Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$3.32

Service Code	NDC 51672211500
Hospital Charge Code	103
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

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$19.88

Service Code	NDC 51672211502
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$12.52
Max. Negotiated Rate	$17.89
Rate for Payer: Aetna Commercial	$16.90
Rate for Payer: Aetna New Business (MI Preferred)	$12.92
Rate for Payer: Cash Price	$15.90
Rate for Payer: Cofinity Advantage	$13.92
Rate for Payer: Cofinity Commercial	$17.10
Rate for Payer: Encore Health Key Benefits Commercial	$15.90
Rate for Payer: Healthscope Commercial	$17.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.91
Rate for Payer: PHP Commercial	$16.90
Rate for Payer: Priority Health SBD	$12.52

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$19.88

Service Code	NDC 51672211502
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$7.81
Max. Negotiated Rate	$17.89
Rate for Payer: Aetna Commercial	$16.90
Rate for Payer: Aetna Medicare	$9.94
Rate for Payer: Aetna New Business (MI Preferred)	$12.92
Rate for Payer: BCBS Complete	$7.95
Rate for Payer: Cash Price	$15.90
Rate for Payer: Cofinity Advantage	$13.92
Rate for Payer: Cofinity Commercial	$17.10
Rate for Payer: Encore Health Key Benefits Commercial	$15.90
Rate for Payer: Healthscope Commercial	$17.89
Rate for Payer: MI Amish Medical Board Commercial	$15.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.91
Rate for Payer: PHP Commercial	$16.90
Rate for Payer: Priority Health SBD	$12.52
Rate for Payer: UHC All Payor (Choice/PPO)	$12.92
Rate for Payer: UHC Core	$10.36
Rate for Payer: UHC Exchange	$7.81

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$17.86

Service Code	NDC 39328003105
Hospital Charge Code	119321
Hospital Revenue Code	637
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$16.07
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna Medicare	$8.93
Rate for Payer: Aetna New Business (MI Preferred)	$11.61
Rate for Payer: BCBS Complete	$7.14
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cofinity Advantage	$12.50
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Encore Health Key Benefits Commercial	$14.29
Rate for Payer: Healthscope Commercial	$16.07
Rate for Payer: MI Amish Medical Board Commercial	$14.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.39
Rate for Payer: PHP Commercial	$15.18
Rate for Payer: Priority Health SBD	$11.25
Rate for Payer: UHC All Payor (Choice/PPO)	$11.61
Rate for Payer: UHC Core	$9.31
Rate for Payer: UHC Exchange	$7.02

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$17.86

Service Code	NDC 39328003105
Hospital Charge Code	119321
Hospital Revenue Code	637
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$16.07
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna New Business (MI Preferred)	$11.61
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cofinity Advantage	$12.50
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Encore Health Key Benefits Commercial	$14.29
Rate for Payer: Healthscope Commercial	$16.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.39
Rate for Payer: PHP Commercial	$15.18
Rate for Payer: Priority Health SBD	$11.25

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$17.86

Service Code	NDC 39328003150
Hospital Charge Code	119321
Hospital Revenue Code	637
Min. Negotiated Rate	$7.02
Max. Negotiated Rate	$16.07
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna Medicare	$8.93
Rate for Payer: Aetna New Business (MI Preferred)	$11.61
Rate for Payer: BCBS Complete	$7.14
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cofinity Advantage	$12.50
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Encore Health Key Benefits Commercial	$14.29
Rate for Payer: Healthscope Commercial	$16.07
Rate for Payer: MI Amish Medical Board Commercial	$14.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.39
Rate for Payer: PHP Commercial	$15.18
Rate for Payer: Priority Health SBD	$11.25
Rate for Payer: UHC All Payor (Choice/PPO)	$11.61
Rate for Payer: UHC Core	$9.31
Rate for Payer: UHC Exchange	$7.02

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION

Facility

$17.86

Service Code	NDC 39328003150
Hospital Charge Code	119321
Hospital Revenue Code	637
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$16.07
Rate for Payer: Aetna Commercial	$15.18
Rate for Payer: Aetna New Business (MI Preferred)	$11.61
Rate for Payer: Cash Price	$14.29
Rate for Payer: Cofinity Advantage	$12.50
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Encore Health Key Benefits Commercial	$14.29
Rate for Payer: Healthscope Commercial	$16.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.39
Rate for Payer: PHP Commercial	$15.18
Rate for Payer: Priority Health SBD	$11.25

