|
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
|
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
|
$4.32
|
|
|
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
|
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
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| 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 ORAL LIQUID
|
Facility
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 09900000331
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.77
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$1.92
|
| Rate for Payer: BCN Medicare Advantage |
$0.62
|
| 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: Health Alliance Plan Medicare Advantage |
$0.62
|
| Rate for Payer: Healthscope Commercial |
$2.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PACE Senior Care Partners |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.62
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| Rate for Payer: Railroad Medicare Medicare |
$0.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.62
|
| Rate for Payer: UHC Exchange |
$0.62
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$2.47
|
|
|
Service Code
|
NDC 09900000331
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| 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 Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.65
|
| 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 160 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 00990000030
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| 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 Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.48
|
| 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
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 00990000030
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.22
|
| Rate for Payer: BCBS Complete |
$0.28
|
| Rate for Payer: BCBS MAPPO |
$0.18
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.55
|
| Rate for Payer: BCN Medicare Advantage |
$0.18
|
| 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: Health Alliance Plan Medicare Advantage |
$0.18
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.17
|
| Rate for Payer: PACE SWMI |
$0.18
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: PHP Medicare Advantage |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.46
|
| Rate for Payer: Priority Health HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Medicare |
$0.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.62
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Medicare Advantage |
$0.18
|
| Rate for Payer: VA VA |
$0.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.53
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna Medicare |
$0.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.53
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.41
|
| Rate for Payer: BCN Commercial |
$1.33
|
| Rate for Payer: BCN Medicare Advantage |
$0.43
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.43
|
| Rate for Payer: Healthscope Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.40
|
| Rate for Payer: PACE Senior Care Partners |
$0.41
|
| Rate for Payer: PACE SWMI |
$0.43
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: PHP Medicare Advantage |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1.49
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: Railroad Medicare Medicare |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.50
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.43
|
| Rate for Payer: VA VA |
$0.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: BCBS Trust/PPO |
$8.34
|
| Rate for Payer: BCN Commercial |
$7.90
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO |
$8.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.99
|
| Rate for Payer: UHC Core |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.66
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: Aetna Medicare |
$2.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.19
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$7.95
|
| Rate for Payer: BCN Medicare Advantage |
$2.56
|
| Rate for Payer: Cash Price |
$8.18
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.56
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: PACE Senior Care Partners |
$2.43
|
| Rate for Payer: PACE SWMI |
$2.56
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: PHP Medicare Advantage |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO |
$8.89
|
| Rate for Payer: Priority Health Medicare |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.99
|
| Rate for Payer: UHC Core |
$8.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.56
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.66
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$1.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.11
|
| Rate for Payer: Priority Health HMO/PPO |
$1.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.50
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.65 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$146.17
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.96
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.00
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.46
|
| Rate for Payer: BCN Commercial |
$145.29
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: BCBS Trust/PPO |
$189.38
|
| Rate for Payer: BCN Commercial |
$179.29
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: Nomi Health Commercial |
$190.24
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health HMO/PPO |
$201.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.16
|
| Rate for Payer: UHC Core |
$193.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.10 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: Aetna Medicare |
$60.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.50
|
| Rate for Payer: BCBS Complete |
$92.80
|
| Rate for Payer: BCBS MAPPO |
$58.00
|
| Rate for Payer: BCBS Trust/PPO |
$190.73
|
| Rate for Payer: BCN Commercial |
$180.38
|
| Rate for Payer: BCN Medicare Advantage |
$58.00
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.00
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: Nomi Health Commercial |
$190.24
|
| Rate for Payer: PACE Senior Care Partners |
$55.10
|
| Rate for Payer: PACE SWMI |
$58.00
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health HMO/PPO |
$201.84
|
| Rate for Payer: Priority Health Medicare |
$58.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$155.44
|
| Rate for Payer: Railroad Medicare Medicare |
$58.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.16
|
| Rate for Payer: UHC Core |
$193.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.00
|
| Rate for Payer: UHC Exchange |
$58.00
|
| Rate for Payer: UHC Medicare Advantage |
$58.00
|
| Rate for Payer: VA VA |
