|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.75
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.44
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.75
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.80
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: BCBS MAPPO |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.47
|
| Rate for Payer: BCN Medicare Advantage |
$1.44
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PACE Senior Care Partners |
$1.37
|
| Rate for Payer: PACE SWMI |
$1.44
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Medicare Advantage |
$1.44
|
| Rate for Payer: VA VA |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.75
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$4.69
|
| Rate for Payer: BCN Commercial |
$4.44
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
NDC 00904682076
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: BCBS Trust/PPO |
$2.74
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
NDC 00904682076
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.05
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO |
$2.92
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.96
|
| Rate for Payer: UHC Core |
$2.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Exchange |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: VA VA |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.91
|
| Rate for Payer: UHC Core |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: PACE Senior Care Partners |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.86
|
| Rate for Payer: Priority Health Medicare |
$1.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.91
|
| Rate for Payer: UHC Core |
$3.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.91
|
| Rate for Payer: UHC Core |
$3.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.75
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.80
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: BCBS MAPPO |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$4.73
|
| Rate for Payer: BCN Commercial |
$4.47
|
| Rate for Payer: BCN Medicare Advantage |
$1.44
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.44
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PACE Senior Care Partners |
$1.37
|
| Rate for Payer: PACE SWMI |
$1.44
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: PHP Medicare Advantage |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health HMO/PPO |
$5.00
|
| Rate for Payer: Priority Health Medicare |
$1.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.85
|
| Rate for Payer: Railroad Medicare Medicare |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.06
|
| Rate for Payer: UHC Core |
$4.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.44
|
| Rate for Payer: UHC Exchange |
$1.44
|
| Rate for Payer: UHC Medicare Advantage |
$1.44
|
| Rate for Payer: VA VA |
$1.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$3.77
|
| Rate for Payer: Aetna Medicare |
$1.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.39
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$1.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: BCN Medicare Advantage |
$1.11
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.11
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.77
|
| Rate for Payer: Nomi Health Commercial |
$3.64
|
| Rate for Payer: PACE Senior Care Partners |
$1.05
|
| Rate for Payer: PACE SWMI |
$1.11
|
| Rate for Payer: PHP Commercial |
$3.77
|
| Rate for Payer: PHP Medicare Advantage |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO |
$3.86
|
| Rate for Payer: Priority Health Medicare |
$1.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.91
|
| Rate for Payer: UHC Core |
$3.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.11
|
| Rate for Payer: UHC Exchange |
$1.11
|
| Rate for Payer: UHC Medicare Advantage |
$1.11
|
| Rate for Payer: VA VA |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.33
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.65
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: BCN Medicare Advantage |
$0.52
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.52
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PACE Senior Care Partners |
$0.49
|
| Rate for Payer: PACE SWMI |
$0.52
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.52
|
| Rate for Payer: UHC Exchange |
$0.52
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: VA VA |
$0.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: BCBS Trust/PPO |
$34.53
|
| Rate for Payer: BCN Commercial |
$32.69
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.96
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: Priority Health HMO/PPO |
$36.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.22
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: BCBS MAPPO |
$10.58
|
| Rate for Payer: BCBS Trust/PPO |
$34.77
|
| Rate for Payer: BCN Commercial |
$32.89
|
| Rate for Payer: BCN Medicare Advantage |
$10.58
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$36.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.96
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: PACE Senior Care Partners |
$10.05
|
| Rate for Payer: PACE SWMI |
$10.58
|
| Rate for Payer: PHP Commercial |
$35.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: Priority Health HMO/PPO |
$36.80
|
| Rate for Payer: Priority Health Medicare |
$10.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.22
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.58
|
| Rate for Payer: UHC Exchange |
$10.58
|
| Rate for Payer: UHC Medicare Advantage |
$10.58
|
| Rate for Payer: VA VA |
$10.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.72
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.55 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna Medicare |
$80.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.78
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: BCBS MAPPO |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$254.60
|
| Rate for Payer: BCN Commercial |
$240.79
|
