Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ACETAMINOPHEN 500 MG TABLET

Facility

$409.50

Service Code	NDC 00904672040
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$257.99
Max. Negotiated Rate	$368.55
Rate for Payer: Aetna Commercial	$348.07
Rate for Payer: Aetna New Business (MI Preferred)	$266.18
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: 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

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

$1,449.00

Service Code	NDC 450045045
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$569.46
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 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: MI Amish Medical Board Commercial	$1,159.20
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
Rate for Payer: UHC All Payor (Choice/PPO)	$941.85
Rate for Payer: UHC Core	$754.93
Rate for Payer: UHC Exchange	$569.46

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

$19.67

Service Code	NDC 50580044915
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$7.73
Max. Negotiated Rate	$17.70
Rate for Payer: Aetna Commercial	$16.72
Rate for Payer: Aetna Medicare	$9.84
Rate for Payer: Aetna New Business (MI Preferred)	$12.79
Rate for Payer: BCBS Complete	$7.87
Rate for Payer: Cash Price	$15.74
Rate for Payer: Cofinity Advantage	$13.77
Rate for Payer: Cofinity Commercial	$16.92
Rate for Payer: Encore Health Key Benefits Commercial	$15.74
Rate for Payer: Healthscope Commercial	$17.70
Rate for Payer: MI Amish Medical Board Commercial	$15.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.75
Rate for Payer: PHP Commercial	$16.72
Rate for Payer: Priority Health SBD	$12.39
Rate for Payer: UHC All Payor (Choice/PPO)	$12.79
Rate for Payer: UHC Core	$10.25
Rate for Payer: UHC Exchange	$7.73

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

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

$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

$163.80

Service Code	NDC 00536117201
Hospital Charge Code	102
Hospital Revenue Code	637
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$147.42
Rate for Payer: Aetna Commercial	$139.23
Rate for Payer: Aetna New Business (MI Preferred)	$106.47
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: 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

ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION

Facility

$4.15

Service Code	NDC 00121197100
Hospital Charge Code	119323
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61

ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION

Facility

$4.15

Service Code	NDC 00121197100
Hospital Charge Code	119323
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: BCBS Complete	$1.66
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: MI Amish Medical Board Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61
Rate for Payer: UHC All Payor (Choice/PPO)	$2.70
Rate for Payer: UHC Core	$2.16
Rate for Payer: UHC Exchange	$1.63

ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION

Facility

$4.15

Service Code	NDC 00121197121
Hospital Charge Code	119323
Hospital Revenue Code	637
Min. Negotiated Rate	$1.63
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare	$2.08
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: BCBS Complete	$1.66
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: MI Amish Medical Board Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61
Rate for Payer: UHC All Payor (Choice/PPO)	$2.70
Rate for Payer: UHC Core	$2.16
Rate for Payer: UHC Exchange	$1.63

ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION

Facility

$4.15

Service Code	NDC 00121197121
Hospital Charge Code	119323
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna New Business (MI Preferred)	$2.70
Rate for Payer: Cash Price	$3.32
Rate for Payer: Cofinity Advantage	$2.90
Rate for Payer: Cofinity Commercial	$3.57
Rate for Payer: Encore Health Key Benefits Commercial	$3.32
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.11
Rate for Payer: PHP Commercial	$3.53
Rate for Payer: Priority Health SBD	$2.61

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$7.90

Service Code	NDC 00121282321
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna Commercial	$6.71
Rate for Payer: Aetna New Business (MI Preferred)	$5.13
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Advantage	$5.53
Rate for Payer: Cofinity Commercial	$6.79
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.92
Rate for Payer: PHP Commercial	$6.71
Rate for Payer: Priority Health SBD	$4.98

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$8.68

Service Code	NDC 68094003059
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$7.81
Rate for Payer: Aetna Commercial	$7.38
Rate for Payer: Aetna Medicare	$4.34
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: BCBS Complete	$3.47
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Advantage	$6.08
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.81
Rate for Payer: MI Amish Medical Board Commercial	$6.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.51
Rate for Payer: PHP Commercial	$7.38
Rate for Payer: Priority Health SBD	$5.47
Rate for Payer: UHC All Payor (Choice/PPO)	$5.64
Rate for Payer: UHC Core	$4.52
Rate for Payer: UHC Exchange	$3.41

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$8.68

Service Code	NDC 68094003062
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$7.81
Rate for Payer: Aetna Commercial	$7.38
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Advantage	$6.08
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.51
Rate for Payer: PHP Commercial	$7.38
Rate for Payer: Priority Health SBD	$5.47

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$8.68

Service Code	NDC 68094003062
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.41
Max. Negotiated Rate	$7.81
Rate for Payer: Aetna Commercial	$7.38
Rate for Payer: Aetna Medicare	$4.34
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: BCBS Complete	$3.47
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Advantage	$6.08
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.81
Rate for Payer: MI Amish Medical Board Commercial	$6.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.51
Rate for Payer: PHP Commercial	$7.38
Rate for Payer: Priority Health SBD	$5.47
Rate for Payer: UHC All Payor (Choice/PPO)	$5.64
Rate for Payer: UHC Core	$4.52
Rate for Payer: UHC Exchange	$3.41

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$7.90

Service Code	NDC 00121282321
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna Commercial	$6.71
Rate for Payer: Aetna Medicare	$3.95
Rate for Payer: Aetna New Business (MI Preferred)	$5.13
Rate for Payer: BCBS Complete	$3.16
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Advantage	$5.53
Rate for Payer: Cofinity Commercial	$6.79
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.11
Rate for Payer: MI Amish Medical Board Commercial	$6.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.92
Rate for Payer: PHP Commercial	$6.71
Rate for Payer: Priority Health SBD	$4.98
Rate for Payer: UHC All Payor (Choice/PPO)	$5.13
Rate for Payer: UHC Core	$4.12
Rate for Payer: UHC Exchange	$3.10