$58.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$119.70
|
|
|
Service Code
|
NDC 00904672060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.74
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.41
|
| Rate for Payer: BCBS Complete |
$47.88
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCBS Trust/PPO |
$98.41
|
| Rate for Payer: BCN Commercial |
$93.07
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| 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: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.74
|
| Rate for Payer: Nomi Health Commercial |
$98.15
|
| Rate for Payer: PACE Senior Care Partners |
$28.43
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PHP Commercial |
$101.74
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.80
|
| Rate for Payer: Priority Health HMO/PPO |
$104.14
|
| Rate for Payer: Priority Health Medicare |
$30.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.20
|
| Rate for Payer: Railroad Medicare Medicare |
$29.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.34
|
| Rate for Payer: UHC Core |
$99.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Exchange |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
| Rate for Payer: VA VA |
$29.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.78
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: BCBS Trust/PPO |
$104.49
|
| Rate for Payer: BCN Commercial |
$98.92
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: Nomi Health Commercial |
$104.96
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO |
$111.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.64
|
| Rate for Payer: UHC Core |
$106.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$238.00
|
| Rate for Payer: BCBS Trust/PPO |
$228.56
|
| Rate for Payer: BCN Commercial |
$216.38
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$240.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.00
|
| Rate for Payer: Healthscope Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.00
|
| Rate for Payer: Nomi Health Commercial |
$229.60
|
| Rate for Payer: PHP Commercial |
$238.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
| Rate for Payer: Priority Health HMO/PPO |
$243.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.40
|
| Rate for Payer: UHC Core |
$233.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$119.70
|
|
|
Service Code
|
NDC 00904672060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.74
|
| Rate for Payer: BCBS Trust/PPO |
$97.71
|
| 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 Commercial |
$101.74
|
| Rate for Payer: Nomi Health Commercial |
$98.15
|
| Rate for Payer: PHP Commercial |
$101.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.80
|
| Rate for Payer: Priority Health HMO/PPO |
$104.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.20
|
| 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
|
$882.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: BCBS Trust/PPO |
$719.98
|
| Rate for Payer: BCN Commercial |
$681.61
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: Nomi Health Commercial |
$723.24
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO |
$767.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.16
|
| Rate for Payer: UHC Core |
$736.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$238.00
|
| Rate for Payer: Aetna Medicare |
$72.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.50
|
| Rate for Payer: BCBS Complete |
$112.00
|
| Rate for Payer: BCBS MAPPO |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$230.19
|
| Rate for Payer: BCN Commercial |
$217.70
|
| Rate for Payer: BCN Medicare Advantage |
$70.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$240.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.00
|
| Rate for Payer: Healthscope Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.00
|
| Rate for Payer: Nomi Health Commercial |
$229.60
|
| Rate for Payer: PACE Senior Care Partners |
$66.50
|
| Rate for Payer: PACE SWMI |
$70.00
|
| Rate for Payer: PHP Commercial |
$238.00
|
| Rate for Payer: PHP Medicare Advantage |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
| Rate for Payer: Priority Health HMO/PPO |
$243.60
|
| Rate for Payer: Priority Health Medicare |
$70.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.60
|
| Rate for Payer: Railroad Medicare Medicare |
$70.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.40
|
| Rate for Payer: UHC Core |
$233.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.00
|
| Rate for Payer: UHC Exchange |
$70.00
|
| Rate for Payer: UHC Medicare Advantage |
$70.00
|
| Rate for Payer: VA VA |
$70.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.48 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Medicare |
$229.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.62
|
| Rate for Payer: BCBS Complete |
$352.80
|
| Rate for Payer: BCBS MAPPO |
$220.50
|
| Rate for Payer: BCBS Trust/PPO |
$725.09
|
| Rate for Payer: BCN Commercial |
$685.76
|
| Rate for Payer: BCN Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: Nomi Health Commercial |
$723.24
|
| Rate for Payer: PACE Senior Care Partners |
$209.48
|
| Rate for Payer: PACE SWMI |
$220.50
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: PHP Medicare Advantage |
$220.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO |
$767.34
|
| Rate for Payer: Priority Health Medicare |
$222.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$590.94
|
| Rate for Payer: Railroad Medicare Medicare |
$220.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.16
|
| Rate for Payer: UHC Core |
$736.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.50
|
| Rate for Payer: UHC Exchange |
$220.50
|
| Rate for Payer: UHC Medicare Advantage |
$220.50
|
| Rate for Payer: VA VA |
$220.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$105.23
|
| Rate for Payer: BCN Commercial |
$99.52
|
| Rate for Payer: BCN Medicare Advantage |
$32.00
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.00
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: Nomi Health Commercial |
$104.96
|
| Rate for Payer: PACE Senior Care Partners |
$30.40
|
| Rate for Payer: PACE SWMI |
$32.00
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: PHP Medicare Advantage |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO |
$111.36
|
| Rate for Payer: Priority Health Medicare |
$32.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.76
|
| Rate for Payer: Railroad Medicare Medicare |
$32.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.64
|
| Rate for Payer: UHC Core |
$106.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.00
|
| Rate for Payer: UHC Exchange |
$32.00
|
| Rate for Payer: UHC Medicare Advantage |
$32.00
|
| Rate for Payer: VA VA |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
