Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

Facility

$4.32

Service Code	NDC 68094023161
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.89
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.81
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Commercial	$3.72
Rate for Payer: Cofinity Medicare Advantage	$3.02
Rate for Payer: Encore Health Key Benefits Commercial	$3.46
Rate for Payer: Healthscope Commercial	$3.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.67
Rate for Payer: PHP Commercial	$3.67
Rate for Payer: Priority Health Cigna Priority Health	$2.81
Rate for Payer: Priority Health SBD	$2.72

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

Facility

$4.32

Service Code	NDC 68094023159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$3.89
Rate for Payer: Aetna Commercial	$3.67
Rate for Payer: Aetna New Business (MI Preferred)	$2.81
Rate for Payer: Cash Price	$3.46
Rate for Payer: Cofinity Commercial	$3.02
Rate for Payer: Cofinity Commercial	$3.72
Rate for Payer: Cofinity Medicare Advantage	$3.02
Rate for Payer: Encore Health Key Benefits Commercial	$3.46
Rate for Payer: Healthscope Commercial	$3.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.67
Rate for Payer: PHP Commercial	$3.67
Rate for Payer: Priority Health Cigna Priority Health	$2.81
Rate for Payer: Priority Health SBD	$2.72

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

Facility

$4.95

Service Code	NDC 00121178100
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna Commercial	$4.21
Rate for Payer: Aetna New Business (MI Preferred)	$3.22
Rate for Payer: Cash Price	$3.96
Rate for Payer: Cofinity Commercial	$3.46
Rate for Payer: Cofinity Commercial	$4.26
Rate for Payer: Cofinity Medicare Advantage	$3.46
Rate for Payer: Encore Health Key Benefits Commercial	$3.96
Rate for Payer: Healthscope Commercial	$4.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.21
Rate for Payer: PHP Commercial	$4.21
Rate for Payer: Priority Health Cigna Priority Health	$3.22
Rate for Payer: Priority Health SBD	$3.12

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

Facility

$4.95

Service Code	NDC 00121178105
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$4.46
Rate for Payer: Aetna Commercial	$4.21
Rate for Payer: Aetna New Business (MI Preferred)	$3.22
Rate for Payer: Cash Price	$3.96
Rate for Payer: Cofinity Commercial	$3.46
Rate for Payer: Cofinity Commercial	$4.26
Rate for Payer: Cofinity Medicare Advantage	$3.46
Rate for Payer: Encore Health Key Benefits Commercial	$3.96
Rate for Payer: Healthscope Commercial	$4.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.21
Rate for Payer: PHP Commercial	$4.21
Rate for Payer: Priority Health Cigna Priority Health	$3.22
Rate for Payer: Priority Health SBD	$3.12

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

Facility

$4.76

Service Code	NDC 68094001561
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$4.28
Rate for Payer: Aetna Commercial	$4.05
Rate for Payer: Aetna Medicare	$2.38
Rate for Payer: Aetna New Business (MI Preferred)	$3.09
Rate for Payer: BCBS Complete	$1.90
Rate for Payer: Cash Price	$3.81
Rate for Payer: Cofinity Commercial	$3.33
Rate for Payer: Cofinity Commercial	$4.09
Rate for Payer: Cofinity Medicare Advantage	$3.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.81
Rate for Payer: Healthscope Commercial	$4.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.05
Rate for Payer: PHP Commercial	$4.05
Rate for Payer: Priority Health Cigna Priority Health	$3.09
Rate for Payer: Priority Health SBD	$3.00

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 Commercial	$1.20
Rate for Payer: Cofinity Commercial	$1.47
Rate for Payer: Cofinity Medicare Advantage	$1.20
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: PHP Commercial	$1.45
Rate for Payer: Priority Health Cigna Priority Health	$1.11
Rate for Payer: Priority Health SBD	$1.08

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 Commercial	$7.15
Rate for Payer: Cofinity Commercial	$8.79
Rate for Payer: Cofinity Medicare Advantage	$7.15
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: PHP Commercial	$8.69
Rate for Payer: Priority Health Cigna Priority Health	$6.64
Rate for Payer: Priority Health SBD	$6.44

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$87.36

Service Code	NDC 51672211604
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$34.94
Max. Negotiated Rate	$78.62
Rate for Payer: Aetna Commercial	$74.26
Rate for Payer: Aetna Medicare	$43.68
Rate for Payer: Aetna New Business (MI Preferred)	$56.78
Rate for Payer: BCBS Complete	$34.94
Rate for Payer: Cash Price	$69.89
Rate for Payer: Cofinity Commercial	$61.15
Rate for Payer: Cofinity Commercial	$75.13
Rate for Payer: Cofinity Medicare Advantage	$61.15
Rate for Payer: Encore Health Key Benefits Commercial	$69.89
Rate for Payer: Healthscope Commercial	$78.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.26
Rate for Payer: PHP Commercial	$74.26
Rate for Payer: Priority Health Cigna Priority Health	$56.78
Rate for Payer: Priority Health SBD	$55.04