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.64

Service Code	NDC 00121178100
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Advantage	$3.25
Rate for Payer: Cofinity Commercial	$3.99
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.48
Rate for Payer: PHP Commercial	$3.94
Rate for Payer: Priority Health SBD	$2.92

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$6.36

Service Code	NDC 68094006159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.50
Max. Negotiated Rate	$5.72
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna Medicare	$3.18
Rate for Payer: Aetna New Business (MI Preferred)	$4.13
Rate for Payer: BCBS Complete	$2.54
Rate for Payer: Cash Price	$5.09
Rate for Payer: Cofinity Advantage	$4.45
Rate for Payer: Cofinity Commercial	$5.47
Rate for Payer: Encore Health Key Benefits Commercial	$5.09
Rate for Payer: Healthscope Commercial	$5.72
Rate for Payer: MI Amish Medical Board Commercial	$5.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.77
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health SBD	$4.01
Rate for Payer: UHC All Payor (Choice/PPO)	$4.13
Rate for Payer: UHC Core	$3.31
Rate for Payer: UHC Exchange	$2.50

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.64

Service Code	NDC 00121178105
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Advantage	$3.25
Rate for Payer: Cofinity Commercial	$3.99
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.48
Rate for Payer: PHP Commercial	$3.94
Rate for Payer: Priority Health SBD	$2.92

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$6.53

Service Code	NDC 68094006162
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$5.88
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna Medicare	$3.27
Rate for Payer: Aetna New Business (MI Preferred)	$4.24
Rate for Payer: BCBS Complete	$2.61
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cofinity Advantage	$4.57
Rate for Payer: Cofinity Commercial	$5.62
Rate for Payer: Encore Health Key Benefits Commercial	$5.22
Rate for Payer: Healthscope Commercial	$5.88
Rate for Payer: MI Amish Medical Board Commercial	$5.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.90
Rate for Payer: PHP Commercial	$5.55
Rate for Payer: Priority Health SBD	$4.11
Rate for Payer: UHC All Payor (Choice/PPO)	$4.24
Rate for Payer: UHC Core	$3.40
Rate for Payer: UHC Exchange	$2.57

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023161
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023161
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: MI Amish Medical Board Commercial	$3.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74
Rate for Payer: UHC All Payor (Choice/PPO)	$2.83
Rate for Payer: UHC Core	$2.27
Rate for Payer: UHC Exchange	$1.71

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: MI Amish Medical Board Commercial	$3.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74
Rate for Payer: UHC All Payor (Choice/PPO)	$2.83
Rate for Payer: UHC Core	$2.27
Rate for Payer: UHC Exchange	$1.71

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.64

Service Code	NDC 00121178105
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: Aetna Medicare	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Advantage	$3.25
Rate for Payer: Cofinity Commercial	$3.99
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: MI Amish Medical Board Commercial	$3.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.48
Rate for Payer: PHP Commercial	$3.94
Rate for Payer: Priority Health SBD	$2.92
Rate for Payer: UHC All Payor (Choice/PPO)	$3.02
Rate for Payer: UHC Core	$2.42
Rate for Payer: UHC Exchange	$1.82

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023162
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$6.36

Service Code	NDC 68094006159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$5.72
Rate for Payer: Aetna Commercial	$5.41
Rate for Payer: Aetna New Business (MI Preferred)	$4.13
Rate for Payer: Cash Price	$5.09
Rate for Payer: Cofinity Advantage	$4.45
Rate for Payer: Cofinity Commercial	$5.47
Rate for Payer: Encore Health Key Benefits Commercial	$5.09
Rate for Payer: Healthscope Commercial	$5.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.77
Rate for Payer: PHP Commercial	$5.41
Rate for Payer: Priority Health SBD	$4.01

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.64

Service Code	NDC 00121178100
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.82
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: Aetna Medicare	$2.32
Rate for Payer: Aetna New Business (MI Preferred)	$3.02
Rate for Payer: BCBS Complete	$1.86
Rate for Payer: Cash Price	$3.71
Rate for Payer: Cofinity Advantage	$3.25
Rate for Payer: Cofinity Commercial	$3.99
Rate for Payer: Encore Health Key Benefits Commercial	$3.71
Rate for Payer: Healthscope Commercial	$4.18
Rate for Payer: MI Amish Medical Board Commercial	$3.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.48
Rate for Payer: PHP Commercial	$3.94
Rate for Payer: Priority Health SBD	$2.92
Rate for Payer: UHC All Payor (Choice/PPO)	$3.02
Rate for Payer: UHC Core	$2.42
Rate for Payer: UHC Exchange	$1.82

