Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

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 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 Advantage	$182.00
Rate for Payer: Cofinity Commercial	$223.60
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: Opus (Opus Packaging Group) HMA	$195.00
Rate for Payer: PHP Commercial	$221.00
Rate for Payer: Priority Health SBD	$163.80

ACETAMINOPHEN 325 MG TABLET

Facility

$693.00

Service Code	NDC 00536132710
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$436.59
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna Commercial	$589.05
Rate for Payer: Aetna New Business (MI Preferred)	$450.45
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cofinity Advantage	$485.10
Rate for Payer: Cofinity Commercial	$595.98
Rate for Payer: Encore Health Key Benefits Commercial	$554.40
Rate for Payer: Healthscope Commercial	$623.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$589.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.75
Rate for Payer: PHP Commercial	$589.05
Rate for Payer: Priority Health SBD	$436.59

ACETAMINOPHEN 325 MG TABLET

Facility

$260.00

Service Code	NDC 50580049698
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$102.18
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 Advantage	$182.00
Rate for Payer: Cofinity Commercial	$223.60
Rate for Payer: Encore Health Key Benefits Commercial	$208.00
Rate for Payer: Healthscope Commercial	$234.00
Rate for Payer: MI Amish Medical Board Commercial	$208.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.00
Rate for Payer: PHP Commercial	$221.00
Rate for Payer: Priority Health SBD	$163.80
Rate for Payer: UHC All Payor (Choice/PPO)	$169.00
Rate for Payer: UHC Core	$135.46
Rate for Payer: UHC Exchange	$102.18

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 Advantage	$79.38
Rate for Payer: Cofinity Commercial	$97.52
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: Opus (Opus Packaging Group) HMA	$85.05
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health SBD	$71.44

ACETAMINOPHEN 325 MG TABLET

Facility

$693.00

Service Code	NDC 00536132710
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$272.35
Max. Negotiated Rate	$623.70
Rate for Payer: Aetna Commercial	$589.05
Rate for Payer: Aetna Medicare	$346.50
Rate for Payer: Aetna New Business (MI Preferred)	$450.45
Rate for Payer: BCBS Complete	$277.20
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cofinity Advantage	$485.10
Rate for Payer: Cofinity Commercial	$595.98
Rate for Payer: Encore Health Key Benefits Commercial	$554.40
Rate for Payer: Healthscope Commercial	$623.70
Rate for Payer: MI Amish Medical Board Commercial	$554.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$589.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.75
Rate for Payer: PHP Commercial	$589.05
Rate for Payer: Priority Health SBD	$436.59
Rate for Payer: UHC All Payor (Choice/PPO)	$450.45
Rate for Payer: UHC Core	$361.05
Rate for Payer: UHC Exchange	$272.35

ACETAMINOPHEN 325 MG TABLET

Facility

$188.00

Service Code	NDC 00904677361
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$73.88
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 Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: MI Amish Medical Board Commercial	$150.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44
Rate for Payer: UHC All Payor (Choice/PPO)	$122.20
Rate for Payer: UHC Core	$97.95
Rate for Payer: UHC Exchange	$73.88

ACETAMINOPHEN 325 MG TABLET

Facility

$188.00

Service Code	NDC 904677361
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$73.88
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 Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
Rate for Payer: Encore Health Key Benefits Commercial	$150.40
Rate for Payer: Healthscope Commercial	$169.20
Rate for Payer: MI Amish Medical Board Commercial	$150.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44
Rate for Payer: UHC All Payor (Choice/PPO)	$122.20
Rate for Payer: UHC Core	$97.95
Rate for Payer: UHC Exchange	$73.88

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 Advantage	$131.60
Rate for Payer: Cofinity Commercial	$161.68
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: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: PHP Commercial	$159.80
Rate for Payer: Priority Health SBD	$118.44

ACETAMINOPHEN 325 MG TABLET

Facility

$88.20

Service Code	NDC 50580045811
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$55.57
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Advantage	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.15
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health SBD	$55.57

ACETAMINOPHEN 325 MG TABLET

Facility

$157.50

Service Code	NDC 49483034001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$99.22
Max. Negotiated Rate	$141.75
Rate for Payer: Aetna Commercial	$133.88
Rate for Payer: Aetna New Business (MI Preferred)	$102.38
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cofinity Advantage	$110.25
Rate for Payer: Cofinity Commercial	$135.45
Rate for Payer: Encore Health Key Benefits Commercial	$126.00
Rate for Payer: Healthscope Commercial	$141.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.12
Rate for Payer: PHP Commercial	$133.88
Rate for Payer: Priority Health SBD	$99.22

