Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

AMITRIPTYLINE 50 MG TABLET

Facility

$3.32

Service Code	NDC 51079013301
Hospital Charge Code	436
Hospital Revenue Code	637
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$2.16
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Advantage	$2.32
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health SBD	$2.09

AMLODIPINE 10 MG TABLET

Facility

$338.40

Service Code	NDC 60687049601
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$132.99
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna Medicare	$169.20
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: BCBS Complete	$135.36
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Advantage	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: MI Amish Medical Board Commercial	$270.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.80
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health SBD	$213.19
Rate for Payer: UHC All Payor (Choice/PPO)	$219.96
Rate for Payer: UHC Core	$176.31
Rate for Payer: UHC Exchange	$132.99

AMLODIPINE 10 MG TABLET

Facility

$157.45

Service Code	NDC 00904637161
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$99.19
Max. Negotiated Rate	$141.71
Rate for Payer: Aetna Commercial	$133.83
Rate for Payer: Aetna New Business (MI Preferred)	$102.34
Rate for Payer: Cash Price	$125.96
Rate for Payer: Cofinity Advantage	$110.22
Rate for Payer: Cofinity Commercial	$135.41
Rate for Payer: Encore Health Key Benefits Commercial	$125.96
Rate for Payer: Healthscope Commercial	$141.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.09
Rate for Payer: PHP Commercial	$133.83
Rate for Payer: Priority Health SBD	$99.19

AMLODIPINE 10 MG TABLET

Facility

$3.39

Service Code	NDC 60687049611
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cofinity Advantage	$2.37
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.71
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.54
Rate for Payer: PHP Commercial	$2.88
Rate for Payer: Priority Health SBD	$2.14

AMLODIPINE 10 MG TABLET

Facility

$40.19

Service Code	NDC 69097012805
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$25.32
Max. Negotiated Rate	$36.17
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna New Business (MI Preferred)	$26.12
Rate for Payer: Cash Price	$32.15
Rate for Payer: Cofinity Advantage	$28.13
Rate for Payer: Cofinity Commercial	$34.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.15
Rate for Payer: Healthscope Commercial	$36.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.14
Rate for Payer: PHP Commercial	$34.16
Rate for Payer: Priority Health SBD	$25.32

AMLODIPINE 10 MG TABLET

Facility

$40.19

Service Code	NDC 69097012805
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$15.79
Max. Negotiated Rate	$36.17
Rate for Payer: Aetna Commercial	$34.16
Rate for Payer: Aetna Medicare	$20.09
Rate for Payer: Aetna New Business (MI Preferred)	$26.12
Rate for Payer: BCBS Complete	$16.08
Rate for Payer: Cash Price	$32.15
Rate for Payer: Cofinity Advantage	$28.13
Rate for Payer: Cofinity Commercial	$34.56
Rate for Payer: Encore Health Key Benefits Commercial	$32.15
Rate for Payer: Healthscope Commercial	$36.17
Rate for Payer: MI Amish Medical Board Commercial	$32.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$34.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.14
Rate for Payer: PHP Commercial	$34.16
Rate for Payer: Priority Health SBD	$25.32
Rate for Payer: UHC All Payor (Choice/PPO)	$26.12
Rate for Payer: UHC Core	$20.94
Rate for Payer: UHC Exchange	$15.79

AMLODIPINE 10 MG TABLET

Facility

$3.39

Service Code	NDC 60687049611
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$3.05
Rate for Payer: Aetna Commercial	$2.88
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.20
Rate for Payer: BCBS Complete	$1.36
Rate for Payer: Cash Price	$2.71
Rate for Payer: Cofinity Advantage	$2.37
Rate for Payer: Cofinity Commercial	$2.92
Rate for Payer: Encore Health Key Benefits Commercial	$2.71
Rate for Payer: Healthscope Commercial	$3.05
Rate for Payer: MI Amish Medical Board Commercial	$2.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.54
Rate for Payer: PHP Commercial	$2.88
Rate for Payer: Priority Health SBD	$2.14
Rate for Payer: UHC All Payor (Choice/PPO)	$2.20
Rate for Payer: UHC Core	$1.77
Rate for Payer: UHC Exchange	$1.33

