|
ABATACEPT INJECTION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$62.31 |
| Rate for Payer: Aetna Commercial |
$57.98
|
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$50.93
|
| Rate for Payer: BCN Medicare Advantage |
$43.27
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.43
|
| Rate for Payer: PACE SWMI |
$43.27
|
| Rate for Payer: PHP Medicare Advantage |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$43.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.27
|
| Rate for Payer: UHC Medicare Advantage |
$44.57
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$32.93
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.08 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$25.45
|
| Rate for Payer: BCN Commercial |
$25.45
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.99
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$14.03
|
|
|
Service Code
|
NDC 51672-2115-2
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Aetna Commercial |
$11.93
|
| Rate for Payer: BCBS Trust/PPO |
$10.84
|
| Rate for Payer: BCN Commercial |
$10.84
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$12.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$12.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.93
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.35
|
| Rate for Payer: UHC Core |
$11.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.52
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.55
|
|
|
Service Code
|
NDC 45802-732-00
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.24
|
| Rate for Payer: Healthscope Commercial |
$1.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.32
|
| Rate for Payer: PHP Commercial |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.36
|
| Rate for Payer: UHC Core |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.16
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 51672-2115-0
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.99
|
| Rate for Payer: PHP Commercial |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC Core |
$1.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$18.57
|
|
|
Service Code
|
NDC 45802-732-30
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$16.71 |
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$14.35
|
| Rate for Payer: BCN Commercial |
$14.35
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$15.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$16.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.34
|
| Rate for Payer: UHC Core |
$15.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.93
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.99
|
|
|
Service Code
|
NDC 68094-231-61
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.51
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.87
|
|
|
Service Code
|
NDC 0904-7278-41
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-0966-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.87
|
|
|
Service Code
|
NDC 0904-7278-70
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.99
|
|
|
Service Code
|
NDC 68094-231-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.59 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.19
|
| Rate for Payer: Healthscope Commercial |
$3.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.51
|
| Rate for Payer: UHC Core |
$3.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.99
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094-015-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.19
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-0966-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$4.01
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.57
|
| Rate for Payer: UHC Core |
$4.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094-015-61
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.19
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID
|
Facility
IP
|
$0.71
|
|
|
Service Code
|
NDC 9900-0003-30
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.55
|
| Rate for Payer: BCN Commercial |
$0.55
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cofinity Commercial |
$0.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.57
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.60
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.62
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID
|
Facility
IP
|
$2.47
|
|
|
Service Code
|
NDC 9900-0003-31
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.10
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 51672-2116-0
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.49
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.27
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$10.12
|
|
|
Service Code
|
NDC 51672-2116-2
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: Aetna Commercial |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$7.82
|
| Rate for Payer: BCN Commercial |
$7.82
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$8.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.60
|
| Rate for Payer: PHP Commercial |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.91
|
| Rate for Payer: UHC Core |
$8.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.59
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
NDC 0904-6773-61
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.22 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: BCBS Trust/PPO |
$142.20
|
| Rate for Payer: BCN Commercial |
$142.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.92
|
| Rate for Payer: UHC Core |
$153.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 50580-458-11
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.79 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCN Commercial |
$68.16
|
| Rate for Payer: Cash Price |
$70.56
|
| 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: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
NDC 0904-6730-61
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: BCBS Trust/PPO |
$95.83
|
| Rate for Payer: BCN Commercial |
$95.83
|
| Rate for Payer: Cash Price |
$99.20
|
| 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: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.12
|
| Rate for Payer: UHC Core |
$103.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$119.70
|
|
|
Service Code
|
NDC 0904-6720-60
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.74
|
| Rate for Payer: BCBS Trust/PPO |
$92.50
|
| Rate for Payer: BCN Commercial |
$92.50
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$101.74
|
| Rate for Payer: PHP Commercial |
$101.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.34
|
| Rate for Payer: UHC Core |
$99.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$819.00
|
|
|
Service Code
|
NDC 0904-6730-80
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.51 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: BCBS Trust/PPO |
$632.92
|
| Rate for Payer: BCN Commercial |
$632.92
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$704.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Healthscope Commercial |
$737.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.72
|
| Rate for Payer: UHC Core |
$683.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
