Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$252.00

Service Code	NDC 16103036611
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$158.76
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna New Business (MI Preferred)	$163.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cofinity Commercial	$176.40
Rate for Payer: Cofinity Commercial	$216.72
Rate for Payer: Cofinity Medicare Advantage	$176.40
Rate for Payer: Encore Health Key Benefits Commercial	$201.60
Rate for Payer: Healthscope Commercial	$226.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.20
Rate for Payer: PHP Commercial	$214.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health SBD	$158.76

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$566.50

Service Code	NDC 66553000201
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$356.89
Max. Negotiated Rate	$509.85
Rate for Payer: Aetna Commercial	$481.52
Rate for Payer: Aetna New Business (MI Preferred)	$368.23
Rate for Payer: Cash Price	$453.20
Rate for Payer: Cofinity Commercial	$396.55
Rate for Payer: Cofinity Commercial	$487.19
Rate for Payer: Cofinity Medicare Advantage	$396.55
Rate for Payer: Encore Health Key Benefits Commercial	$453.20
Rate for Payer: Healthscope Commercial	$509.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.52
Rate for Payer: PHP Commercial	$481.52
Rate for Payer: Priority Health Cigna Priority Health	$368.23
Rate for Payer: Priority Health SBD	$356.89

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$441.00

Service Code	NDC 00904679480
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$176.40
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna Commercial	$374.85
Rate for Payer: Aetna Medicare	$220.50
Rate for Payer: Aetna New Business (MI Preferred)	$286.65
Rate for Payer: BCBS Complete	$176.40
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cofinity Commercial	$308.70
Rate for Payer: Cofinity Commercial	$379.26
Rate for Payer: Cofinity Medicare Advantage	$308.70
Rate for Payer: Encore Health Key Benefits Commercial	$352.80
Rate for Payer: Healthscope Commercial	$396.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.85
Rate for Payer: PHP Commercial	$374.85
Rate for Payer: Priority Health Cigna Priority Health	$286.65
Rate for Payer: Priority Health SBD	$277.83

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$684.00

Service Code	NDC 00904679430
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$430.92
Max. Negotiated Rate	$615.60
Rate for Payer: Aetna Commercial	$581.40
Rate for Payer: Aetna New Business (MI Preferred)	$444.60
Rate for Payer: Cash Price	$547.20
Rate for Payer: Cofinity Commercial	$478.80
Rate for Payer: Cofinity Commercial	$588.24
Rate for Payer: Cofinity Medicare Advantage	$478.80
Rate for Payer: Encore Health Key Benefits Commercial	$547.20
Rate for Payer: Healthscope Commercial	$615.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$581.40
Rate for Payer: PHP Commercial	$581.40
Rate for Payer: Priority Health Cigna Priority Health	$444.60
Rate for Payer: Priority Health SBD	$430.92

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$61.24

Service Code	NDC 00536100836
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$55.12
Rate for Payer: Aetna Commercial	$52.05
Rate for Payer: Aetna Medicare	$30.62
Rate for Payer: Aetna New Business (MI Preferred)	$39.81
Rate for Payer: BCBS Complete	$24.50
Rate for Payer: Cash Price	$48.99
Rate for Payer: Cofinity Commercial	$42.87
Rate for Payer: Cofinity Commercial	$52.67
Rate for Payer: Cofinity Medicare Advantage	$42.87
Rate for Payer: Encore Health Key Benefits Commercial	$48.99
Rate for Payer: Healthscope Commercial	$55.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.05
Rate for Payer: PHP Commercial	$52.05
Rate for Payer: Priority Health Cigna Priority Health	$39.81
Rate for Payer: Priority Health SBD	$38.58

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$441.00

Service Code	NDC 00904679480
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$277.83
Max. Negotiated Rate	$396.90
Rate for Payer: Aetna Commercial	$374.85
Rate for Payer: Aetna New Business (MI Preferred)	$286.65
Rate for Payer: Cash Price	$352.80
Rate for Payer: Cofinity Commercial	$308.70
Rate for Payer: Cofinity Commercial	$379.26
Rate for Payer: Cofinity Medicare Advantage	$308.70
Rate for Payer: Encore Health Key Benefits Commercial	$352.80
Rate for Payer: Healthscope Commercial	$396.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$374.85
Rate for Payer: PHP Commercial	$374.85
Rate for Payer: Priority Health Cigna Priority Health	$286.65
Rate for Payer: Priority Health SBD	$277.83

