Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

Facility

$10,050.52

Service Code	CPT 15769
Hospital Revenue Code	360
Min. Negotiated Rate	$1,913.77
Max. Negotiated Rate	$10,050.52
Rate for Payer: Aetna Medicare	$3,713.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,463.09
Rate for Payer: Amish Plain Church Group Commercial	$4,463.09
Rate for Payer: BCBS Complete	$2,009.46
Rate for Payer: BCBS MAPPO	$3,570.47
Rate for Payer: BCN Medicare Advantage	$3,570.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,570.47
Rate for Payer: Mclaren Medicaid	$1,913.77
Rate for Payer: Mclaren Medicare	$3,570.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,748.99
Rate for Payer: Meridian Medicaid	$2,009.46
Rate for Payer: MI Amish Medical Board Commercial	$4,106.04
Rate for Payer: PACE Medicare	$3,391.95
Rate for Payer: PACE SWMI	$3,570.47
Rate for Payer: PHP Medicare Advantage	$3,570.47
Rate for Payer: Priority Health Choice Medicaid	$1,913.77
Rate for Payer: Priority Health Medicare	$3,570.47
Rate for Payer: Railroad Medicare Medicare	$3,570.47
Rate for Payer: UHC All Payor (Choice/PPO)	$10,050.52
Rate for Payer: UHC Dual Complete DSNP	$3,570.47
Rate for Payer: UHC Medicare Advantage	$3,570.47
Rate for Payer: UHCCP Medicaid	$2,010.17
Rate for Payer: VA VA	$3,570.47

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.73

Service Code	NDC 00121148810
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna New Business (MI Preferred)	$5.02
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$5.41
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Cofinity Medicare Advantage	$5.41
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$6.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.57
Rate for Payer: PHP Commercial	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.87

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.73

Service Code	NDC 00121148810
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare	$3.87
Rate for Payer: Aetna New Business (MI Preferred)	$5.02
Rate for Payer: BCBS Complete	$3.09
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$5.41
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Cofinity Medicare Advantage	$5.41
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$6.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.57
Rate for Payer: PHP Commercial	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.87

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.73

Service Code	NDC 00121148800
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna New Business (MI Preferred)	$5.02
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$5.41
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Cofinity Medicare Advantage	$5.41
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$6.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.57
Rate for Payer: PHP Commercial	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.87

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.14

Service Code	NDC 50383006312
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: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$7.73

Service Code	NDC 00121148800
Hospital Charge Code	3542
Hospital Revenue Code	637
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: Aetna Medicare	$3.87
Rate for Payer: Aetna New Business (MI Preferred)	$5.02
Rate for Payer: BCBS Complete	$3.09
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$5.41
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Cofinity Medicare Advantage	$5.41
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$6.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.57
Rate for Payer: PHP Commercial	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.02
Rate for Payer: Priority Health SBD	$4.87

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	$1.52
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 Commercial	$2.66
Rate for Payer: Cofinity Commercial	$3.27
Rate for Payer: Cofinity Medicare Advantage	$2.66
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: PHP Commercial	$3.23
Rate for Payer: Priority Health Cigna Priority Health	$2.47
Rate for Payer: Priority Health SBD	$2.39

GUAIFENESIN 100 MG/5 ML ORAL LIQUID

Facility

$3.14

Service Code	NDC 50383006312
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 Medicare	$1.57
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: Cofinity Medicare Advantage	$2.20
Rate for Payer: Encore Health Key Benefits Commercial	$2.51
Rate for Payer: Healthscope Commercial	$2.83
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.67
Rate for Payer: PHP Commercial	$2.67
Rate for Payer: Priority Health Cigna Priority Health	$2.04
Rate for Payer: Priority Health SBD	$1.98

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	$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: Cofinity Medicare Advantage	$2.66
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: PHP Commercial	$3.23
Rate for Payer: Priority Health Cigna Priority Health	$2.47
Rate for Payer: Priority Health SBD	$2.39

