Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

ABDOMINAL PAIN

Facility

$4,492.57

Service Code	APR-DRG 2512
Min. Negotiated Rate	$4,061.82
Max. Negotiated Rate	$4,492.57
Rate for Payer: BCBS Complete	$4,492.57
Rate for Payer: Mclaren Medicaid	$4,278.64
Rate for Payer: Meridian Medicaid	$4,492.57
Rate for Payer: PHP Medicaid	$4,061.82
Rate for Payer: Priority Health Choice Medicaid	$4,278.64
Rate for Payer: UHC Medicaid	$4,278.64
Rate for Payer: UHCCP Medicaid	$4,278.64

ABDOMINAL PAIN

Facility

$8,557.89

Service Code	APR-DRG 2514
Min. Negotiated Rate	$7,737.36
Max. Negotiated Rate	$8,557.89
Rate for Payer: BCBS Complete	$8,557.89
Rate for Payer: Mclaren Medicaid	$8,150.38
Rate for Payer: Meridian Medicaid	$8,557.89
Rate for Payer: PHP Medicaid	$7,737.36
Rate for Payer: Priority Health Choice Medicaid	$8,150.38
Rate for Payer: UHC Medicaid	$8,150.38
Rate for Payer: UHCCP Medicaid	$8,150.38

ABDOMINAL PAIN

Facility

$5,559.58

Service Code	APR-DRG 2513
Min. Negotiated Rate	$5,026.53
Max. Negotiated Rate	$5,559.58
Rate for Payer: BCBS Complete	$5,559.58
Rate for Payer: Mclaren Medicaid	$5,294.84
Rate for Payer: Meridian Medicaid	$5,559.58
Rate for Payer: PHP Medicaid	$5,026.53
Rate for Payer: Priority Health Choice Medicaid	$5,294.84
Rate for Payer: UHC Medicaid	$5,294.84
Rate for Payer: UHCCP Medicaid	$5,294.84

ABDOMINAL PAIN

Facility

$3,754.71

Service Code	APR-DRG 2511
Min. Negotiated Rate	$3,394.70
Max. Negotiated Rate	$3,754.71
Rate for Payer: BCBS Complete	$3,754.71
Rate for Payer: Mclaren Medicaid	$3,575.91
Rate for Payer: Meridian Medicaid	$3,754.71
Rate for Payer: PHP Medicaid	$3,394.70
Rate for Payer: Priority Health Choice Medicaid	$3,575.91
Rate for Payer: UHC Medicaid	$3,575.91
Rate for Payer: UHCCP Medicaid	$3,575.91

ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE

Facility

$1,400.77

Service Code	CPT 49082
Hospital Revenue Code	361
Min. Negotiated Rate	$472.65
Max. Negotiated Rate	$1,400.77
Rate for Payer: Aetna Medicare	$903.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,129.65
Rate for Payer: Amish Plain Church Group Commercial	$1,129.65
Rate for Payer: BCBS Complete	$496.32
Rate for Payer: BCBS MAPPO	$903.72
Rate for Payer: BCN Medicare Advantage	$903.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$903.72
Rate for Payer: Humana Choice PPO Medicare	$903.72
Rate for Payer: Mclaren Medicaid	$903.72
Rate for Payer: Mclaren Medicare	$903.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$948.91
Rate for Payer: Meridian Medicaid	$496.32
Rate for Payer: MI Amish Medical Board Commercial	$1,039.28
Rate for Payer: Molina Medicare/Medicaid	$994.09
Rate for Payer: PACE Medicare	$858.53
Rate for Payer: PACE SWMI	$903.72
Rate for Payer: PHP Commercial	$994.09
Rate for Payer: PHP Medicaid	$484.39
Rate for Payer: PHP Medicare Advantage	$903.72
Rate for Payer: Priority Health Choice Medicaid	$472.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$927.28
Rate for Payer: Priority Health Medicare	$903.72
Rate for Payer: Priority Health Narrow Network	$741.82
Rate for Payer: Railroad Medicare Medicare	$903.72
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$903.72
Rate for Payer: UHC Exchange	$1,400.77
Rate for Payer: UHC Medicaid	$472.65
Rate for Payer: UHCCP DNSP	$903.72
Rate for Payer: UHCCP Medicaid	$472.65
Rate for Payer: VA VA	$903.72

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,791.23

Service Code	APR-DRG 5431
Min. Negotiated Rate	$2,523.61
Max. Negotiated Rate	$2,791.23
Rate for Payer: BCBS Complete	$2,791.23
Rate for Payer: Mclaren Medicaid	$2,658.32
Rate for Payer: Meridian Medicaid	$2,791.23
Rate for Payer: PHP Medicaid	$2,523.61
Rate for Payer: Priority Health Choice Medicaid	$2,658.32
Rate for Payer: UHC Medicaid	$2,658.32
Rate for Payer: UHCCP Medicaid	$2,658.32