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$684.00

Service Code	NDC 00904679430
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$273.60
Max. Negotiated Rate	$615.60
Rate for Payer: Aetna Commercial	$581.40
Rate for Payer: Aetna Medicare	$342.00
Rate for Payer: Aetna New Business (MI Preferred)	$444.60
Rate for Payer: BCBS Complete	$273.60
Rate for Payer: Cash Price	$547.20
Rate for Payer: Cofinity Commercial	$478.80
Rate for Payer: Cofinity Commercial	$588.24
Rate for Payer: Cofinity Medicare Advantage	$478.80
Rate for Payer: Encore Health Key Benefits Commercial	$547.20
Rate for Payer: Healthscope Commercial	$615.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$581.40
Rate for Payer: PHP Commercial	$581.40
Rate for Payer: Priority Health Cigna Priority Health	$444.60
Rate for Payer: Priority Health SBD	$430.92

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$61.24

Service Code	NDC 00536100836
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$38.58
Max. Negotiated Rate	$55.12
Rate for Payer: Aetna Commercial	$52.05
Rate for Payer: Aetna New Business (MI Preferred)	$39.81
Rate for Payer: Cash Price	$48.99
Rate for Payer: Cofinity Commercial	$42.87
Rate for Payer: Cofinity Commercial	$52.67
Rate for Payer: Cofinity Medicare Advantage	$42.87
Rate for Payer: Encore Health Key Benefits Commercial	$48.99
Rate for Payer: Healthscope Commercial	$55.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$52.05
Rate for Payer: PHP Commercial	$52.05
Rate for Payer: Priority Health Cigna Priority Health	$39.81
Rate for Payer: Priority Health SBD	$38.58

ASPIRIN 81 MG CHEWABLE TABLET

Facility

$252.00

Service Code	NDC 16103036611
Hospital Charge Code	679
Hospital Revenue Code	637
Min. Negotiated Rate	$100.80
Max. Negotiated Rate	$226.80
Rate for Payer: Aetna Commercial	$214.20
Rate for Payer: Aetna Medicare	$126.00
Rate for Payer: Aetna New Business (MI Preferred)	$163.80
Rate for Payer: BCBS Complete	$100.80
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cofinity Commercial	$176.40
Rate for Payer: Cofinity Commercial	$216.72
Rate for Payer: Cofinity Medicare Advantage	$176.40
Rate for Payer: Encore Health Key Benefits Commercial	$201.60
Rate for Payer: Healthscope Commercial	$226.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$214.20
Rate for Payer: PHP Commercial	$214.20
Rate for Payer: Priority Health Cigna Priority Health	$163.80
Rate for Payer: Priority Health SBD	$158.76

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$46.82

Service Code	NDC 70000014601
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare	$23.41
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: BCBS Complete	$18.73
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Cofinity Medicare Advantage	$32.77
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health Cigna Priority Health	$30.43
Rate for Payer: Priority Health SBD	$29.50

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$46.82

Service Code	NDC 96295012960
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Cofinity Medicare Advantage	$32.77
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health Cigna Priority Health	$30.43
Rate for Payer: Priority Health SBD	$29.50

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$58.75

Service Code	NDC 00536132601
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$37.01
Max. Negotiated Rate	$52.88
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Aetna New Business (MI Preferred)	$38.19
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Cofinity Medicare Advantage	$41.12
Rate for Payer: Encore Health Key Benefits Commercial	$47.00
Rate for Payer: Healthscope Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.94
Rate for Payer: PHP Commercial	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$38.19
Rate for Payer: Priority Health SBD	$37.01

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$44.65

Service Code	NDC 00904513559
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$17.86
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna Medicare	$22.32
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: BCBS Complete	$17.86
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$58.75

Service Code	NDC 00536132601
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$23.50
Max. Negotiated Rate	$52.88
Rate for Payer: Aetna Commercial	$49.94
Rate for Payer: Aetna Medicare	$29.38
Rate for Payer: Aetna New Business (MI Preferred)	$38.19
Rate for Payer: BCBS Complete	$23.50
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cofinity Commercial	$41.12
Rate for Payer: Cofinity Commercial	$50.52
Rate for Payer: Cofinity Medicare Advantage	$41.12
Rate for Payer: Encore Health Key Benefits Commercial	$47.00
Rate for Payer: Healthscope Commercial	$52.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.94
Rate for Payer: PHP Commercial	$49.94
Rate for Payer: Priority Health Cigna Priority Health	$38.19
Rate for Payer: Priority Health SBD	$37.01

