Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

ABDOMINAL PAIN

Facility

$5,364.62

Service Code	APR-DRG 2513
Min. Negotiated Rate	$5,109.16
Max. Negotiated Rate	$5,364.62
Rate for Payer: BCBS Complete	$5,364.62
Rate for Payer: Mclaren Medicaid	$5,109.16
Rate for Payer: Meridian Medicaid	$5,364.62
Rate for Payer: Priority Health Choice Medicaid	$5,109.16
Rate for Payer: UHC Medicaid	$5,109.16
Rate for Payer: UHCCP Medicaid	$5,109.16

ABDOMINAL PAIN

Facility

$8,257.79

Service Code	APR-DRG 2514
Min. Negotiated Rate	$7,864.56
Max. Negotiated Rate	$8,257.79
Rate for Payer: BCBS Complete	$8,257.79
Rate for Payer: Mclaren Medicaid	$7,864.56
Rate for Payer: Meridian Medicaid	$8,257.79
Rate for Payer: Priority Health Choice Medicaid	$7,864.56
Rate for Payer: UHC Medicaid	$7,864.56
Rate for Payer: UHCCP Medicaid	$7,864.56

ABDOMINAL PAIN

Facility

$3,623.04

Service Code	APR-DRG 2511
Min. Negotiated Rate	$3,450.51
Max. Negotiated Rate	$3,623.04
Rate for Payer: BCBS Complete	$3,623.04
Rate for Payer: Mclaren Medicaid	$3,450.51
Rate for Payer: Meridian Medicaid	$3,623.04
Rate for Payer: Priority Health Choice Medicaid	$3,450.51
Rate for Payer: UHC Medicaid	$3,450.51
Rate for Payer: UHCCP Medicaid	$3,450.51

ABDOMINAL PAIN

Facility

$4,335.02

Service Code	APR-DRG 2512
Min. Negotiated Rate	$4,128.60
Max. Negotiated Rate	$4,335.02
Rate for Payer: BCBS Complete	$4,335.02
Rate for Payer: Mclaren Medicaid	$4,128.60
Rate for Payer: Meridian Medicaid	$4,335.02
Rate for Payer: Priority Health Choice Medicaid	$4,128.60
Rate for Payer: UHC Medicaid	$4,128.60
Rate for Payer: UHCCP Medicaid	$4,128.60

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,380.63

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,219.64
Max. Negotiated Rate	$3,380.63
Rate for Payer: BCBS Complete	$3,380.63
Rate for Payer: Mclaren Medicaid	$3,219.64
Rate for Payer: Meridian Medicaid	$3,380.63
Rate for Payer: Priority Health Choice Medicaid	$3,219.64
Rate for Payer: UHC Medicaid	$3,219.64
Rate for Payer: UHCCP Medicaid	$3,219.64

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,693.35

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,565.10
Max. Negotiated Rate	$2,693.35
Rate for Payer: BCBS Complete	$2,693.35
Rate for Payer: Mclaren Medicaid	$2,565.10
Rate for Payer: Meridian Medicaid	$2,693.35
Rate for Payer: Priority Health Choice Medicaid	$2,565.10
Rate for Payer: UHC Medicaid	$2,565.10
Rate for Payer: UHCCP Medicaid	$2,565.10

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,253.67

Service Code	APR-DRG 5433
Min. Negotiated Rate	$5,003.49
Max. Negotiated Rate	$5,253.67
Rate for Payer: BCBS Complete	$5,253.67
Rate for Payer: Mclaren Medicaid	$5,003.49
Rate for Payer: Meridian Medicaid	$5,253.67
Rate for Payer: Priority Health Choice Medicaid	$5,003.49
Rate for Payer: UHC Medicaid	$5,003.49
Rate for Payer: UHCCP Medicaid	$5,003.49