AMLODIPINE 10 MG TABLET

Facility

$338.40

Service Code	NDC 60687049601
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$213.19
Max. Negotiated Rate	$304.56
Rate for Payer: Aetna Commercial	$287.64
Rate for Payer: Aetna New Business (MI Preferred)	$219.96
Rate for Payer: Cash Price	$270.72
Rate for Payer: Cofinity Advantage	$236.88
Rate for Payer: Cofinity Commercial	$291.02
Rate for Payer: Encore Health Key Benefits Commercial	$270.72
Rate for Payer: Healthscope Commercial	$304.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$287.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.80
Rate for Payer: PHP Commercial	$287.64
Rate for Payer: Priority Health SBD	$213.19

AMLODIPINE 10 MG TABLET

Facility

$157.45

Service Code	NDC 00904637161
Hospital Charge Code	9069
Hospital Revenue Code	637
Min. Negotiated Rate	$61.88
Max. Negotiated Rate	$141.71
Rate for Payer: Aetna Commercial	$133.83
Rate for Payer: Aetna Medicare	$78.72
Rate for Payer: Aetna New Business (MI Preferred)	$102.34
Rate for Payer: BCBS Complete	$62.98
Rate for Payer: Cash Price	$125.96
Rate for Payer: Cofinity Advantage	$110.22
Rate for Payer: Cofinity Commercial	$135.41
Rate for Payer: Encore Health Key Benefits Commercial	$125.96
Rate for Payer: Healthscope Commercial	$141.71
Rate for Payer: MI Amish Medical Board Commercial	$125.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.09
Rate for Payer: PHP Commercial	$133.83
Rate for Payer: Priority Health SBD	$99.19
Rate for Payer: UHC All Payor (Choice/PPO)	$102.34
Rate for Payer: UHC Core	$82.03
Rate for Payer: UHC Exchange	$61.88

AMLODIPINE 2.5 MG TABLET

Facility

$227.95

Service Code	NDC 00904636961
Hospital Charge Code	9070
Hospital Revenue Code	637
Min. Negotiated Rate	$143.61
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Advantage	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$170.96
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health SBD	$143.61

AMLODIPINE 2.5 MG TABLET

Facility

$31.73

Service Code	NDC 69097012605
Hospital Charge Code	9070
Hospital Revenue Code	637
Min. Negotiated Rate	$19.99
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Advantage	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.80
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health SBD	$19.99

AMLODIPINE 2.5 MG TABLET

Facility

$31.73

Service Code	NDC 69097012605
Hospital Charge Code	9070
Hospital Revenue Code	637
Min. Negotiated Rate	$12.47
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Commercial	$26.97
Rate for Payer: Aetna Medicare	$15.87
Rate for Payer: Aetna New Business (MI Preferred)	$20.62
Rate for Payer: BCBS Complete	$12.69
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cofinity Advantage	$22.21
Rate for Payer: Cofinity Commercial	$27.29
Rate for Payer: Encore Health Key Benefits Commercial	$25.38
Rate for Payer: Healthscope Commercial	$28.56
Rate for Payer: MI Amish Medical Board Commercial	$25.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$26.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.80
Rate for Payer: PHP Commercial	$26.97
Rate for Payer: Priority Health SBD	$19.99
Rate for Payer: UHC All Payor (Choice/PPO)	$20.62
Rate for Payer: UHC Core	$16.53
Rate for Payer: UHC Exchange	$12.47

AMLODIPINE 2.5 MG TABLET

Facility

$227.95

Service Code	NDC 00904636961
Hospital Charge Code	9070
Hospital Revenue Code	637
Min. Negotiated Rate	$89.58
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna Medicare	$113.97
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: BCBS Complete	$91.18
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Advantage	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: MI Amish Medical Board Commercial	$182.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$170.96
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health SBD	$143.61
Rate for Payer: UHC All Payor (Choice/PPO)	$148.17
Rate for Payer: UHC Core	$118.76
Rate for Payer: UHC Exchange	$89.58