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$46.82

Service Code	NDC 70000014601
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$29.50
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Cofinity Medicare Advantage	$32.77
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health Cigna Priority Health	$30.43
Rate for Payer: Priority Health SBD	$29.50

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$4.85

Service Code	NDC 47682022864
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Commercial	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Cofinity Medicare Advantage	$3.40
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health Cigna Priority Health	$3.15
Rate for Payer: Priority Health SBD	$3.06

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$46.82

Service Code	NDC 96295012960
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$42.14
Rate for Payer: Aetna Commercial	$39.80
Rate for Payer: Aetna Medicare	$23.41
Rate for Payer: Aetna New Business (MI Preferred)	$30.43
Rate for Payer: BCBS Complete	$18.73
Rate for Payer: Cash Price	$37.46
Rate for Payer: Cofinity Commercial	$32.77
Rate for Payer: Cofinity Commercial	$40.27
Rate for Payer: Cofinity Medicare Advantage	$32.77
Rate for Payer: Encore Health Key Benefits Commercial	$37.46
Rate for Payer: Healthscope Commercial	$42.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.80
Rate for Payer: PHP Commercial	$39.80
Rate for Payer: Priority Health Cigna Priority Health	$30.43
Rate for Payer: Priority Health SBD	$29.50

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$4.85

Service Code	NDC 47682022864
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$4.37
Rate for Payer: Aetna Commercial	$4.12
Rate for Payer: Aetna Medicare	$2.42
Rate for Payer: Aetna New Business (MI Preferred)	$3.15
Rate for Payer: BCBS Complete	$1.94
Rate for Payer: Cash Price	$3.88
Rate for Payer: Cofinity Commercial	$3.40
Rate for Payer: Cofinity Commercial	$4.17
Rate for Payer: Cofinity Medicare Advantage	$3.40
Rate for Payer: Encore Health Key Benefits Commercial	$3.88
Rate for Payer: Healthscope Commercial	$4.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.12
Rate for Payer: PHP Commercial	$4.12
Rate for Payer: Priority Health Cigna Priority Health	$3.15
Rate for Payer: Priority Health SBD	$3.06

ASPIRIN-ACETAMINOPHEN-CAFFEINE 250 MG-250 MG-65 MG TABLET

Facility

$44.65

Service Code	NDC 00904513559
Hospital Charge Code	9158
Hospital Revenue Code	637
Min. Negotiated Rate	$28.13
Max. Negotiated Rate	$40.19
Rate for Payer: Aetna Commercial	$37.95
Rate for Payer: Aetna New Business (MI Preferred)	$29.02
Rate for Payer: Cash Price	$35.72
Rate for Payer: Cofinity Commercial	$31.25
Rate for Payer: Cofinity Commercial	$38.40
Rate for Payer: Cofinity Medicare Advantage	$31.25
Rate for Payer: Encore Health Key Benefits Commercial	$35.72
Rate for Payer: Healthscope Commercial	$40.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.95
Rate for Payer: PHP Commercial	$37.95
Rate for Payer: Priority Health Cigna Priority Health	$29.02
Rate for Payer: Priority Health SBD	$28.13

ATENOLOL 25 MG TABLET

Facility

$705.00

Service Code	NDC 00093078710
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$282.00
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna Commercial	$599.25
Rate for Payer: Aetna Medicare	$352.50
Rate for Payer: Aetna New Business (MI Preferred)	$458.25
Rate for Payer: BCBS Complete	$282.00
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cofinity Commercial	$493.50
Rate for Payer: Cofinity Commercial	$606.30
Rate for Payer: Cofinity Medicare Advantage	$493.50
Rate for Payer: Encore Health Key Benefits Commercial	$564.00
Rate for Payer: Healthscope Commercial	$634.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.25
Rate for Payer: PHP Commercial	$599.25
Rate for Payer: Priority Health Cigna Priority Health	$458.25
Rate for Payer: Priority Health SBD	$444.15