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,503.48

Service Code	APR-DRG 5432
Min. Negotiated Rate	$3,167.57
Max. Negotiated Rate	$3,503.48
Rate for Payer: BCBS Complete	$3,503.48
Rate for Payer: Mclaren Medicaid	$3,336.65
Rate for Payer: Meridian Medicaid	$3,503.48
Rate for Payer: PHP Medicaid	$3,167.57
Rate for Payer: Priority Health Choice Medicaid	$3,336.65
Rate for Payer: UHC Medicaid	$3,336.65
Rate for Payer: UHCCP Medicaid	$3,336.65

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$13,031.39

Service Code	APR-DRG 5434
Min. Negotiated Rate	$11,781.94
Max. Negotiated Rate	$13,031.39
Rate for Payer: BCBS Complete	$13,031.39
Rate for Payer: Mclaren Medicaid	$12,410.85
Rate for Payer: Meridian Medicaid	$13,031.39
Rate for Payer: PHP Medicaid	$11,781.94
Rate for Payer: Priority Health Choice Medicaid	$12,410.85
Rate for Payer: UHC Medicaid	$12,410.85
Rate for Payer: UHCCP Medicaid	$12,410.85

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$13,911.48

Service Code	MSDRG 770
Min. Negotiated Rate	$6,041.77
Max. Negotiated Rate	$13,911.48
Rate for Payer: Aetna Medicare	$8,975.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,218.94
Rate for Payer: Amish Plain Church Group Commercial	$11,218.94
Rate for Payer: BCBS MAPPO	$8,975.15
Rate for Payer: BCN Medicare Advantage	$8,975.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,975.15
Rate for Payer: Humana Choice PPO Medicare	$8,975.15
Rate for Payer: Mclaren Medicare	$8,975.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,423.91
Rate for Payer: MI Amish Medical Board Commercial	$10,321.42
Rate for Payer: Molina Medicare/Medicaid	$9,872.67
Rate for Payer: PACE Medicare	$8,526.39
Rate for Payer: PACE SWMI	$8,975.15
Rate for Payer: PHP Commercial	$9,872.67
Rate for Payer: PHP Medicare Advantage	$8,975.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$7,552.22
Rate for Payer: Priority Health Medicare	$8,975.15
Rate for Payer: Priority Health Narrow Network	$6,041.77
Rate for Payer: Railroad Medicare Medicare	$8,975.15
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,975.15
Rate for Payer: UHC Exchange	$13,911.48
Rate for Payer: UHCCP DNSP	$8,975.15
Rate for Payer: VA VA	$8,975.15

ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$5,444.60

Service Code	APR-DRG 5433
Min. Negotiated Rate	$4,922.57
Max. Negotiated Rate	$5,444.60
Rate for Payer: BCBS Complete	$5,444.60
Rate for Payer: Mclaren Medicaid	$5,185.33
Rate for Payer: Meridian Medicaid	$5,444.60
Rate for Payer: PHP Medicaid	$4,922.57
Rate for Payer: Priority Health Choice Medicaid	$5,185.33
Rate for Payer: UHC Medicaid	$5,185.33
Rate for Payer: UHCCP Medicaid	$5,185.33

ABORTION WITHOUT D&C

Facility

$12,109.95

Service Code	MSDRG 779
Min. Negotiated Rate	$4,859.14
Max. Negotiated Rate	$12,109.95
Rate for Payer: Aetna Medicare	$7,812.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$9,766.09
Rate for Payer: Amish Plain Church Group Commercial	$9,766.09
Rate for Payer: BCBS MAPPO	$7,812.87
Rate for Payer: BCN Medicare Advantage	$7,812.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$7,812.87
Rate for Payer: Humana Choice PPO Medicare	$7,812.87
Rate for Payer: Mclaren Medicare	$7,812.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,203.51
Rate for Payer: MI Amish Medical Board Commercial	$8,984.80
Rate for Payer: Molina Medicare/Medicaid	$8,594.16
Rate for Payer: PACE Medicare	$7,422.23
Rate for Payer: PACE SWMI	$7,812.87
Rate for Payer: PHP Commercial	$8,594.16
Rate for Payer: PHP Medicare Advantage	$7,812.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$6,073.92
Rate for Payer: Priority Health Medicare	$7,812.87
Rate for Payer: Priority Health Narrow Network	$4,859.14
Rate for Payer: Railroad Medicare Medicare	$7,812.87
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$7,812.87
Rate for Payer: UHC Exchange	$12,109.95
Rate for Payer: UHCCP DNSP	$7,812.87
Rate for Payer: VA VA	$7,812.87