| Rate for Payer: BCN Medicare Advantage |
$77.42
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PACE Senior Care Partners |
$73.55
|
| Rate for Payer: PACE SWMI |
$77.42
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Medicare |
$78.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: Railroad Medicare Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.42
|
| Rate for Payer: UHC Exchange |
$77.42
|
| Rate for Payer: UHC Medicare Advantage |
$77.42
|
| Rate for Payer: VA VA |
$77.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: BCBS Trust/PPO |
$252.81
|
| Rate for Payer: BCN Commercial |
$239.34
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: BCBS Trust/PPO |
$252.81
|
| Rate for Payer: BCN Commercial |
$239.34
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: Aetna Medicare |
$2.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.92
|
| Rate for Payer: BCBS Complete |
$3.74
|
| Rate for Payer: BCBS MAPPO |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$7.69
|
| Rate for Payer: BCN Commercial |
$7.27
|
| Rate for Payer: BCN Medicare Advantage |
$2.34
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$8.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: Nomi Health Commercial |
$7.67
|
| Rate for Payer: PACE Senior Care Partners |
$2.22
|
| Rate for Payer: PACE SWMI |
$2.34
|
| Rate for Payer: PHP Commercial |
$7.95
|
| Rate for Payer: PHP Medicare Advantage |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health HMO/PPO |
$8.13
|
| Rate for Payer: Priority Health Medicare |
$2.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.23
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.34
|
| Rate for Payer: UHC Exchange |
$2.34
|
| Rate for Payer: UHC Medicare Advantage |
$2.34
|
| Rate for Payer: VA VA |
$2.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.01
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.92 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: Aetna Medicare |
$121.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$145.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$145.95
|
| Rate for Payer: BCBS Complete |
$186.82
|
| Rate for Payer: BCBS MAPPO |
$116.76
|
| Rate for Payer: BCBS Trust/PPO |
$383.95
|
| Rate for Payer: BCN Commercial |
$363.12
|
| Rate for Payer: BCN Medicare Advantage |
$116.76
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.76
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Nomi Health Commercial |
$382.97
|
| Rate for Payer: PACE Senior Care Partners |
$110.92
|
| Rate for Payer: PACE SWMI |
$116.76
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: PHP Medicare Advantage |
$116.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: Priority Health HMO/PPO |
$406.32
|
| Rate for Payer: Priority Health Medicare |
$117.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.92
|
| Rate for Payer: Railroad Medicare Medicare |
$116.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.00
|
| Rate for Payer: UHC Core |
$389.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.76
|
| Rate for Payer: UHC Exchange |
$116.76
|
| Rate for Payer: UHC Medicare Advantage |
$116.76
|
| Rate for Payer: VA VA |
$116.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Aetna Commercial |
$7.95
|
| Rate for Payer: BCBS Trust/PPO |
$7.63
|
| Rate for Payer: BCN Commercial |
$7.23
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Cofinity Commercial |
$8.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.48
|
| Rate for Payer: Healthscope Commercial |
$8.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: Nomi Health Commercial |
$7.67
|
| Rate for Payer: PHP Commercial |
$7.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health HMO/PPO |
$8.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.23
|
| Rate for Payer: UHC Core |
$7.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.01
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$309.70
|
|
|
Service Code
|
NDC 51672402301
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.55 |
| Max. Negotiated Rate |
$278.73 |
| Rate for Payer: Aetna Commercial |
$263.24
|
| Rate for Payer: Aetna Medicare |
$80.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.78
|
| Rate for Payer: BCBS Complete |
$123.88
|
| Rate for Payer: BCBS MAPPO |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$254.60
|
| Rate for Payer: BCN Commercial |
$240.79
|
| Rate for Payer: BCN Medicare Advantage |
$77.42
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$266.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.42
|
| Rate for Payer: Healthscope Commercial |
$278.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$81.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: PACE Senior Care Partners |
$73.55
|
| Rate for Payer: PACE SWMI |
$77.42
|
| Rate for Payer: PHP Commercial |
$263.24
|
| Rate for Payer: PHP Medicare Advantage |
$77.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: Priority Health HMO/PPO |
$269.44
|
| Rate for Payer: Priority Health Medicare |
$78.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$207.50
|
| Rate for Payer: Railroad Medicare Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.54
|
| Rate for Payer: UHC Core |
$258.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.42
|
| Rate for Payer: UHC Exchange |
$77.42
|
| Rate for Payer: UHC Medicare Advantage |
$77.42
|
| Rate for Payer: VA VA |
$77.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$420.34 |
| Rate for Payer: Aetna Commercial |
$396.98
|
| Rate for Payer: BCBS Trust/PPO |
$381.24
|
| Rate for Payer: BCN Commercial |
$360.93
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$401.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$420.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Nomi Health Commercial |
$382.97
|
| Rate for Payer: PHP Commercial |
$396.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: Priority Health HMO/PPO |
$406.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.00
|
| Rate for Payer: UHC Core |
$389.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.28