ACETAMINOPHEN 325 MG TABLET

Facility

$88.20

Service Code	NDC 50580045811
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$34.66
Max. Negotiated Rate	$79.38
Rate for Payer: Aetna Commercial	$74.97
Rate for Payer: Aetna Medicare	$44.10
Rate for Payer: Aetna New Business (MI Preferred)	$57.33
Rate for Payer: BCBS Complete	$35.28
Rate for Payer: Cash Price	$70.56
Rate for Payer: Cofinity Advantage	$61.74
Rate for Payer: Cofinity Commercial	$75.85
Rate for Payer: Encore Health Key Benefits Commercial	$70.56
Rate for Payer: Healthscope Commercial	$79.38
Rate for Payer: MI Amish Medical Board Commercial	$70.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.15
Rate for Payer: PHP Commercial	$74.97
Rate for Payer: Priority Health SBD	$55.57
Rate for Payer: UHC All Payor (Choice/PPO)	$57.33
Rate for Payer: UHC Core	$45.95
Rate for Payer: UHC Exchange	$34.66

ACETAMINOPHEN 325 MG TABLET

Facility

$157.50

Service Code	NDC 49483034001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$61.90
Max. Negotiated Rate	$141.75
Rate for Payer: Aetna Commercial	$133.88
Rate for Payer: Aetna Medicare	$78.75
Rate for Payer: Aetna New Business (MI Preferred)	$102.38
Rate for Payer: BCBS Complete	$63.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cofinity Advantage	$110.25
Rate for Payer: Cofinity Commercial	$135.45
Rate for Payer: Encore Health Key Benefits Commercial	$126.00
Rate for Payer: Healthscope Commercial	$141.75
Rate for Payer: MI Amish Medical Board Commercial	$126.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$133.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.12
Rate for Payer: PHP Commercial	$133.88
Rate for Payer: Priority Health SBD	$99.22
Rate for Payer: UHC All Payor (Choice/PPO)	$102.38
Rate for Payer: UHC Core	$82.06
Rate for Payer: UHC Exchange	$61.90

ACETAMINOPHEN 325 MG TABLET

Facility

$113.40

Service Code	NDC 69618001001
Hospital Charge Code	101
Hospital Revenue Code	637
Min. Negotiated Rate	$44.57
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 Advantage	$79.38
Rate for Payer: Cofinity Commercial	$97.52
Rate for Payer: Encore Health Key Benefits Commercial	$90.72
Rate for Payer: Healthscope Commercial	$102.06
Rate for Payer: MI Amish Medical Board Commercial	$90.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$96.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.05
Rate for Payer: PHP Commercial	$96.39
Rate for Payer: Priority Health SBD	$71.44
Rate for Payer: UHC All Payor (Choice/PPO)	$73.71
Rate for Payer: UHC Core	$59.08
Rate for Payer: UHC Exchange	$44.57

ACETAMINOPHEN 500 MG TABLET

Facility

$144.90

Service Code	NDC 50580045711
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$56.95
Max. Negotiated Rate	$130.41
Rate for Payer: Aetna Commercial	$123.17
Rate for Payer: Aetna Medicare	$72.45
Rate for Payer: Aetna New Business (MI Preferred)	$94.19
Rate for Payer: BCBS Complete	$57.96
Rate for Payer: Cash Price	$115.92
Rate for Payer: Cofinity Advantage	$101.43
Rate for Payer: Cofinity Commercial	$124.61
Rate for Payer: Encore Health Key Benefits Commercial	$115.92
Rate for Payer: Healthscope Commercial	$130.41
Rate for Payer: MI Amish Medical Board Commercial	$115.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.67
Rate for Payer: PHP Commercial	$123.17
Rate for Payer: Priority Health SBD	$91.29
Rate for Payer: UHC All Payor (Choice/PPO)	$94.19
Rate for Payer: UHC Core	$75.49
Rate for Payer: UHC Exchange	$56.95

ACETAMINOPHEN 500 MG TABLET

Facility

$144.90

Service Code	NDC 50580045711
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$91.29
Max. Negotiated Rate	$130.41
Rate for Payer: Aetna Commercial	$123.17
Rate for Payer: Aetna New Business (MI Preferred)	$94.19
Rate for Payer: Cash Price	$115.92
Rate for Payer: Cofinity Advantage	$101.43
Rate for Payer: Cofinity Commercial	$124.61
Rate for Payer: Encore Health Key Benefits Commercial	$115.92
Rate for Payer: Healthscope Commercial	$130.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.67
Rate for Payer: PHP Commercial	$123.17
Rate for Payer: Priority Health SBD	$91.29

ACETAMINOPHEN 500 MG TABLET

Facility

$882.00

Service Code	NDC 00904672080
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 Advantage	$617.40
Rate for Payer: Cofinity Commercial	$758.52
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: Opus (Opus Packaging Group) HMA	$661.50
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health SBD	$555.66

ACETAMINOPHEN 500 MG TABLET

Facility

$124.00

Service Code	NDC 00904673061
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$48.73
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna Commercial	$105.40
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: Aetna New Business (MI Preferred)	$80.60
Rate for Payer: BCBS Complete	$49.60
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cofinity Advantage	$86.80
Rate for Payer: Cofinity Commercial	$106.64
Rate for Payer: Encore Health Key Benefits Commercial	$99.20
Rate for Payer: Healthscope Commercial	$111.60
Rate for Payer: MI Amish Medical Board Commercial	$99.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: PHP Commercial	$105.40
Rate for Payer: Priority Health SBD	$78.12
Rate for Payer: UHC All Payor (Choice/PPO)	$80.60
Rate for Payer: UHC Core	$64.60
Rate for Payer: UHC Exchange	$48.73