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$8,694.68

Service Code	APR-DRG 5644
Min. Negotiated Rate	$7,861.03
Max. Negotiated Rate	$8,694.68
Rate for Payer: BCBS Complete	$8,694.68
Rate for Payer: Mclaren Medicaid	$8,280.65
Rate for Payer: Meridian Medicaid	$8,694.68
Rate for Payer: PHP Medicaid	$7,861.03
Rate for Payer: Priority Health Choice Medicaid	$8,280.65
Rate for Payer: UHC Medicaid	$8,280.65
Rate for Payer: UHCCP Medicaid	$8,280.65

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$3,107.30

Service Code	APR-DRG 5642
Min. Negotiated Rate	$2,809.38
Max. Negotiated Rate	$3,107.30
Rate for Payer: BCBS Complete	$3,107.30
Rate for Payer: Mclaren Medicaid	$2,959.34
Rate for Payer: Meridian Medicaid	$3,107.30
Rate for Payer: PHP Medicaid	$2,809.38
Rate for Payer: Priority Health Choice Medicaid	$2,959.34
Rate for Payer: UHC Medicaid	$2,959.34
Rate for Payer: UHCCP Medicaid	$2,959.34

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$4,502.92

Service Code	APR-DRG 5643
Min. Negotiated Rate	$4,071.18
Max. Negotiated Rate	$4,502.92
Rate for Payer: BCBS Complete	$4,502.92
Rate for Payer: Mclaren Medicaid	$4,288.50
Rate for Payer: Meridian Medicaid	$4,502.92
Rate for Payer: PHP Medicaid	$4,071.18
Rate for Payer: Priority Health Choice Medicaid	$4,288.50
Rate for Payer: UHC Medicaid	$4,288.50
Rate for Payer: UHCCP Medicaid	$4,288.50

ABORTION WITHOUT D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY

Facility

$2,136.75

Service Code	APR-DRG 5641
Min. Negotiated Rate	$1,931.88
Max. Negotiated Rate	$2,136.75
Rate for Payer: BCBS Complete	$2,136.75
Rate for Payer: Mclaren Medicaid	$2,035.00
Rate for Payer: Meridian Medicaid	$2,136.75
Rate for Payer: PHP Medicaid	$1,931.88
Rate for Payer: Priority Health Choice Medicaid	$2,035.00
Rate for Payer: UHC Medicaid	$2,035.00
Rate for Payer: UHCCP Medicaid	$2,035.00

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

Facility

$4.61

Service Code	NDC 121096605
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$4.61
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: ASR ASR	$4.47
Rate for Payer: BCBS Complete	$1.84
Rate for Payer: BCBS Trust/PPO	$3.80
Rate for Payer: BCN Commercial	$3.80
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.47
Rate for Payer: Healthscope Whirlpool	$4.61
Rate for Payer: Mclaren Commercial	$4.15
Rate for Payer: MI Amish Medical Board Commercial	$3.69
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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$4.04
Rate for Payer: Priority Health Narrow Network	$3.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.06

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

Facility

$4.61

Service Code	NDC 121096600
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$4.61
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: ASR ASR	$4.47
Rate for Payer: BCBS Trust/PPO	$3.78
Rate for Payer: BCN Commercial	$3.78
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.47
Rate for Payer: Healthscope Whirlpool	$4.61
Rate for Payer: Mclaren Commercial	$4.15
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: UHC All Payor (Choice/PPO) + Core	$4.06

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

Facility

$4.61

Service Code	NDC 121096600
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$4.61
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: Aetna Medicare	$1.70
Rate for Payer: ASR ASR	$4.47
Rate for Payer: BCBS Complete	$1.84
Rate for Payer: BCBS Trust/PPO	$3.80
Rate for Payer: BCN Commercial	$3.80
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.47
Rate for Payer: Healthscope Whirlpool	$4.61
Rate for Payer: Mclaren Commercial	$4.15
Rate for Payer: MI Amish Medical Board Commercial	$3.69
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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$4.04
Rate for Payer: Priority Health Narrow Network	$3.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$4.06

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

Facility

$4.61

Service Code	NDC 121096605
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$4.61
Rate for Payer: Aetna Commercial	$4.15
Rate for Payer: ASR ASR	$4.47
Rate for Payer: BCBS Trust/PPO	$3.78
Rate for Payer: BCN Commercial	$3.78
Rate for Payer: Cash Price	$3.69
Rate for Payer: Cofinity Commercial	$4.33
Rate for Payer: Encore Health Key Benefits Commercial	$3.69
Rate for Payer: Healthscope Commercial	$4.47
Rate for Payer: Healthscope Whirlpool	$4.61
Rate for Payer: Mclaren Commercial	$4.15
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: UHC All Payor (Choice/PPO) + Core	$4.06