AMLODIPINE 5 MG TABLET

Facility

$195.05

Service Code	NDC 00904637061
Hospital Charge Code	9071
Hospital Revenue Code	637
Min. Negotiated Rate	$122.88
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Advantage	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.29
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health SBD	$122.88

AMLODIPINE 5 MG TABLET

Facility

$195.05

Service Code	NDC 904637061
Hospital Charge Code	9071
Hospital Revenue Code	637
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna Medicare	$97.53
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: BCBS Complete	$78.02
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Advantage	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: MI Amish Medical Board Commercial	$156.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.29
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health SBD	$122.88
Rate for Payer: UHC All Payor (Choice/PPO)	$126.78
Rate for Payer: UHC Core	$101.62
Rate for Payer: UHC Exchange	$76.65

AMLODIPINE 5 MG TABLET

Facility

$1.84

Service Code	NDC 51079045101
Hospital Charge Code	9071
Hospital Revenue Code	637
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna Commercial	$1.56
Rate for Payer: Aetna New Business (MI Preferred)	$1.20
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cofinity Advantage	$1.29
Rate for Payer: Cofinity Commercial	$1.58
Rate for Payer: Encore Health Key Benefits Commercial	$1.47
Rate for Payer: Healthscope Commercial	$1.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.38
Rate for Payer: PHP Commercial	$1.56
Rate for Payer: Priority Health SBD	$1.16

AMLODIPINE 5 MG TABLET

Facility

$1.84

Service Code	NDC 51079045101
Hospital Charge Code	9071
Hospital Revenue Code	637
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.66
Rate for Payer: Aetna Commercial	$1.56
Rate for Payer: Aetna Medicare	$0.92
Rate for Payer: Aetna New Business (MI Preferred)	$1.20
Rate for Payer: BCBS Complete	$0.74
Rate for Payer: Cash Price	$1.47
Rate for Payer: Cofinity Advantage	$1.29
Rate for Payer: Cofinity Commercial	$1.58
Rate for Payer: Encore Health Key Benefits Commercial	$1.47
Rate for Payer: Healthscope Commercial	$1.66
Rate for Payer: MI Amish Medical Board Commercial	$1.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.38
Rate for Payer: PHP Commercial	$1.56
Rate for Payer: Priority Health SBD	$1.16
Rate for Payer: UHC All Payor (Choice/PPO)	$1.20
Rate for Payer: UHC Core	$0.96
Rate for Payer: UHC Exchange	$0.72

AMLODIPINE 5 MG TABLET

Facility

$195.05

Service Code	NDC 00904637061
Hospital Charge Code	9071
Hospital Revenue Code	637
Min. Negotiated Rate	$76.65
Max. Negotiated Rate	$175.54
Rate for Payer: Aetna Commercial	$165.79
Rate for Payer: Aetna Medicare	$97.53
Rate for Payer: Aetna New Business (MI Preferred)	$126.78
Rate for Payer: BCBS Complete	$78.02
Rate for Payer: Cash Price	$156.04
Rate for Payer: Cofinity Advantage	$136.53
Rate for Payer: Cofinity Commercial	$167.74
Rate for Payer: Encore Health Key Benefits Commercial	$156.04
Rate for Payer: Healthscope Commercial	$175.54
Rate for Payer: MI Amish Medical Board Commercial	$156.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.29
Rate for Payer: PHP Commercial	$165.79
Rate for Payer: Priority Health SBD	$122.88
Rate for Payer: UHC All Payor (Choice/PPO)	$126.78
Rate for Payer: UHC Core	$101.62
Rate for Payer: UHC Exchange	$76.65

