|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| 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 |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| 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: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| 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: 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 Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| 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 Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$22.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.56
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$72.51
|
| Rate for Payer: BCN Commercial |
$72.51
|
| Rate for Payer: BCN Medicare Advantage |
$22.05
|
| 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: Health Alliance Plan Medicare Advantage |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.15
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.25
|
| 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: PACE Senior Care Partners |
$20.95
|
| Rate for Payer: PACE SWMI |
$22.05
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: PHP Medicare Advantage |
$22.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.73
|
| Rate for Payer: Priority Health Medicare |
$22.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.39
|
| Rate for Payer: Railroad Medicare Medicare |
$22.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.62
|
| Rate for Payer: UHC Core |
$73.65
|
| Rate for Payer: UHC Exchange |
$22.05
|
| Rate for Payer: UHC Medicaid |
$15.55
|
| Rate for Payer: UHC Medicare Advantage |
$22.05
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: VA VA |
$22.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 00904672060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.28
|
| Rate for Payer: BCBS Complete |
$26.82
|
| Rate for Payer: BCBS MAPPO |
$36.23
|
| Rate for Payer: BCBS Trust/PPO |
$119.12
|
| Rate for Payer: BCN Commercial |
$119.12
|
| Rate for Payer: BCN Medicare Advantage |
$36.23
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Mclaren Medicaid |
$25.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.04
|
| Rate for Payer: Meridian Medicaid |
$26.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PACE Senior Care Partners |
$34.41
|
| Rate for Payer: PACE SWMI |
$36.23
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: PHP Medicare Advantage |
$36.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Medicare |
$36.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.85
|
| Rate for Payer: Railroad Medicare Medicare |
$36.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: UHC Exchange |
$36.23
|
| Rate for Payer: UHC Medicaid |
$25.55
|
| Rate for Payer: UHC Medicare Advantage |
$36.23
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
| Rate for Payer: VA VA |
$36.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.30 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: BCBS Trust/PPO |
$102.41
|
| Rate for Payer: BCN Commercial |
$102.41
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.12
|
| Rate for Payer: UHC Core |
$103.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna Commercial |
$803.25
|
| Rate for Payer: Aetna Medicare |
$245.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.31
|
| Rate for Payer: BCBS Complete |
$174.92
|
| Rate for Payer: BCBS MAPPO |
$236.25
|
| Rate for Payer: BCBS Trust/PPO |
$776.88
|
| Rate for Payer: BCN Commercial |
$776.88
|
| Rate for Payer: BCN Medicare Advantage |
$236.25
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$812.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.25
|
| Rate for Payer: Healthscope Commercial |
$850.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.75
|
| Rate for Payer: Mclaren Medicaid |
$166.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.06
|
| Rate for Payer: Meridian Medicaid |
$174.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.25
|
| Rate for Payer: Nomi Health Commercial |
$774.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$708.75
|
| Rate for Payer: PACE Senior Care Partners |
$224.44
|
| Rate for Payer: PACE SWMI |
$236.25
|
| Rate for Payer: PHP Commercial |
$803.25
|
| Rate for Payer: PHP Medicare Advantage |
$236.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.15
|
| Rate for Payer: Priority Health Medicare |
$238.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.72
|
| Rate for Payer: Railroad Medicare Medicare |
$236.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$831.60
|
| Rate for Payer: UHC Core |
$789.08
|
| Rate for Payer: UHC Exchange |
$236.25
|
| Rate for Payer: UHC Medicaid |
$166.60
|
| Rate for Payer: UHC Medicare Advantage |
$236.25
|
| Rate for Payer: UHCCP Medicaid |
$166.60
|
| Rate for Payer: VA VA |
$236.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.75
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.85 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: BCBS Trust/PPO |
$119.67
|
| Rate for Payer: BCN Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 00904672060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.85 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: BCBS Trust/PPO |
$119.67
|
| Rate for Payer: BCN Commercial |
$119.67
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
NDC 57896020110
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.82 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna Medicare |
$278.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$334.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$334.69
|
| Rate for Payer: BCBS Complete |
$198.24
|
| Rate for Payer: BCBS MAPPO |
$267.75
|
| Rate for Payer: BCBS Trust/PPO |
$880.47
|
| Rate for Payer: BCN Commercial |
$880.47
|
| Rate for Payer: BCN Medicare Advantage |
$267.75
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.75
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Mclaren Medicaid |
$188.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.14
|
| Rate for Payer: Meridian Medicaid |