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

Facility

$4.34

Service Code	NDC 68094023159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna Commercial	$3.91
Rate for Payer: Aetna Medicare	$1.61
Rate for Payer: ASR ASR	$4.21
Rate for Payer: BCBS Complete	$1.74
Rate for Payer: BCBS Trust/PPO	$3.58
Rate for Payer: BCN Commercial	$3.58
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Healthscope Whirlpool	$4.34
Rate for Payer: Mclaren Commercial	$3.91
Rate for Payer: MI Amish Medical Board Commercial	$3.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.69
Rate for Payer: Nomi Health Commercial	$3.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$3.81
Rate for Payer: Priority Health Narrow Network	$3.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.82

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

Facility

$4.34

Service Code	NDC 68094023159
Hospital Charge Code	8943
Hospital Revenue Code	637
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna Commercial	$3.91
Rate for Payer: ASR ASR	$4.21
Rate for Payer: BCBS Trust/PPO	$3.57
Rate for Payer: BCN Commercial	$3.57
Rate for Payer: Cash Price	$3.48
Rate for Payer: Cofinity Commercial	$4.08
Rate for Payer: Encore Health Key Benefits Commercial	$3.48
Rate for Payer: Healthscope Commercial	$4.21
Rate for Payer: Healthscope Whirlpool	$4.34
Rate for Payer: Mclaren Commercial	$3.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.69
Rate for Payer: Nomi Health Commercial	$3.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3.82

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$87.36

Service Code	NDC 51672211604
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$87.36
Rate for Payer: Aetna Commercial	$78.62
Rate for Payer: ASR ASR	$84.74
Rate for Payer: BCBS Trust/PPO	$71.74
Rate for Payer: BCN Commercial	$71.74
Rate for Payer: Cash Price	$69.89
Rate for Payer: Cofinity Commercial	$82.12
Rate for Payer: Encore Health Key Benefits Commercial	$69.89
Rate for Payer: Healthscope Commercial	$84.74
Rate for Payer: Healthscope Whirlpool	$87.36
Rate for Payer: Mclaren Commercial	$78.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$74.26
Rate for Payer: Nomi Health Commercial	$71.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.52
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$76.88

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$1.70

Service Code	NDC 51672211600
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: Aetna Medicare	$0.63
Rate for Payer: ASR ASR	$1.65
Rate for Payer: BCBS Complete	$0.68
Rate for Payer: BCBS Trust/PPO	$1.40
Rate for Payer: BCN Commercial	$1.40
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Encore Health Key Benefits Commercial	$1.36
Rate for Payer: Healthscope Commercial	$1.65
Rate for Payer: Healthscope Whirlpool	$1.70
Rate for Payer: Mclaren Commercial	$1.53
Rate for Payer: MI Amish Medical Board Commercial	$1.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.45
Rate for Payer: Nomi Health Commercial	$1.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$1.49
Rate for Payer: Priority Health Narrow Network	$1.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.50

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$10.22

Service Code	NDC 51672211602
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$10.21
Rate for Payer: Aetna Commercial	$9.19
Rate for Payer: ASR ASR	$9.91
Rate for Payer: BCBS Trust/PPO	$8.39
Rate for Payer: BCN Commercial	$8.39
Rate for Payer: Cash Price	$8.17
Rate for Payer: Cofinity Commercial	$9.60
Rate for Payer: Encore Health Key Benefits Commercial	$8.17
Rate for Payer: Healthscope Commercial	$9.91
Rate for Payer: Healthscope Whirlpool	$10.21
Rate for Payer: Mclaren Commercial	$9.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.68
Rate for Payer: Nomi Health Commercial	$8.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.99

ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY

Facility

$1.70

Service Code	NDC 51672211600
Hospital Charge Code	104
Hospital Revenue Code	637
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna Commercial	$1.53
Rate for Payer: ASR ASR	$1.65
Rate for Payer: BCBS Trust/PPO	$1.40
Rate for Payer: BCN Commercial	$1.40
Rate for Payer: Cash Price	$1.36
Rate for Payer: Cofinity Commercial	$1.60
Rate for Payer: Encore Health Key Benefits Commercial	$1.36
Rate for Payer: Healthscope Commercial	$1.65
Rate for Payer: Healthscope Whirlpool	$1.70
Rate for Payer: Mclaren Commercial	$1.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.45
Rate for Payer: Nomi Health Commercial	$1.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.28
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1.50

Know your out-of-pocket cost for care.

All Charges