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$101.42
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$91.28 |
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Medicare |
$43.03
|
| Rate for Payer: Aetna Medicare |
$26.37
|
| Rate for Payer: Aetna Medicare |
$31.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.72
|
| Rate for Payer: BCBS Complete |
$48.42
|
| Rate for Payer: BCBS Complete |
$40.57
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$41.38
|
| Rate for Payer: BCBS MAPPO |
$25.36
|
| Rate for Payer: BCBS MAPPO |
$30.26
|
| Rate for Payer: BCBS Trust/PPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$83.38
|
| Rate for Payer: BCBS Trust/PPO |
$136.06
|
| Rate for Payer: BCN Commercial |
$94.11
|
| Rate for Payer: BCN Commercial |
$128.68
|
| Rate for Payer: BCN Commercial |
$78.85
|
| Rate for Payer: BCN Medicare Advantage |
$25.36
|
| Rate for Payer: BCN Medicare Advantage |
$30.26
|
| Rate for Payer: BCN Medicare Advantage |
$41.38
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.36
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Nomi Health Commercial |
$135.71
|
| Rate for Payer: Nomi Health Commercial |
$83.16
|
| Rate for Payer: Nomi Health Commercial |
$99.25
|
| Rate for Payer: PACE Senior Care Partners |
$39.31
|
| Rate for Payer: PACE Senior Care Partners |
$24.09
|
| Rate for Payer: PACE Senior Care Partners |
$28.75
|
| Rate for Payer: PACE SWMI |
$30.26
|
| Rate for Payer: PACE SWMI |
$25.36
|
| Rate for Payer: PACE SWMI |
$41.38
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Medicare Advantage |
$30.26
|
| Rate for Payer: PHP Medicare Advantage |
$41.38
|
| Rate for Payer: PHP Medicare Advantage |
$25.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| Rate for Payer: Priority Health HMO/PPO |
$143.98
|
| Rate for Payer: Priority Health HMO/PPO |
$88.24
|
| Rate for Payer: Priority Health HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$25.61
|
| Rate for Payer: Priority Health Medicare |
$41.79
|
| Rate for Payer: Priority Health Medicare |
$30.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.95
|
| Rate for Payer: Railroad Medicare Medicare |
$30.26
|
| Rate for Payer: Railroad Medicare Medicare |
$41.38
|
| Rate for Payer: Railroad Medicare Medicare |
$25.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.25
|
| Rate for Payer: UHC Core |
$138.19
|
| Rate for Payer: UHC Core |
$101.07
|
| Rate for Payer: UHC Core |
$84.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.26
|
| Rate for Payer: UHC Exchange |
$30.26
|
| Rate for Payer: UHC Exchange |
$25.36
|
| Rate for Payer: UHC Exchange |
$41.38
|
| Rate for Payer: UHC Medicare Advantage |
$25.36
|
| Rate for Payer: UHC Medicare Advantage |
$30.26
|
| Rate for Payer: UHC Medicare Advantage |
$41.38
|
| Rate for Payer: VA VA |
$30.26
|
| Rate for Payer: VA VA |
$41.38
|
| Rate for Payer: VA VA |
$25.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
ACETAZOLAMIDE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$101.42
|
|
|
Service Code
|
HCPCS J1120
|
| Hospital Charge Code |
114
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.92 |
| Max. Negotiated Rate |
$91.28 |
| Rate for Payer: Aetna Commercial |
$86.21
|
| Rate for Payer: Aetna Commercial |
$102.88
|
| Rate for Payer: Aetna Commercial |
$140.68
|
| Rate for Payer: BCBS Trust/PPO |
$98.80
|
| Rate for Payer: BCBS Trust/PPO |
$82.79
|
| Rate for Payer: BCBS Trust/PPO |
$135.10
|
| Rate for Payer: BCN Commercial |
$93.54
|
| Rate for Payer: BCN Commercial |
$78.38
|
| Rate for Payer: BCN Commercial |
$127.90
|
| Rate for Payer: Cash Price |
$81.14
|
| Rate for Payer: Cash Price |
$132.40
|
| Rate for Payer: Cash Price |
$96.83
|
| Rate for Payer: Cofinity Commercial |
$142.33
|
| Rate for Payer: Cofinity Commercial |
$104.09
|
| Rate for Payer: Cofinity Commercial |
$87.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.40
|
| Rate for Payer: Healthscope Commercial |
$108.94
|
| Rate for Payer: Healthscope Commercial |
$91.28
|
| Rate for Payer: Healthscope Commercial |
$148.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.68
|
| Rate for Payer: Nomi Health Commercial |
$83.16
|
| Rate for Payer: Nomi Health Commercial |
$99.25
|
| Rate for Payer: Nomi Health Commercial |
$135.71
|
| Rate for Payer: PHP Commercial |
$102.88
|
| Rate for Payer: PHP Commercial |
$86.21
|
| Rate for Payer: PHP Commercial |
$140.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.68
|
| Rate for Payer: Priority Health HMO/PPO |
$143.98
|
| Rate for Payer: Priority Health HMO/PPO |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO |
$88.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.25
|
| Rate for Payer: UHC Core |
$84.69
|
| Rate for Payer: UHC Core |
$138.19
|
| Rate for Payer: UHC Core |
$101.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.78
|
|
|
ACETIC ACID 2 % EAR SOLUTION
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 60432074115
|
| Hospital Charge Code |
17801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.11
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: BCBS MAPPO |
$24.09
|
| Rate for Payer: BCBS Trust/PPO |
$79.21
|
| Rate for Payer: BCN Commercial |
$74.91
|
| Rate for Payer: BCN Medicare Advantage |
$24.09
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.09
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$79.01
|
| Rate for Payer: PACE Senior Care Partners |
$22.88
|
| Rate for Payer: PACE SWMI |
$24.09
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: PHP Medicare Advantage |
$24.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health HMO/PPO |
$83.82
|
| Rate for Payer: Priority Health Medicare |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.55
|
| Rate for Payer: Railroad Medicare Medicare |
$24.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.79
|
| Rate for Payer: UHC Core |
$80.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.09
|
| Rate for Payer: UHC Exchange |
$24.09
|
| Rate for Payer: UHC Medicare Advantage |
$24.09
|
| Rate for Payer: VA VA |
$24.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