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$12,574.41

Service Code	APR-DRG 5434
Min. Negotiated Rate	$11,975.63
Max. Negotiated Rate	$12,574.41
Rate for Payer: BCBS Complete	$12,574.41
Rate for Payer: Mclaren Medicaid	$11,975.63
Rate for Payer: Meridian Medicaid	$12,574.41
Rate for Payer: Priority Health Choice Medicaid	$11,975.63
Rate for Payer: UHC Medicaid	$11,975.63
Rate for Payer: UHCCP Medicaid	$11,975.63

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,345.02

Service Code	APR-DRG 5643
Min. Negotiated Rate	$4,138.11
Max. Negotiated Rate	$4,345.02
Rate for Payer: BCBS Complete	$4,345.02
Rate for Payer: Mclaren Medicaid	$4,138.11
Rate for Payer: Meridian Medicaid	$4,345.02
Rate for Payer: Priority Health Choice Medicaid	$4,138.11
Rate for Payer: UHC Medicaid	$4,138.11
Rate for Payer: UHCCP Medicaid	$4,138.11

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$8,389.78

Service Code	APR-DRG 5644
Min. Negotiated Rate	$7,990.26
Max. Negotiated Rate	$8,389.78
Rate for Payer: BCBS Complete	$8,389.78
Rate for Payer: Mclaren Medicaid	$7,990.26
Rate for Payer: Meridian Medicaid	$8,389.78
Rate for Payer: Priority Health Choice Medicaid	$7,990.26
Rate for Payer: UHC Medicaid	$7,990.26
Rate for Payer: UHCCP Medicaid	$7,990.26

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,998.34

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,855.56
Max. Negotiated Rate	$2,998.34
Rate for Payer: BCBS Complete	$2,998.34
Rate for Payer: Mclaren Medicaid	$2,855.56
Rate for Payer: Meridian Medicaid	$2,998.34
Rate for Payer: Priority Health Choice Medicaid	$2,855.56
Rate for Payer: UHC Medicaid	$2,855.56
Rate for Payer: UHCCP Medicaid	$2,855.56

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,061.82

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,963.64
Max. Negotiated Rate	$2,061.82
Rate for Payer: BCBS Complete	$2,061.82
Rate for Payer: Mclaren Medicaid	$1,963.64
Rate for Payer: Meridian Medicaid	$2,061.82
Rate for Payer: Priority Health Choice Medicaid	$1,963.64
Rate for Payer: UHC Medicaid	$1,963.64
Rate for Payer: UHCCP Medicaid	$1,963.64

ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION

Facility

$19.58

Service Code	HCPCS J0131
Hospital Charge Code	151854
Hospital Revenue Code	636
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$17.62
Rate for Payer: Aetna Commercial	$16.64
Rate for Payer: Aetna Medicare	$5.09
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.12
Rate for Payer: Amish Plain Church Group Commercial	$6.12
Rate for Payer: BCBS Complete	$3.62
Rate for Payer: BCBS MAPPO	$4.89
Rate for Payer: BCBS Trust/PPO	$16.10
Rate for Payer: BCN Commercial	$16.10
Rate for Payer: BCN Medicare Advantage	$4.89
Rate for Payer: Cash Price	$15.66
Rate for Payer: Cofinity Commercial	$16.84
Rate for Payer: Encore Health Key Benefits Commercial	$15.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.89
Rate for Payer: Healthscope Commercial	$17.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.69
Rate for Payer: Mclaren Medicaid	$3.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.14
Rate for Payer: Meridian Medicaid	$3.62
Rate for Payer: MI Amish Medical Board Commercial	$5.63
Rate for Payer: Molina Medicare/Medicaid	$5.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.64
Rate for Payer: Nomi Health Commercial	$16.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.69
Rate for Payer: PACE Senior Care Partners	$4.65
Rate for Payer: PACE SWMI	$4.89
Rate for Payer: PHP Commercial	$16.64
Rate for Payer: PHP Medicare Advantage	$4.89
Rate for Payer: Priority Health Choice Medicaid	$3.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.03
Rate for Payer: Priority Health Medicare	$4.94
Rate for Payer: Priority Health Narrow/Tiered Network	$13.63
Rate for Payer: Railroad Medicare Medicare	$4.89
Rate for Payer: UHC All Payor (Choice/PPO)	$17.23
Rate for Payer: UHC Core	$16.35
Rate for Payer: UHC Exchange	$4.89
Rate for Payer: UHC Medicaid	$3.45
Rate for Payer: UHC Medicare Advantage	$4.89
Rate for Payer: UHCCP Medicaid	$3.45
Rate for Payer: VA VA	$4.89
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.69

ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION

Facility

$19.58

Service Code	HCPCS J0131
Hospital Charge Code	151854
Hospital Revenue Code	636
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$17.62
Rate for Payer: Aetna Commercial	$16.64
Rate for Payer: BCBS Trust/PPO	$16.17
Rate for Payer: BCN Commercial	$16.17
Rate for Payer: Cash Price	$15.66
Rate for Payer: Cofinity Commercial	$16.84
Rate for Payer: Encore Health Key Benefits Commercial	$15.66
Rate for Payer: Healthscope Commercial	$17.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.64
Rate for Payer: Nomi Health Commercial	$16.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.69
Rate for Payer: PHP Commercial	$16.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.03
Rate for Payer: Priority Health Narrow/Tiered Network	$13.63
Rate for Payer: UHC All Payor (Choice/PPO)	$17.23
Rate for Payer: UHC Core	$16.35
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.69

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$18.99

Service Code	NDC 45802073230
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$17.09
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: Aetna Medicare	$4.94
Rate for Payer: Allen County Amish Medical Aid Commercial	$5.93
Rate for Payer: Amish Plain Church Group Commercial	$5.93
Rate for Payer: BCBS Complete	$3.52
Rate for Payer: BCBS MAPPO	$4.75
Rate for Payer: BCBS Trust/PPO	$15.61
Rate for Payer: BCN Commercial	$15.61
Rate for Payer: BCN Medicare Advantage	$4.75
Rate for Payer: Cash Price	$15.19
Rate for Payer: Cofinity Commercial	$16.33
Rate for Payer: Encore Health Key Benefits Commercial	$15.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.75
Rate for Payer: Healthscope Commercial	$17.09
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.24
Rate for Payer: Mclaren Medicaid	$3.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.98
Rate for Payer: Meridian Medicaid	$3.52
Rate for Payer: MI Amish Medical Board Commercial	$5.46
Rate for Payer: Molina Medicare/Medicaid	$5.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.14
Rate for Payer: Nomi Health Commercial	$15.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.24
Rate for Payer: PACE Senior Care Partners	$4.51
Rate for Payer: PACE SWMI	$4.75
Rate for Payer: PHP Commercial	$16.14
Rate for Payer: PHP Medicare Advantage	$4.75
Rate for Payer: Priority Health Choice Medicaid	$3.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.52
Rate for Payer: Priority Health Medicare	$4.79
Rate for Payer: Priority Health Narrow/Tiered Network	$13.22
Rate for Payer: Railroad Medicare Medicare	$4.75
Rate for Payer: UHC All Payor (Choice/PPO)	$16.71
Rate for Payer: UHC Core	$15.86
Rate for Payer: UHC Exchange	$4.75
Rate for Payer: UHC Medicaid	$3.35
Rate for Payer: UHC Medicare Advantage	$4.75
Rate for Payer: UHCCP Medicaid	$3.35
Rate for Payer: VA VA	$4.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.24

