|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32.93
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.29
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS MAPPO |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$27.07
|
| Rate for Payer: BCN Commercial |
$25.60
|
| Rate for Payer: BCN Medicare Advantage |
$8.23
|
| 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: Health Alliance Plan Medicare Advantage |
$8.23
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: PACE Senior Care Partners |
$7.82
|
| Rate for Payer: PACE SWMI |
$8.23
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Medicare Advantage |
$8.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health Medicare |
$8.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.98
|
| Rate for Payer: UHC Core |
$27.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.23
|
| Rate for Payer: UHC Exchange |
$8.23
|
| Rate for Payer: UHC Medicare Advantage |
$8.23
|
| Rate for Payer: VA VA |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
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 |
$21.40 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: BCBS Trust/PPO |
$26.88
|
| 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 Commercial |
$27.99
|
| Rate for Payer: Nomi Health Commercial |
$27.00
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health HMO/PPO |
$28.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.06
|
| 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
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.50
|
| Rate for Payer: BCN Commercial |
$14.68
|
| 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: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health HMO/PPO |
$16.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.72
|
| 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
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.51 |
| 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 |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS Trust/PPO |
$15.61
|
| Rate for Payer: BCN Commercial |
$14.76
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$15.57
|
| 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 Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health HMO/PPO |
$16.52
|
| Rate for Payer: Priority Health Medicare |
$4.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.72
|
| 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 Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: VA VA |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.41
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.23
|
| 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: PHP Commercial |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.07
|
| 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
|
IP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: BCBS Trust/PPO |
$15.26
|
| Rate for Payer: BCN Commercial |
$14.45
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.02
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$0.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS MAPPO |
$0.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.56
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: BCN Medicare Advantage |
$0.78
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.78
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: PACE Senior Care Partners |
$0.74
|
| Rate for Payer: PACE SWMI |
$0.78
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$0.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO |
$2.71
|
| Rate for Payer: Priority Health Medicare |
$0.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.78
|
| Rate for Payer: UHC Exchange |
$0.78
|
| Rate for Payer: UHC Medicare Advantage |
$0.78
|
| Rate for Payer: VA VA |
$0.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.84
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.37
|
| Rate for Payer: BCN Commercial |
$14.54
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: PACE Senior Care Partners |
$4.44
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health HMO/PPO |
$16.27
|
| Rate for Payer: Priority Health Medicare |
$4.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.53
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$15.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.02
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| 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 |
$0.64
|
| Rate for Payer: BCBS MAPPO |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.24
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.35
|
| Rate for Payer: Nomi Health Commercial |
$1.30
|
| 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 Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health HMO/PPO |
$1.38
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.07
|
| 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 Dual Complete DSNP |
$0.40
|
| Rate for Payer: UHC Exchange |
$0.40
|
| Rate for Payer: UHC Medicare Advantage |
$0.40
|
| Rate for Payer: VA VA |
$0.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.19
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68094023161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.54
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.23
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PACE Senior Care Partners |
$1.17
|
| Rate for Payer: PACE SWMI |
$1.23
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Medicare Advantage |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$1.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.23
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UHC Medicare Advantage |
$1.23
|
| Rate for Payer: VA VA |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68094023161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Nomi Health Commercial |
$4.06
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health HMO/PPO |
$4.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.22
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health HMO/PPO |
$3.41
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.63
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.45
|
| Rate for Payer: UHC Core |
$3.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health HMO/PPO |
$3.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.45
|
| Rate for Payer: UHC Core |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.92
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.22
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.22
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: BCN Medicare Advantage |
$0.98
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.98
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$3.21
|
| Rate for Payer: PACE Senior Care Partners |
$0.93
|
| Rate for Payer: PACE SWMI |
$0.98
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health HMO/PPO |
$3.41
|
| Rate for Payer: Priority Health Medicare |
$0.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.63
|
| Rate for Payer: Railroad Medicare Medicare |
$0.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.45
|
| Rate for Payer: UHC Core |
$3.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.98
|
| Rate for Payer: UHC Exchange |
$0.98
|
| Rate for Payer: UHC Medicare Advantage |
$0.98
|
| Rate for Payer: VA VA |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.55
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS MAPPO |
$1.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.07
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: BCN Medicare Advantage |
$1.24
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.24
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Nomi Health Commercial |
$4.06
|
| Rate for Payer: PACE Senior Care Partners |
$1.18
|
| Rate for Payer: PACE SWMI |
$1.24
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$1.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health HMO/PPO |
$4.31
|
| Rate for Payer: Priority Health Medicare |
$1.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.32
|
| Rate for Payer: Railroad Medicare Medicare |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.24
|
| Rate for Payer: UHC Exchange |
$1.24
|
| Rate for Payer: UHC Medicare Advantage |
$1.24
|
| Rate for Payer: VA VA |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.49
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCN Commercial |
$3.70
|
| Rate for Payer: BCN Medicare Advantage |
$1.19
|
| 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: Health Alliance Plan Medicare Advantage |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.19
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: PHP Medicare Advantage |
$1.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.14
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.19
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.19
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UHC Medicare Advantage |
$1.19
|
| Rate for Payer: VA VA |
$1.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| 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 Commercial |
$4.05
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.19
|
| 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
|
$4.95
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Nomi Health Commercial |
$4.06
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health HMO/PPO |
$4.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.36
|
| Rate for Payer: UHC Core |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