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$6.53

Service Code	NDC 68094006162
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$5.88
Rate for Payer: Aetna Commercial	$5.55
Rate for Payer: Aetna New Business (MI Preferred)	$4.24
Rate for Payer: Cash Price	$5.22
Rate for Payer: Cofinity Advantage	$4.57
Rate for Payer: Cofinity Commercial	$5.62
Rate for Payer: Encore Health Key Benefits Commercial	$5.22
Rate for Payer: Healthscope Commercial	$5.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.90
Rate for Payer: PHP Commercial	$5.55
Rate for Payer: Priority Health SBD	$4.11

ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION

Facility

$4.35

Service Code	NDC 68094023162
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.71
Max. Negotiated Rate	$3.92
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna Medicare	$2.17
Rate for Payer: Aetna New Business (MI Preferred)	$2.83
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Advantage	$3.04
Rate for Payer: Cofinity Commercial	$3.74
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$3.92
Rate for Payer: MI Amish Medical Board Commercial	$3.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: PHP Commercial	$3.70
Rate for Payer: Priority Health SBD	$2.74
Rate for Payer: UHC All Payor (Choice/PPO)	$2.83
Rate for Payer: UHC Core	$2.27
Rate for Payer: UHC Exchange	$1.71

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$10.22

Service Code	NDC 51672211602
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$4.02
Max. Negotiated Rate	$9.20
Rate for Payer: Aetna Commercial	$8.69
Rate for Payer: Aetna Medicare	$5.11
Rate for Payer: Aetna New Business (MI Preferred)	$6.64
Rate for Payer: BCBS Complete	$4.09
Rate for Payer: Cash Price	$8.18
Rate for Payer: Cofinity Advantage	$7.15
Rate for Payer: Cofinity Commercial	$8.79
Rate for Payer: Encore Health Key Benefits Commercial	$8.18
Rate for Payer: Healthscope Commercial	$9.20
Rate for Payer: MI Amish Medical Board Commercial	$8.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.67
Rate for Payer: PHP Commercial	$8.69
Rate for Payer: Priority Health SBD	$6.44
Rate for Payer: UHC All Payor (Choice/PPO)	$6.64
Rate for Payer: UHC Core	$5.32
Rate for Payer: UHC Exchange	$4.02

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$1.71

Service Code	NDC 51672211600
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna Commercial	$1.45
Rate for Payer: Aetna Medicare	$0.86
Rate for Payer: Aetna New Business (MI Preferred)	$1.11
Rate for Payer: BCBS Complete	$0.68
Rate for Payer: Cash Price	$1.37
Rate for Payer: Cofinity Advantage	$1.20
Rate for Payer: Cofinity Commercial	$1.47
Rate for Payer: Encore Health Key Benefits Commercial	$1.37
Rate for Payer: Healthscope Commercial	$1.54
Rate for Payer: MI Amish Medical Board Commercial	$1.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.28
Rate for Payer: PHP Commercial	$1.45
Rate for Payer: Priority Health SBD	$1.08
Rate for Payer: UHC All Payor (Choice/PPO)	$1.11
Rate for Payer: UHC Core	$0.89
Rate for Payer: UHC Exchange	$0.67

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$10.22

Service Code	NDC 51672211602
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$6.44
Max. Negotiated Rate	$9.20
Rate for Payer: Aetna Commercial	$8.69
Rate for Payer: Aetna New Business (MI Preferred)	$6.64
Rate for Payer: Cash Price	$8.18
Rate for Payer: Cofinity Advantage	$7.15
Rate for Payer: Cofinity Commercial	$8.79
Rate for Payer: Encore Health Key Benefits Commercial	$8.18
Rate for Payer: Healthscope Commercial	$9.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.67
Rate for Payer: PHP Commercial	$8.69
Rate for Payer: Priority Health SBD	$6.44

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$1.71

Service Code	NDC 51672211600
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.54
Rate for Payer: Aetna Commercial	$1.45
Rate for Payer: Aetna New Business (MI Preferred)	$1.11
Rate for Payer: Cash Price	$1.37
Rate for Payer: Cofinity Advantage	$1.20
Rate for Payer: Cofinity Commercial	$1.47
Rate for Payer: Encore Health Key Benefits Commercial	$1.37
Rate for Payer: Healthscope Commercial	$1.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.28
Rate for Payer: PHP Commercial	$1.45
Rate for Payer: Priority Health SBD	$1.08

Know your out-of-pocket cost for care.

All Charges