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$3.32

Service Code	NDC 51672211500
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: Aetna Medicare	$0.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.04
Rate for Payer: Amish Plain Church Group Commercial	$1.04
Rate for Payer: BCBS Complete	$0.61
Rate for Payer: BCBS MAPPO	$0.83
Rate for Payer: BCBS Trust/PPO	$2.73
Rate for Payer: BCN Commercial	$2.73
Rate for Payer: BCN Medicare Advantage	$0.83
Rate for Payer: Cash Price	$2.66
Rate for Payer: Cofinity Commercial	$2.86
Rate for Payer: Encore Health Key Benefits Commercial	$2.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.83
Rate for Payer: Healthscope Commercial	$2.99
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.49
Rate for Payer: Mclaren Medicaid	$0.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.87
Rate for Payer: Meridian Medicaid	$0.61
Rate for Payer: MI Amish Medical Board Commercial	$0.95
Rate for Payer: Molina Medicare/Medicaid	$0.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Nomi Health Commercial	$2.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PACE Senior Care Partners	$0.79
Rate for Payer: PACE SWMI	$0.83
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: PHP Medicare Advantage	$0.83
Rate for Payer: Priority Health Choice Medicaid	$0.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2.89
Rate for Payer: Priority Health Medicare	$0.84
Rate for Payer: Priority Health Narrow/Tiered Network	$2.31
Rate for Payer: Railroad Medicare Medicare	$0.83
Rate for Payer: UHC All Payor (Choice/PPO)	$2.92
Rate for Payer: UHC Core	$2.77
Rate for Payer: UHC Exchange	$0.83
Rate for Payer: UHC Medicaid	$0.59
Rate for Payer: UHC Medicare Advantage	$0.83
Rate for Payer: UHCCP Medicaid	$0.59
Rate for Payer: VA VA	$0.83
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.49

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$18.99

Service Code	NDC 45802073230
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$13.22
Max. Negotiated Rate	$17.09
Rate for Payer: Aetna Commercial	$16.14
Rate for Payer: BCBS Trust/PPO	$15.68
Rate for Payer: BCN Commercial	$15.68
Rate for Payer: Cash Price	$15.19
Rate for Payer: Cofinity Commercial	$16.33
Rate for Payer: Encore Health Key Benefits Commercial	$15.19
Rate for Payer: Healthscope Commercial	$17.09
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.14
Rate for Payer: Nomi Health Commercial	$15.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.24
Rate for Payer: PHP Commercial	$16.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.52
Rate for Payer: Priority Health Narrow/Tiered Network	$13.22
Rate for Payer: UHC All Payor (Choice/PPO)	$16.71
Rate for Payer: UHC Core	$15.86
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.24

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$3.32

Service Code	NDC 51672211500
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.99
Rate for Payer: Aetna Commercial	$2.82
Rate for Payer: BCBS Trust/PPO	$2.74
Rate for Payer: BCN Commercial	$2.74
Rate for Payer: Cash Price	$2.66
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: Lakeland Regional Health Systems Commercial	$2.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.82
Rate for Payer: Nomi Health Commercial	$2.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.49
Rate for Payer: PHP Commercial	$2.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2.89
Rate for Payer: Priority Health Narrow/Tiered Network	$2.31
Rate for Payer: UHC All Payor (Choice/PPO)	$2.92
Rate for Payer: UHC Core	$2.77
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.49

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$1.59

Service Code	NDC 45802073200
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: BCBS Trust/PPO	$1.31
Rate for Payer: BCN Commercial	$1.31
Rate for Payer: Cash Price	$1.27
Rate for Payer: Cofinity Commercial	$1.37
Rate for Payer: Encore Health Key Benefits Commercial	$1.27
Rate for Payer: Healthscope Commercial	$1.43
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.35
Rate for Payer: Nomi Health Commercial	$1.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.19
Rate for Payer: PHP Commercial	$1.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1.11
Rate for Payer: UHC All Payor (Choice/PPO)	$1.40
Rate for Payer: UHC Core	$1.33
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.19

