|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 68094023161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.45
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.16
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.10
|
| Rate for Payer: PACE SWMI |
$1.16
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.16
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.35
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.36
|
| Rate for Payer: BCBS Complete |
$0.81
|
| Rate for Payer: BCBS MAPPO |
$1.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$1.09
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.09
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Mclaren Medicaid |
$0.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.14
|
| Rate for Payer: Meridian Medicaid |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.09
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Medicare |
$1.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: UHC Exchange |
$1.09
|
| Rate for Payer: UHC Medicaid |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$1.09
|
| Rate for Payer: UHCCP Medicaid |
$0.77
|
| Rate for Payer: VA VA |
$1.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.45
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$1.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: BCN Medicare Advantage |
$1.16
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.16
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Mclaren Medicaid |
$0.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.22
|
| Rate for Payer: Meridian Medicaid |
$0.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PACE Senior Care Partners |
$1.10
|
| Rate for Payer: PACE SWMI |
$1.16
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.04
|
| Rate for Payer: Priority Health Medicare |
$1.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.08
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: UHC Exchange |
$1.16
|
| Rate for Payer: UHC Medicaid |
$0.82
|
| Rate for Payer: UHC Medicare Advantage |
$1.16
|
| Rate for Payer: UHCCP Medicaid |
$0.82
|
| Rate for Payer: VA VA |
$1.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: Meridian Medicaid |
$0.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PACE Senior Care Partners |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.45
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$0.99
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.99
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.59
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.70
|
| Rate for Payer: Nomi Health Commercial |
$3.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.83
|
| Rate for Payer: UHC Core |
$3.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.26
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.85
|
| Rate for Payer: BCBS MAPPO |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.79
|
| Rate for Payer: BCN Medicare Advantage |
$1.15
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.15
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Mclaren Medicaid |
$0.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.21
|
| Rate for Payer: Meridian Medicaid |
$0.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PACE Senior Care Partners |
$1.09
|
| Rate for Payer: PACE SWMI |
$1.15
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.01
|
| Rate for Payer: Priority Health Medicare |
$1.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.21
|
| Rate for Payer: Railroad Medicare Medicare |
$1.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.06
|
| Rate for Payer: UHC Core |
$3.85
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UHC Medicaid |
$0.81
|
| Rate for Payer: UHC Medicare Advantage |
$1.15
|
| Rate for Payer: UHCCP Medicaid |
$0.81
|
| Rate for Payer: VA VA |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.73
|
| Rate for Payer: BCBS MAPPO |
$0.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.26
|
| Rate for Payer: BCN Commercial |
$3.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.99
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.99
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Mclaren Medicaid |
$0.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: Meridian Medicaid |
$0.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Nomi Health Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PACE Senior Care Partners |
$0.94
|
| Rate for Payer: PACE SWMI |
$0.99
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.45
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: Railroad Medicare Medicare |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$0.99
|
| Rate for Payer: UHC Medicaid |
$0.70
|
| Rate for Payer: UHC Medicare Advantage |
$0.99
|
| Rate for Payer: UHCCP Medicaid |
$0.70
|
| Rate for Payer: VA VA |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL LIQUID
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 0990000030
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Aetna Commercial |
$0.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.59
|
| 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: Opus (Opus Packaging Group) HMA |
$0.53
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.49
|
| 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 0990000030
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.13 |
| 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 |
$0.13
|
| Rate for Payer: BCBS MAPPO |
$0.18
|
| Rate for Payer: BCBS Trust/PPO |
$0.58
|
| Rate for Payer: BCN Commercial |
$0.58
|
| 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: Mclaren Medicaid |
$0.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.19
|
| Rate for Payer: Meridian Medicaid |
$0.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.60
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.53
|
| 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 Choice Medicaid |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$0.62
|
| Rate for Payer: Priority Health Medicare |
$0.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$0.49
|
| 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 Exchange |
$0.18
|
| Rate for Payer: UHC Medicaid |
$0.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.13
|
| Rate for Payer: VA VA |
$0.18
|
| 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 09900000331
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.04
|
| Rate for Payer: BCN Commercial |
$2.04
|
| 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: Opus (Opus Packaging Group) HMA |
$1.85
|
| Rate for Payer: PHP Commercial |
$2.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| 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