ACETAMINOPHEN 500 MG TABLET

Facility

$945.00

Service Code	NDC 00904673080
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$595.35
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna Commercial	$803.25
Rate for Payer: Aetna New Business (MI Preferred)	$614.25
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cofinity Advantage	$661.50
Rate for Payer: Cofinity Commercial	$812.70
Rate for Payer: Encore Health Key Benefits Commercial	$756.00
Rate for Payer: Healthscope Commercial	$850.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$803.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$708.75
Rate for Payer: PHP Commercial	$803.25
Rate for Payer: Priority Health SBD	$595.35

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 Advantage	$1,014.30
Rate for Payer: Cofinity Commercial	$1,246.14
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: Opus (Opus Packaging Group) HMA	$1,086.75
Rate for Payer: PHP Commercial	$1,231.65
Rate for Payer: Priority Health SBD	$912.87

ACETAMINOPHEN 500 MG TABLET

Facility

$144.90

Service Code	NDC 00904672060
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$91.29
Max. Negotiated Rate	$130.41
Rate for Payer: Aetna Commercial	$123.17
Rate for Payer: Aetna New Business (MI Preferred)	$94.19
Rate for Payer: Cash Price	$115.92
Rate for Payer: Cofinity Advantage	$101.43
Rate for Payer: Cofinity Commercial	$124.61
Rate for Payer: Encore Health Key Benefits Commercial	$115.92
Rate for Payer: Healthscope Commercial	$130.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.67
Rate for Payer: PHP Commercial	$123.17
Rate for Payer: Priority Health SBD	$91.29

ACETAMINOPHEN 500 MG TABLET

Facility

$882.00

Service Code	NDC 00904672080
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$346.63
Max. Negotiated Rate	$793.80
Rate for Payer: Aetna Commercial	$749.70
Rate for Payer: Aetna Medicare	$441.00
Rate for Payer: Aetna New Business (MI Preferred)	$573.30
Rate for Payer: BCBS Complete	$352.80
Rate for Payer: Cash Price	$705.60
Rate for Payer: Cofinity Advantage	$617.40
Rate for Payer: Cofinity Commercial	$758.52
Rate for Payer: Encore Health Key Benefits Commercial	$705.60
Rate for Payer: Healthscope Commercial	$793.80
Rate for Payer: MI Amish Medical Board Commercial	$705.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$749.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$661.50
Rate for Payer: PHP Commercial	$749.70
Rate for Payer: Priority Health SBD	$555.66
Rate for Payer: UHC All Payor (Choice/PPO)	$573.30
Rate for Payer: UHC Core	$459.52
Rate for Payer: UHC Exchange	$346.63

ACETAMINOPHEN 500 MG TABLET

Facility

$163.80

Service Code	NDC 00536117201
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$64.37
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna Medicare	$81.90
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
Rate for Payer: BCBS Complete	$65.52
Rate for Payer: Cash Price	$131.04
Rate for Payer: Cofinity Advantage	$114.66
Rate for Payer: Cofinity Commercial	$140.87
Rate for Payer: Encore Health Key Benefits Commercial	$131.04
Rate for Payer: Healthscope Commercial	$147.42
Rate for Payer: MI Amish Medical Board Commercial	$131.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$139.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.85
Rate for Payer: PHP Commercial	$139.23
Rate for Payer: Priority Health SBD	$103.19
Rate for Payer: UHC All Payor (Choice/PPO)	$106.47
Rate for Payer: UHC Core	$85.34
Rate for Payer: UHC Exchange	$64.37

ACETAMINOPHEN 500 MG TABLET

Facility

$409.50

Service Code	NDC 00904672040
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$160.93
Max. Negotiated Rate	$368.55
Rate for Payer: Aetna Commercial	$348.07
Rate for Payer: Aetna Medicare	$204.75
Rate for Payer: Aetna New Business (MI Preferred)	$266.18
Rate for Payer: BCBS Complete	$163.80
Rate for Payer: Cash Price	$327.60
Rate for Payer: Cofinity Advantage	$286.65
Rate for Payer: Cofinity Commercial	$352.17
Rate for Payer: Encore Health Key Benefits Commercial	$327.60
Rate for Payer: Healthscope Commercial	$368.55
Rate for Payer: MI Amish Medical Board Commercial	$327.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$348.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.12
Rate for Payer: PHP Commercial	$348.07
Rate for Payer: Priority Health SBD	$257.99
Rate for Payer: UHC All Payor (Choice/PPO)	$266.18
Rate for Payer: UHC Core	$213.35
Rate for Payer: UHC Exchange	$160.93

Know your out-of-pocket cost for care.

All Charges