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$1.59

Service Code	NDC 45802073200
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$1.43
Rate for Payer: Aetna Commercial	$1.35
Rate for Payer: Aetna Medicare	$0.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$0.50
Rate for Payer: Amish Plain Church Group Commercial	$0.50
Rate for Payer: BCBS Complete	$0.29
Rate for Payer: BCBS MAPPO	$0.40
Rate for Payer: BCBS Trust/PPO	$1.31
Rate for Payer: BCN Commercial	$1.31
Rate for Payer: BCN Medicare Advantage	$0.40
Rate for Payer: Cash Price	$1.27
Rate for Payer: Cofinity Commercial	$1.37
Rate for Payer: Encore Health Key Benefits Commercial	$1.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.40
Rate for Payer: Healthscope Commercial	$1.43
Rate for Payer: Lakeland Regional Health Systems Commercial	$1.19
Rate for Payer: Mclaren Medicaid	$0.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.42
Rate for Payer: Meridian Medicaid	$0.29
Rate for Payer: MI Amish Medical Board Commercial	$0.46
Rate for Payer: Molina Medicare/Medicaid	$0.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.35
Rate for Payer: Nomi Health Commercial	$1.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.19
Rate for Payer: PACE Senior Care Partners	$0.38
Rate for Payer: PACE SWMI	$0.40
Rate for Payer: PHP Commercial	$1.35
Rate for Payer: PHP Medicare Advantage	$0.40
Rate for Payer: Priority Health Choice Medicaid	$0.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1.38
Rate for Payer: Priority Health Medicare	$0.40
Rate for Payer: Priority Health Narrow/Tiered Network	$1.11
Rate for Payer: Railroad Medicare Medicare	$0.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1.40
Rate for Payer: UHC Core	$1.33
Rate for Payer: UHC Exchange	$0.40
Rate for Payer: UHC Medicaid	$0.28
Rate for Payer: UHC Medicare Advantage	$0.40
Rate for Payer: UHCCP Medicaid	$0.28
Rate for Payer: VA VA	$0.40
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1.19

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$19.88

Service Code	NDC 51672211502
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$13.84
Max. Negotiated Rate	$17.89
Rate for Payer: Aetna Commercial	$16.90
Rate for Payer: BCBS Trust/PPO	$16.42
Rate for Payer: BCN Commercial	$16.42
Rate for Payer: Cash Price	$15.90
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: Lakeland Regional Health Systems Commercial	$14.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.90
Rate for Payer: Nomi Health Commercial	$16.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.91
Rate for Payer: PHP Commercial	$16.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.30
Rate for Payer: Priority Health Narrow/Tiered Network	$13.84
Rate for Payer: UHC All Payor (Choice/PPO)	$17.49
Rate for Payer: UHC Core	$16.60
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.91

ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY

Facility

$19.88

Service Code	NDC 51672211502
Hospital Charge Code	103
Hospital Revenue Code	637
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$17.89
Rate for Payer: Aetna Commercial	$16.90
Rate for Payer: Aetna Medicare	$5.17
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.21
Rate for Payer: Amish Plain Church Group Commercial	$6.21
Rate for Payer: BCBS Complete	$3.68
Rate for Payer: BCBS MAPPO	$4.97
Rate for Payer: BCBS Trust/PPO	$16.34
Rate for Payer: BCN Commercial	$16.34
Rate for Payer: BCN Medicare Advantage	$4.97
Rate for Payer: Cash Price	$15.90
Rate for Payer: Cofinity Commercial	$17.10
Rate for Payer: Encore Health Key Benefits Commercial	$15.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.97
Rate for Payer: Healthscope Commercial	$17.89
Rate for Payer: Lakeland Regional Health Systems Commercial	$14.91
Rate for Payer: Mclaren Medicaid	$3.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.22
Rate for Payer: Meridian Medicaid	$3.68
Rate for Payer: MI Amish Medical Board Commercial	$5.72
Rate for Payer: Molina Medicare/Medicaid	$5.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.90
Rate for Payer: Nomi Health Commercial	$16.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.91
Rate for Payer: PACE Senior Care Partners	$4.72
Rate for Payer: PACE SWMI	$4.97
Rate for Payer: PHP Commercial	$16.90
Rate for Payer: PHP Medicare Advantage	$4.97
Rate for Payer: Priority Health Choice Medicaid	$3.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$17.30
Rate for Payer: Priority Health Medicare	$5.02
Rate for Payer: Priority Health Narrow/Tiered Network	$13.84
Rate for Payer: Railroad Medicare Medicare	$4.97
Rate for Payer: UHC All Payor (Choice/PPO)	$17.49
Rate for Payer: UHC Core	$16.60
Rate for Payer: UHC Exchange	$4.97
Rate for Payer: UHC Medicaid	$3.50
Rate for Payer: UHC Medicare Advantage	$4.97
Rate for Payer: UHCCP Medicaid	$3.50
Rate for Payer: VA VA	$4.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$14.91