AMMONIUM LACTATE 12 % LOTION

Facility

$27.81

Service Code	NDC 45802052555
Hospital Charge Code	10380
Hospital Revenue Code	637
Min. Negotiated Rate	$10.93
Max. Negotiated Rate	$25.03
Rate for Payer: Aetna Commercial	$23.64
Rate for Payer: Aetna Medicare	$13.90
Rate for Payer: Aetna New Business (MI Preferred)	$18.08
Rate for Payer: BCBS Complete	$11.12
Rate for Payer: Cash Price	$22.25
Rate for Payer: Cofinity Advantage	$19.47
Rate for Payer: Cofinity Commercial	$23.92
Rate for Payer: Encore Health Key Benefits Commercial	$22.25
Rate for Payer: Healthscope Commercial	$25.03
Rate for Payer: MI Amish Medical Board Commercial	$22.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.86
Rate for Payer: PHP Commercial	$23.64
Rate for Payer: Priority Health SBD	$17.52
Rate for Payer: UHC All Payor (Choice/PPO)	$18.08
Rate for Payer: UHC Core	$14.49
Rate for Payer: UHC Exchange	$10.93

AMMONIUM LACTATE 12 % LOTION

Facility

$27.81

Service Code	NDC 45802052555
Hospital Charge Code	10380
Hospital Revenue Code	637
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$25.03
Rate for Payer: Aetna Commercial	$23.64
Rate for Payer: Aetna New Business (MI Preferred)	$18.08
Rate for Payer: Cash Price	$22.25
Rate for Payer: Cofinity Advantage	$19.47
Rate for Payer: Cofinity Commercial	$23.92
Rate for Payer: Encore Health Key Benefits Commercial	$22.25
Rate for Payer: Healthscope Commercial	$25.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.86
Rate for Payer: PHP Commercial	$23.64
Rate for Payer: Priority Health SBD	$17.52

AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION

Facility

$82.25

Service Code	NDC 00093415573
Hospital Charge Code	454
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

AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION

Facility

$8.23

Service Code	NDC 09900001117
Hospital Charge Code	454
Hospital Revenue Code	637
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$7.41
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna New Business (MI Preferred)	$5.35
Rate for Payer: Cash Price	$6.58
Rate for Payer: Cofinity Advantage	$5.76
Rate for Payer: Cofinity Commercial	$7.08
Rate for Payer: Encore Health Key Benefits Commercial	$6.58
Rate for Payer: Healthscope Commercial	$7.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.17
Rate for Payer: PHP Commercial	$7.00
Rate for Payer: Priority Health SBD	$5.18

AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION

Facility

$77.55

Service Code	NDC 00781604146
Hospital Charge Code	454
Hospital Revenue Code	637
Min. Negotiated Rate	$30.48
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna Medicare	$38.77
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: BCBS Complete	$31.02
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Advantage	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: MI Amish Medical Board Commercial	$62.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.16
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health SBD	$48.86
Rate for Payer: UHC All Payor (Choice/PPO)	$50.41
Rate for Payer: UHC Core	$40.40
Rate for Payer: UHC Exchange	$30.48

AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION

Facility

$77.55

Service Code	NDC 00781604146
Hospital Charge Code	454
Hospital Revenue Code	637
Min. Negotiated Rate	$48.86
Max. Negotiated Rate	$69.80
Rate for Payer: Aetna Commercial	$65.92
Rate for Payer: Aetna New Business (MI Preferred)	$50.41
Rate for Payer: Cash Price	$62.04
Rate for Payer: Cofinity Advantage	$54.28
Rate for Payer: Cofinity Commercial	$66.69
Rate for Payer: Encore Health Key Benefits Commercial	$62.04
Rate for Payer: Healthscope Commercial	$69.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$58.16
Rate for Payer: PHP Commercial	$65.92
Rate for Payer: Priority Health SBD	$48.86

AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION

Facility

$82.25

Service Code	NDC 00093415573
Hospital Charge Code	454
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

Know your out-of-pocket cost for care.

All Charges