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$7.90

Service Code	NDC 00121282394
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$4.98
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna Commercial	$6.71
Rate for Payer: Aetna New Business (MI Preferred)	$5.13
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Advantage	$5.53
Rate for Payer: Cofinity Commercial	$6.79
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.92
Rate for Payer: PHP Commercial	$6.71
Rate for Payer: Priority Health SBD	$4.98

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$7.90

Service Code	NDC 00121282394
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$7.11
Rate for Payer: Aetna Commercial	$6.71
Rate for Payer: Aetna Medicare	$3.95
Rate for Payer: Aetna New Business (MI Preferred)	$5.13
Rate for Payer: BCBS Complete	$3.16
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Advantage	$5.53
Rate for Payer: Cofinity Commercial	$6.79
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.11
Rate for Payer: MI Amish Medical Board Commercial	$6.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.92
Rate for Payer: PHP Commercial	$6.71
Rate for Payer: Priority Health SBD	$4.98
Rate for Payer: UHC All Payor (Choice/PPO)	$5.13
Rate for Payer: UHC Core	$4.12
Rate for Payer: UHC Exchange	$3.10

ACETAMINOPHEN 650 MG/20.3 ML ORAL SUSPENSION

Facility

$8.68

Service Code	NDC 68094003059
Hospital Charge Code	88505
Hospital Revenue Code	637
Min. Negotiated Rate	$5.47
Max. Negotiated Rate	$7.81
Rate for Payer: Aetna Commercial	$7.38
Rate for Payer: Aetna New Business (MI Preferred)	$5.64
Rate for Payer: Cash Price	$6.94
Rate for Payer: Cofinity Advantage	$6.08
Rate for Payer: Cofinity Commercial	$7.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.94
Rate for Payer: Healthscope Commercial	$7.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.51
Rate for Payer: PHP Commercial	$7.38
Rate for Payer: Priority Health SBD	$5.47

ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY

Facility

$18.65

Service Code	NDC 45802073030
Hospital Charge Code	105
Hospital Revenue Code	637
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$16.79
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: Aetna New Business (MI Preferred)	$12.12
Rate for Payer: Cash Price	$14.92
Rate for Payer: Cofinity Advantage	$13.05
Rate for Payer: Cofinity Commercial	$16.04
Rate for Payer: Encore Health Key Benefits Commercial	$14.92
Rate for Payer: Healthscope Commercial	$16.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.99
Rate for Payer: PHP Commercial	$15.85
Rate for Payer: Priority Health SBD	$11.75

ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY

Facility

$18.65

Service Code	NDC 45802073030
Hospital Charge Code	105
Hospital Revenue Code	637
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$16.79
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: Aetna Medicare	$9.32
Rate for Payer: Aetna New Business (MI Preferred)	$12.12
Rate for Payer: BCBS Complete	$7.46
Rate for Payer: Cash Price	$14.92
Rate for Payer: Cofinity Advantage	$13.05
Rate for Payer: Cofinity Commercial	$16.04
Rate for Payer: Encore Health Key Benefits Commercial	$14.92
Rate for Payer: Healthscope Commercial	$16.79
Rate for Payer: MI Amish Medical Board Commercial	$14.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.99
Rate for Payer: PHP Commercial	$15.85
Rate for Payer: Priority Health SBD	$11.75
Rate for Payer: UHC All Payor (Choice/PPO)	$12.12
Rate for Payer: UHC Core	$9.72
Rate for Payer: UHC Exchange	$7.33

ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY

Facility

$103.95

Service Code	NDC 45802073032
Hospital Charge Code	105
Hospital Revenue Code	637
Min. Negotiated Rate	$65.49
Max. Negotiated Rate	$93.56
Rate for Payer: Aetna Commercial	$88.36
Rate for Payer: Aetna New Business (MI Preferred)	$67.57
Rate for Payer: Cash Price	$83.16
Rate for Payer: Cofinity Advantage	$72.77
Rate for Payer: Cofinity Commercial	$89.40
Rate for Payer: Encore Health Key Benefits Commercial	$83.16
Rate for Payer: Healthscope Commercial	$93.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.96
Rate for Payer: PHP Commercial	$88.36
Rate for Payer: Priority Health SBD	$65.49

ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY

Facility

$103.95

Service Code	NDC 45802073032
Hospital Charge Code	105
Hospital Revenue Code	637
Min. Negotiated Rate	$40.85
Max. Negotiated Rate	$93.56
Rate for Payer: Aetna Commercial	$88.36
Rate for Payer: Aetna Medicare	$51.98
Rate for Payer: Aetna New Business (MI Preferred)	$67.57
Rate for Payer: BCBS Complete	$41.58
Rate for Payer: Cash Price	$83.16
Rate for Payer: Cofinity Advantage	$72.77
Rate for Payer: Cofinity Commercial	$89.40
Rate for Payer: Encore Health Key Benefits Commercial	$83.16
Rate for Payer: Healthscope Commercial	$93.56
Rate for Payer: MI Amish Medical Board Commercial	$83.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.96
Rate for Payer: PHP Commercial	$88.36
Rate for Payer: Priority Health SBD	$65.49
Rate for Payer: UHC All Payor (Choice/PPO)	$67.57
Rate for Payer: UHC Core	$54.16
Rate for Payer: UHC Exchange	$40.85

Know your out-of-pocket cost for care.

All Charges