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	$50.48
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 Commercial	$108.53
Rate for Payer: Cofinity Commercial	$88.34
Rate for Payer: Cofinity Medicare Advantage	$88.34
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: PHP Commercial	$107.27
Rate for Payer: Priority Health Cigna Priority Health	$82.03
Rate for Payer: Priority Health SBD	$79.51

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	$46.36
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 Commercial	$81.13
Rate for Payer: Cofinity Commercial	$99.67
Rate for Payer: Cofinity Medicare Advantage	$81.13
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: PHP Commercial	$98.52
Rate for Payer: Priority Health Cigna Priority Health	$75.33
Rate for Payer: Priority Health SBD	$73.02

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$3.64

Service Code	NDC 68084057211
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna New Business (MI Preferred)	$2.37
Rate for Payer: Cash Price	$2.91
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Commercial	$3.13
Rate for Payer: Cofinity Medicare Advantage	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.91
Rate for Payer: Healthscope Commercial	$3.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.09
Rate for Payer: PHP Commercial	$3.09
Rate for Payer: Priority Health Cigna Priority Health	$2.37
Rate for Payer: Priority Health SBD	$2.29

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$363.36

Service Code	NDC 68084057201
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$228.92
Max. Negotiated Rate	$327.02
Rate for Payer: Aetna Commercial	$308.86
Rate for Payer: Aetna New Business (MI Preferred)	$236.18
Rate for Payer: Cash Price	$290.69
Rate for Payer: Cofinity Commercial	$254.35
Rate for Payer: Cofinity Commercial	$312.49
Rate for Payer: Cofinity Medicare Advantage	$254.35
Rate for Payer: Encore Health Key Benefits Commercial	$290.69
Rate for Payer: Healthscope Commercial	$327.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$308.86
Rate for Payer: PHP Commercial	$308.86
Rate for Payer: Priority Health Cigna Priority Health	$236.18
Rate for Payer: Priority Health SBD	$228.92

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	$467.40
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 Commercial	$1,004.91
Rate for Payer: Cofinity Commercial	$817.95
Rate for Payer: Cofinity Medicare Advantage	$817.95
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: PHP Commercial	$993.23
Rate for Payer: Priority Health Cigna Priority Health	$759.52
Rate for Payer: Priority Health SBD	$736.15

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 Commercial	$81.13
Rate for Payer: Cofinity Commercial	$99.67
Rate for Payer: Cofinity Medicare Advantage	$81.13
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: PHP Commercial	$98.52
Rate for Payer: Priority Health Cigna Priority Health	$75.33
Rate for Payer: Priority Health SBD	$73.02

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 Commercial	$1,004.91
Rate for Payer: Cofinity Commercial	$817.95
Rate for Payer: Cofinity Medicare Advantage	$817.95
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: PHP Commercial	$993.23
Rate for Payer: Priority Health Cigna Priority Health	$759.52
Rate for Payer: Priority Health SBD	$736.15

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 Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Cofinity Medicare Advantage	$188.86
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: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$175.37
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 Commercial	$108.53
Rate for Payer: Cofinity Commercial	$88.34
Rate for Payer: Cofinity Medicare Advantage	$88.34
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: PHP Commercial	$107.27
Rate for Payer: Priority Health Cigna Priority Health	$82.03
Rate for Payer: Priority Health SBD	$79.51

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	$107.92
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 Commercial	$188.86
Rate for Payer: Cofinity Commercial	$232.03
Rate for Payer: Cofinity Medicare Advantage	$188.86
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: PHP Commercial	$229.33
Rate for Payer: Priority Health Cigna Priority Health	$175.37
Rate for Payer: Priority Health SBD	$169.97