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	$3.23
Max. Negotiated Rate	$4.18
Rate for Payer: Aetna Commercial	$3.94
Rate for Payer: BCBS Trust/PPO	$3.83
Rate for Payer: BCN Commercial	$3.83
Rate for Payer: Cash Price	$3.71
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: Lakeland Regional Health Systems Commercial	$3.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.94
Rate for Payer: Nomi Health Commercial	$3.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.48
Rate for Payer: PHP Commercial	$3.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.04
Rate for Payer: Priority Health Narrow/Tiered Network	$3.23
Rate for Payer: UHC All Payor (Choice/PPO)	$4.08
Rate for Payer: UHC Core	$3.87
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$3.48

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

Facility

$3.96

Service Code	NDC 00904727841
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$3.56
Rate for Payer: Aetna Commercial	$3.37
Rate for Payer: Aetna Medicare	$1.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$1.24
Rate for Payer: Amish Plain Church Group Commercial	$1.24
Rate for Payer: BCBS Complete	$0.73
Rate for Payer: BCBS MAPPO	$0.99
Rate for Payer: BCBS Trust/PPO	$3.26
Rate for Payer: BCN Commercial	$3.26
Rate for Payer: BCN Medicare Advantage	$0.99
Rate for Payer: Cash Price	$3.17
Rate for Payer: Cofinity Commercial	$3.41
Rate for Payer: Encore Health Key Benefits Commercial	$3.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.99
Rate for Payer: Healthscope Commercial	$3.56
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.97
Rate for Payer: Mclaren Medicaid	$0.70
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1.04
Rate for Payer: Meridian Medicaid	$0.73
Rate for Payer: MI Amish Medical Board Commercial	$1.14
Rate for Payer: Molina Medicare/Medicaid	$1.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.37
Rate for Payer: Nomi Health Commercial	$3.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.97
Rate for Payer: PACE Senior Care Partners	$0.94
Rate for Payer: PACE SWMI	$0.99
Rate for Payer: PHP Commercial	$3.37
Rate for Payer: PHP Medicare Advantage	$0.99
Rate for Payer: Priority Health Choice Medicaid	$0.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3.45
Rate for Payer: Priority Health Medicare	$1.00
Rate for Payer: Priority Health Narrow/Tiered Network	$2.76
Rate for Payer: Railroad Medicare Medicare	$0.99
Rate for Payer: UHC All Payor (Choice/PPO)	$3.48
Rate for Payer: UHC Core	$3.31
Rate for Payer: UHC Exchange	$0.99
Rate for Payer: UHC Medicaid	$0.70
Rate for Payer: UHC Medicare Advantage	$0.99
Rate for Payer: UHCCP Medicaid	$0.70
Rate for Payer: VA VA	$0.99
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.97

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

Facility

$4.61

Service Code	NDC 00121096605
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$4.15
Rate for Payer: Aetna Commercial	$3.92
Rate for Payer: BCBS Trust/PPO	$3.81
Rate for Payer: BCN Commercial	$3.81
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$3.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.92
Rate for Payer: Nomi Health Commercial	$3.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.46
Rate for Payer: PHP Commercial	$3.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4.01
Rate for Payer: Priority Health Narrow/Tiered Network	$3.21
Rate for Payer: UHC All Payor (Choice/PPO)	$4.06
Rate for Payer: UHC Core	$3.85
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$3.46

Know your out-of-pocket cost for care.

All Charges