|
OP
|
$2.47
|
|
|
Service Code
|
NDC 09900000331
|
| Hospital Charge Code |
100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| 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 |
$0.46
|
| Rate for Payer: BCBS MAPPO |
$0.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$2.03
|
| 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: Mclaren Medicaid |
$0.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.65
|
| Rate for Payer: Meridian Medicaid |
$0.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.10
|
| Rate for Payer: Nomi Health Commercial |
$2.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.85
|
| 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 Choice Medicaid |
$0.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.15
|
| Rate for Payer: Priority Health Medicare |
$0.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| 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 Exchange |
$0.62
|
| Rate for Payer: UHC Medicaid |
$0.44
|
| Rate for Payer: UHC Medicare Advantage |
$0.62
|
| Rate for Payer: UHCCP Medicaid |
$0.44
|
| Rate for Payer: VA VA |
$0.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.85
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$10.22
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.69
|
| Rate for Payer: BCBS Trust/PPO |
$8.44
|
| Rate for Payer: BCN Commercial |
$8.44
|
| 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 |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| Rate for Payer: PHP Commercial |
$8.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.11
|
| 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 |
$7.67
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| 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 |
$1.89
|
| Rate for Payer: BCBS MAPPO |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$8.40
|
| Rate for Payer: BCN Commercial |
$8.40
|
| 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 |
$7.67
|
| Rate for Payer: Mclaren Medicaid |
$1.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.68
|
| Rate for Payer: Meridian Medicaid |
$1.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.69
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.67
|
| 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 Choice Medicaid |
$1.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.89
|
| Rate for Payer: Priority Health Medicare |
$2.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.11
|
| 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 Exchange |
$2.56
|
| Rate for Payer: UHC Medicaid |
$1.80
|
| Rate for Payer: UHC Medicare Advantage |
$2.56
|
| Rate for Payer: UHCCP Medicaid |
$1.80
|
| Rate for Payer: VA VA |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.67
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$1.41
|
| Rate for Payer: BCN Commercial |
$1.41
|
| 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: Opus (Opus Packaging Group) HMA |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.19
|
| 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 RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.30 |
| 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 |
$0.32
|
| Rate for Payer: BCBS MAPPO |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$1.41
|
| Rate for Payer: BCN Commercial |
$1.41
|
| 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: Mclaren Medicaid |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.45
|
| Rate for Payer: Meridian Medicaid |
$0.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.28
|
| Rate for Payer: 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 Choice Medicaid |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.49
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.19
|
| 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 Exchange |
$0.43
|
| Rate for Payer: UHC Medicaid |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.43
|
| Rate for Payer: UHCCP Medicaid |
$0.30
|
| Rate for Payer: VA VA |
$0.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
NDC 00536132710
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$482.33 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: BCBS Trust/PPO |
$572.35
|
| Rate for Payer: BCN Commercial |
$572.35
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Nomi Health Commercial |
$568.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.84
|
| Rate for Payer: UHC Core |
$578.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| 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: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| 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
|
OP
|
$693.00
|
|
|
Service Code
|
NDC 00536132710
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.18 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna Medicare |
$180.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$216.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$216.56
|
| Rate for Payer: BCBS Complete |
$128.27
|
| Rate for Payer: BCBS MAPPO |
$173.25
|
| Rate for Payer: BCBS Trust/PPO |
$569.72
|
| Rate for Payer: BCN Commercial |
$569.72
|
| Rate for Payer: BCN Medicare Advantage |
$173.25
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.25
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.75
|
| Rate for Payer: Mclaren Medicaid |
$122.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.91
|
| Rate for Payer: Meridian Medicaid |
$128.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$190.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Nomi Health Commercial |
$568.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE Senior Care Partners |
$164.59
|
| Rate for Payer: PACE SWMI |
$173.25
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: PHP Medicare Advantage |
$173.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$602.91
|
| Rate for Payer: Priority Health Medicare |
$174.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$482.33
|
| Rate for Payer: Railroad Medicare Medicare |
$173.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.84
|
| Rate for Payer: UHC Core |
$578.65
|
| Rate for Payer: UHC Exchange |
$173.25
|
| Rate for Payer: UHC Medicaid |
$122.18
|
| Rate for Payer: UHC Medicare Advantage |
$173.25
|
| Rate for Payer: UHCCP Medicaid |
$122.18
|
| Rate for Payer: VA VA |
$173.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: BCBS Trust/PPO |
$72.84
|
| Rate for Payer: BCN Commercial |
$72.84
|
| 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 Commercial |
$74.97
|
| Rate for Payer: Nomi Health Commercial |
$72.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.39
|
| 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
|
|