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$87.36

Service Code	NDC 51672211604
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$55.04
Max. Negotiated Rate	$78.62
Rate for Payer: Aetna Commercial	$74.26
Rate for Payer: Aetna New Business (MI Preferred)	$56.78
Rate for Payer: Cash Price	$69.89
Rate for Payer: Cofinity Commercial	$61.15
Rate for Payer: Cofinity Commercial	$75.13
Rate for Payer: Cofinity Medicare Advantage	$61.15
Rate for Payer: Encore Health Key Benefits Commercial	$69.89
Rate for Payer: Healthscope Commercial	$78.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.26
Rate for Payer: PHP Commercial	$74.26
Rate for Payer: Priority Health Cigna Priority Health	$56.78
Rate for Payer: Priority Health SBD	$55.04

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$1.71

Service Code	NDC 51672211600
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$0.68
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 Commercial	$1.20
Rate for Payer: Cofinity Commercial	$1.47
Rate for Payer: Cofinity Medicare Advantage	$1.20
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: PHP Commercial	$1.45
Rate for Payer: Priority Health Cigna Priority Health	$1.11
Rate for Payer: Priority Health SBD	$1.08

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$10.22

Service Code	NDC 51672211602
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$4.09
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 Commercial	$7.15
Rate for Payer: Cofinity Commercial	$8.79
Rate for Payer: Cofinity Medicare Advantage	$7.15
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: PHP Commercial	$8.69
Rate for Payer: Priority Health Cigna Priority Health	$6.64
Rate for Payer: Priority Health SBD	$6.44

ACETAMINOPHEN 325 MG TABLET

Facility

$132.30

Service Code	NDC 49483034001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$83.35
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.46
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
Rate for Payer: Cash Price	$105.84
Rate for Payer: Cofinity Commercial	$113.78
Rate for Payer: Cofinity Commercial	$92.61
Rate for Payer: Cofinity Medicare Advantage	$92.61
Rate for Payer: Encore Health Key Benefits Commercial	$105.84
Rate for Payer: Healthscope Commercial	$119.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.46
Rate for Payer: PHP Commercial	$112.46
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

ACETAMINOPHEN 325 MG TABLET

Facility

$113.40

Service Code	NDC 69618001001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

ACETAMINOPHEN 325 MG TABLET

Facility

$113.40

Service Code	NDC 69618001001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$102.06
Rate for Payer: Aetna Commercial	$96.39
Rate for Payer: Aetna Medicare	$56.70
Rate for Payer: Aetna New Business (MI Preferred)	$73.71
Rate for Payer: BCBS Complete	$45.36
Rate for Payer: Cash Price	$90.72
Rate for Payer: Cofinity Commercial	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Cofinity Medicare Advantage	$79.38
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health Cigna Priority Health	$73.71
Rate for Payer: Priority Health SBD	$71.44

ACETAMINOPHEN 325 MG TABLET

Facility

$188.00

Service Code	NDC 00904677361
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$118.44
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Cofinity Medicare Advantage	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health Cigna Priority Health	$122.20
Rate for Payer: Priority Health SBD	$118.44

ACETAMINOPHEN 325 MG TABLET

Facility

$260.00

Service Code	NDC 50580049698
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Aetna Medicare	$130.00
Rate for Payer: Aetna New Business (MI Preferred)	$169.00
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cofinity Commercial	$182.00
Rate for Payer: Cofinity Commercial	$223.60
Rate for Payer: Cofinity Medicare Advantage	$182.00
Rate for Payer: Encore Health Key Benefits Commercial	$208.00
Rate for Payer: Healthscope Commercial	$234.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.00
Rate for Payer: PHP Commercial	$221.00
Rate for Payer: Priority Health Cigna Priority Health	$169.00
Rate for Payer: Priority Health SBD	$163.80

ACETAMINOPHEN 325 MG TABLET

Facility

$260.00

Service Code	NDC 50580049698
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$163.80
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$221.00
Rate for Payer: Aetna New Business (MI Preferred)	$169.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cofinity Commercial	$182.00
Rate for Payer: Cofinity Commercial	$223.60
Rate for Payer: Cofinity Medicare Advantage	$182.00
Rate for Payer: Encore Health Key Benefits Commercial	$208.00
Rate for Payer: Healthscope Commercial	$234.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.00
Rate for Payer: PHP Commercial	$221.00
Rate for Payer: Priority Health Cigna Priority Health	$169.00
Rate for Payer: Priority Health SBD	$163.80

ACETAMINOPHEN 325 MG TABLET

Facility

$188.00

Service Code	NDC 00904677361
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$169.20
Rate for Payer: Aetna Commercial	$159.80
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: Aetna New Business (MI Preferred)	$122.20
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cofinity Commercial	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Cofinity Medicare Advantage	$131.60
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health Cigna Priority Health	$122.20
Rate for Payer: Priority Health SBD	$118.44