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$363.36

Service Code	NDC 68084057201
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$145.34
Max. Negotiated Rate	$327.02
Rate for Payer: Aetna Commercial	$308.86
Rate for Payer: Aetna Medicare	$181.68
Rate for Payer: Aetna New Business (MI Preferred)	$236.18
Rate for Payer: BCBS Complete	$145.34
Rate for Payer: Cash Price	$290.69
Rate for Payer: Cofinity Commercial	$254.35
Rate for Payer: Cofinity Commercial	$312.49
Rate for Payer: Cofinity Medicare Advantage	$254.35
Rate for Payer: Encore Health Key Benefits Commercial	$290.69
Rate for Payer: Healthscope Commercial	$327.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$308.86
Rate for Payer: PHP Commercial	$308.86
Rate for Payer: Priority Health Cigna Priority Health	$236.18
Rate for Payer: Priority Health SBD	$228.92

GUAIFENESIN ER 600 MG TABLET, EXTENDED RELEASE 12 HR

Facility

$3.64

Service Code	NDC 68084057211
Hospital Charge Code	170771
Hospital Revenue Code	637
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$3.28
Rate for Payer: Aetna Commercial	$3.09
Rate for Payer: Aetna Medicare	$1.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.37
Rate for Payer: BCBS Complete	$1.46
Rate for Payer: Cash Price	$2.91
Rate for Payer: Cofinity Commercial	$2.55
Rate for Payer: Cofinity Commercial	$3.13
Rate for Payer: Cofinity Medicare Advantage	$2.55
Rate for Payer: Encore Health Key Benefits Commercial	$2.91
Rate for Payer: Healthscope Commercial	$3.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.09
Rate for Payer: PHP Commercial	$3.09
Rate for Payer: Priority Health Cigna Priority Health	$2.37
Rate for Payer: Priority Health SBD	$2.29

GUANFACINE 1 MG TABLET

Facility

$6.33

Service Code	NDC 68094001959
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$5.70
Rate for Payer: Aetna Commercial	$5.38
Rate for Payer: Aetna Medicare	$3.17
Rate for Payer: Aetna New Business (MI Preferred)	$4.11
Rate for Payer: BCBS Complete	$2.53
Rate for Payer: Cash Price	$5.06
Rate for Payer: Cofinity Commercial	$4.43
Rate for Payer: Cofinity Commercial	$5.44
Rate for Payer: Cofinity Medicare Advantage	$4.43
Rate for Payer: Encore Health Key Benefits Commercial	$5.06
Rate for Payer: Healthscope Commercial	$5.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.38
Rate for Payer: PHP Commercial	$5.38
Rate for Payer: Priority Health Cigna Priority Health	$4.11
Rate for Payer: Priority Health SBD	$3.99

GUANFACINE 1 MG TABLET

Facility

$6.37

Service Code	NDC 68084074895
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$5.73
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna Medicare	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$4.14
Rate for Payer: BCBS Complete	$2.55
Rate for Payer: Cash Price	$5.10
Rate for Payer: Cofinity Commercial	$4.46
Rate for Payer: Cofinity Commercial	$5.48
Rate for Payer: Cofinity Medicare Advantage	$4.46
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.14
Rate for Payer: Priority Health SBD	$4.01

GUANFACINE 1 MG TABLET

Facility

$190.95

Service Code	NDC 68084074825
Hospital Charge Code	10149
Hospital Revenue Code	637
Min. Negotiated Rate	$120.30
Max. Negotiated Rate	$171.85
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: Cofinity Medicare Advantage	$133.66
Rate for Payer: Encore Health Key Benefits Commercial	$152.76
Rate for Payer: Healthscope Commercial	$171.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$162.31
Rate for Payer: PHP Commercial	$162.31
Rate for Payer: Priority Health Cigna Priority Health	$124.12
Rate for Payer: Priority Health SBD	$120.30

GUANFACINE 1 MG TABLET

Facility

$6.37

Service Code	NDC 68084074895
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: Cofinity Medicare Advantage	$4.46
Rate for Payer: Encore Health Key Benefits Commercial	$5.10
Rate for Payer: Healthscope Commercial	$5.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health Cigna Priority Health	$4.14
Rate for Payer: Priority Health SBD	$4.01

Know your out-of-pocket cost for care.

All Charges