000815
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 Advantage	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Encore Health Key Benefits Commercial	$215.84
Rate for Payer: Healthscope Commercial	$242.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$229.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$202.35
Rate for Payer: PHP Commercial	$229.33
Rate for Payer: Priority Health SBD	$169.97

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$126.20

Service Code	NDC 96295012390
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 Advantage	$88.34
Rate for Payer: Cofinity Commercial	$108.53
Rate for Payer: Encore Health Key Benefits Commercial	$100.96
Rate for Payer: Healthscope Commercial	$113.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$107.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.65
Rate for Payer: PHP Commercial	$107.27
Rate for Payer: Priority Health SBD	$79.51

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$1,168.50

Service Code	NDC 00904698640
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$736.15
Max. Negotiated Rate	$1,051.65
Rate for Payer: Aetna Commercial	$993.23
Rate for Payer: Aetna New Business (MI Preferred)	$759.52
Rate for Payer: Cash Price	$934.80
Rate for Payer: Cofinity Advantage	$817.95
Rate for Payer: Cofinity Commercial	$1,004.91
Rate for Payer: Encore Health Key Benefits Commercial	$934.80
Rate for Payer: Healthscope Commercial	$1,051.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$993.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$876.38
Rate for Payer: PHP Commercial	$993.23
Rate for Payer: Priority Health SBD	$736.15

Know your out-of-pocket cost for care.

All Charges