ACETAMINOPHEN 325 MG TABLET

Facility

$132.30

Service Code	NDC 49483034001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$119.07
Rate for Payer: Aetna Commercial	$112.46
Rate for Payer: Aetna Medicare	$66.15
Rate for Payer: Aetna New Business (MI Preferred)	$86.00
Rate for Payer: BCBS Complete	$52.92
Rate for Payer: Cash Price	$105.84
Rate for Payer: Cofinity Commercial	$113.78
Rate for Payer: Cofinity Commercial	$92.61
Rate for Payer: Cofinity Medicare Advantage	$92.61
Rate for Payer: Encore Health Key Benefits Commercial	$105.84
Rate for Payer: Healthscope Commercial	$119.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.46
Rate for Payer: PHP Commercial	$112.46
Rate for Payer: Priority Health Cigna Priority Health	$86.00
Rate for Payer: Priority Health SBD	$83.35

ACETAMINOPHEN 500 MG TABLET

Facility

$1,449.00

Service Code	NDC 00450045045
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$912.87
Max. Negotiated Rate	$1,304.10
Rate for Payer: Aetna Commercial	$1,231.65
Rate for Payer: Aetna New Business (MI Preferred)	$941.85
Rate for Payer: Cash Price	$1,159.20
Rate for Payer: Cofinity Commercial	$1,014.30
Rate for Payer: Cofinity Commercial	$1,246.14
Rate for Payer: Cofinity Medicare Advantage	$1,014.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,159.20
Rate for Payer: Healthscope Commercial	$1,304.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,231.65
Rate for Payer: PHP Commercial	$1,231.65
Rate for Payer: Priority Health Cigna Priority Health	$941.85
Rate for Payer: Priority Health SBD	$912.87

ACETAMINOPHEN 500 MG TABLET

Facility

$756.00

Service Code	NDC 00904672080
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$476.28
Max. Negotiated Rate	$680.40
Rate for Payer: Aetna Commercial	$642.60
Rate for Payer: Aetna New Business (MI Preferred)	$491.40
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cofinity Commercial	$529.20
Rate for Payer: Cofinity Commercial	$650.16
Rate for Payer: Cofinity Medicare Advantage	$529.20
Rate for Payer: Encore Health Key Benefits Commercial	$604.80
Rate for Payer: Healthscope Commercial	$680.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$642.60
Rate for Payer: PHP Commercial	$642.60
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health SBD	$476.28

ACETAMINOPHEN 500 MG TABLET

Facility

$756.00

Service Code	NDC 00904672080
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$680.40
Rate for Payer: Aetna Commercial	$642.60
Rate for Payer: Aetna Medicare	$378.00
Rate for Payer: Aetna New Business (MI Preferred)	$491.40
Rate for Payer: BCBS Complete	$302.40
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cofinity Commercial	$529.20
Rate for Payer: Cofinity Commercial	$650.16
Rate for Payer: Cofinity Medicare Advantage	$529.20
Rate for Payer: Encore Health Key Benefits Commercial	$604.80
Rate for Payer: Healthscope Commercial	$680.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$642.60
Rate for Payer: PHP Commercial	$642.60
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health SBD	$476.28

ACETAMINOPHEN 500 MG TABLET

Facility

$1,449.00

Service Code	NDC 00450045045
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$579.60
Max. Negotiated Rate	$1,304.10
Rate for Payer: Aetna Commercial	$1,231.65
Rate for Payer: Aetna Medicare	$724.50
Rate for Payer: Aetna New Business (MI Preferred)	$941.85
Rate for Payer: BCBS Complete	$579.60
Rate for Payer: Cash Price	$1,159.20
Rate for Payer: Cofinity Commercial	$1,014.30
Rate for Payer: Cofinity Commercial	$1,246.14
Rate for Payer: Cofinity Medicare Advantage	$1,014.30
Rate for Payer: Encore Health Key Benefits Commercial	$1,159.20
Rate for Payer: Healthscope Commercial	$1,304.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,231.65
Rate for Payer: PHP Commercial	$1,231.65
Rate for Payer: Priority Health Cigna Priority Health	$941.85
Rate for Payer: Priority Health SBD	$912.87

ACETAMINOPHEN 500 MG TABLET

Facility

$280.00

Service Code	NDC 50580045711
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna Commercial	$238.00
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: Aetna New Business (MI Preferred)	$182.00
Rate for Payer: BCBS Complete	$112.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cofinity Commercial	$196.00
Rate for Payer: Cofinity Commercial	$240.80
Rate for Payer: Cofinity Medicare Advantage	$196.00
Rate for Payer: Encore Health Key Benefits Commercial	$224.00
Rate for Payer: Healthscope Commercial	$252.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.00
Rate for Payer: PHP Commercial	$238.00
Rate for Payer: Priority Health Cigna Priority Health	$182.00
Rate for Payer: Priority Health SBD	$176.40

ACETAMINOPHEN 500 MG TABLET

Facility

$882.00

Service Code	NDC 00904673080
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$555.66
Max. Negotiated Rate	$793.80
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Commercial	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Cofinity Medicare Advantage	$617.40
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.70
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health Cigna Priority Health	$573.30
Rate for Payer: Priority Health SBD	$555.66

Know your out-of-pocket cost for care.

All Charges