ATENOLOL 25 MG TABLET

Facility

$430.05

Service Code	NDC 51079075920
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$172.02
Max. Negotiated Rate	$387.05
Rate for Payer: Aetna Commercial	$365.54
Rate for Payer: Aetna Medicare	$215.03
Rate for Payer: Aetna New Business (MI Preferred)	$279.53
Rate for Payer: BCBS Complete	$172.02
Rate for Payer: Cash Price	$344.04
Rate for Payer: Cofinity Commercial	$301.04
Rate for Payer: Cofinity Commercial	$369.84
Rate for Payer: Cofinity Medicare Advantage	$301.04
Rate for Payer: Encore Health Key Benefits Commercial	$344.04
Rate for Payer: Healthscope Commercial	$387.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$365.54
Rate for Payer: PHP Commercial	$365.54
Rate for Payer: Priority Health Cigna Priority Health	$279.53
Rate for Payer: Priority Health SBD	$270.93

ATENOLOL 25 MG TABLET

Facility

$75.20

Service Code	NDC 00093078701
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$47.38
Max. Negotiated Rate	$67.68
Rate for Payer: Aetna Commercial	$63.92
Rate for Payer: Aetna New Business (MI Preferred)	$48.88
Rate for Payer: Cash Price	$60.16
Rate for Payer: Cofinity Commercial	$52.64
Rate for Payer: Cofinity Commercial	$64.67
Rate for Payer: Cofinity Medicare Advantage	$52.64
Rate for Payer: Encore Health Key Benefits Commercial	$60.16
Rate for Payer: Healthscope Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.92
Rate for Payer: PHP Commercial	$63.92
Rate for Payer: Priority Health Cigna Priority Health	$48.88
Rate for Payer: Priority Health SBD	$47.38

ATENOLOL 25 MG TABLET

Facility

$75.20

Service Code	NDC 00093078701
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$30.08
Max. Negotiated Rate	$67.68
Rate for Payer: Aetna Commercial	$63.92
Rate for Payer: Aetna Medicare	$37.60
Rate for Payer: Aetna New Business (MI Preferred)	$48.88
Rate for Payer: BCBS Complete	$30.08
Rate for Payer: Cash Price	$60.16
Rate for Payer: Cofinity Commercial	$52.64
Rate for Payer: Cofinity Commercial	$64.67
Rate for Payer: Cofinity Medicare Advantage	$52.64
Rate for Payer: Encore Health Key Benefits Commercial	$60.16
Rate for Payer: Healthscope Commercial	$67.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.92
Rate for Payer: PHP Commercial	$63.92
Rate for Payer: Priority Health Cigna Priority Health	$48.88
Rate for Payer: Priority Health SBD	$47.38

ATENOLOL 25 MG TABLET

Facility

$705.00

Service Code	NDC 00093078710
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$444.15
Max. Negotiated Rate	$634.50
Rate for Payer: Aetna Commercial	$599.25
Rate for Payer: Aetna New Business (MI Preferred)	$458.25
Rate for Payer: Cash Price	$564.00
Rate for Payer: Cofinity Commercial	$493.50
Rate for Payer: Cofinity Commercial	$606.30
Rate for Payer: Cofinity Medicare Advantage	$493.50
Rate for Payer: Encore Health Key Benefits Commercial	$564.00
Rate for Payer: Healthscope Commercial	$634.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$599.25
Rate for Payer: PHP Commercial	$599.25
Rate for Payer: Priority Health Cigna Priority Health	$458.25
Rate for Payer: Priority Health SBD	$444.15

ATENOLOL 25 MG TABLET

Facility

$430.05

Service Code	NDC 51079075920
Hospital Charge Code	717
Hospital Revenue Code	637
Min. Negotiated Rate	$270.93
Max. Negotiated Rate	$387.05
Rate for Payer: Aetna Commercial	$365.54
Rate for Payer: Aetna New Business (MI Preferred)	$279.53
Rate for Payer: Cash Price	$344.04
Rate for Payer: Cofinity Commercial	$301.04
Rate for Payer: Cofinity Commercial	$369.84
Rate for Payer: Cofinity Medicare Advantage	$301.04
Rate for Payer: Encore Health Key Benefits Commercial	$344.04
Rate for Payer: Healthscope Commercial	$387.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$365.54
Rate for Payer: PHP Commercial	$365.54
Rate for Payer: Priority Health Cigna Priority Health	$279.53
Rate for Payer: Priority Health SBD	$270.93

Know your out-of-pocket cost for care.

All Charges