$198.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$307.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$294.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PACE Senior Care Partners |
$254.36
|
| Rate for Payer: PACE SWMI |
$267.75
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: PHP Medicare Advantage |
$267.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Medicare |
$270.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.42
|
| Rate for Payer: Railroad Medicare Medicare |
$267.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: UHC Exchange |
$267.75
|
| Rate for Payer: UHC Medicaid |
$188.82
|
| Rate for Payer: UHC Medicare Advantage |
$267.75
|
| Rate for Payer: UHCCP Medicaid |
$188.82
|
| Rate for Payer: VA VA |
$267.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
NDC 57896020110
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$745.42 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: BCBS Trust/PPO |
$884.54
|
| Rate for Payer: BCN Commercial |
$884.54
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Nomi Health Commercial |
$878.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$931.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$942.48
|
| Rate for Payer: UHC Core |
$894.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$138.60
|
|
|
Service Code
|
NDC 00904672059
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: Aetna Medicare |
$36.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.31
|
| Rate for Payer: BCBS Complete |
$25.65
|
| Rate for Payer: BCBS MAPPO |
$34.65
|
| Rate for Payer: BCBS Trust/PPO |
$113.94
|
| Rate for Payer: BCN Commercial |
$113.94
|
| Rate for Payer: BCN Medicare Advantage |
$34.65
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.65
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Mclaren Medicaid |
$24.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.38
|
| Rate for Payer: Meridian Medicaid |
$25.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: Nomi Health Commercial |
$113.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.95
|
| Rate for Payer: PACE Senior Care Partners |
$32.92
|
| Rate for Payer: PACE SWMI |
$34.65
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: PHP Medicare Advantage |
$34.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.58
|
| Rate for Payer: Priority Health Medicare |
$35.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.47
|
| Rate for Payer: Railroad Medicare Medicare |
$34.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.97
|
| Rate for Payer: UHC Core |
$115.73
|
| Rate for Payer: UHC Exchange |
$34.65
|
| Rate for Payer: UHC Medicaid |
$24.44
|
| Rate for Payer: UHC Medicare Advantage |
$34.65
|
| Rate for Payer: UHCCP Medicaid |
$24.44
|
| Rate for Payer: VA VA |
$34.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$657.72 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna Commercial |
$803.25
|
| Rate for Payer: BCBS Trust/PPO |
$780.48
|
| Rate for Payer: BCN Commercial |
$780.48
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cofinity Commercial |
$812.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.00
|
| Rate for Payer: Healthscope Commercial |
$850.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.25
|
| Rate for Payer: Nomi Health Commercial |
$774.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$708.75
|
| Rate for Payer: PHP Commercial |
$803.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$822.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$657.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$831.60
|
| Rate for Payer: UHC Core |
$789.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.75
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$138.60
|
|
|
Service Code
|
NDC 00904672059
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.47 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Aetna Commercial |
$117.81
|
| Rate for Payer: BCBS Trust/PPO |
$114.47
|
| Rate for Payer: BCN Commercial |
$114.47
|
| Rate for Payer: Cash Price |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$119.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.88
|
| Rate for Payer: Healthscope Commercial |
$124.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.81
|
| Rate for Payer: Nomi Health Commercial |
$113.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.95
|
| Rate for Payer: PHP Commercial |
$117.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.97
|
| Rate for Payer: UHC Core |
$115.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.95
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna Medicare |
$37.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.28
|
| Rate for Payer: BCBS Complete |
$26.82
|
| Rate for Payer: BCBS MAPPO |
$36.23
|
| Rate for Payer: BCBS Trust/PPO |
$119.12
|
| Rate for Payer: BCN Commercial |
$119.12
|
| Rate for Payer: BCN Medicare Advantage |
$36.23
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.23
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Mclaren Medicaid |
$25.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.04
|
| Rate for Payer: Meridian Medicaid |
$26.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: PACE Senior Care Partners |
$34.41
|
| Rate for Payer: PACE SWMI |
$36.23
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: PHP Medicare Advantage |
$36.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.06
|
| Rate for Payer: Priority Health Medicare |
$36.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.85
|
| Rate for Payer: Railroad Medicare Medicare |
$36.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.51
|
| Rate for Payer: UHC Core |
$120.99
|
| Rate for Payer: UHC Exchange |
$36.23
|
| Rate for Payer: UHC Medicaid |
$25.55
|
| Rate for Payer: UHC Medicare Advantage |
$36.23
|
| Rate for Payer: UHCCP Medicaid |
$25.55
|
| Rate for Payer: VA VA |
$36.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$32.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.75
|
| Rate for Payer: BCBS Complete |
$22.95
|
| Rate for Payer: BCBS MAPPO |
$31.00
|
| Rate for Payer: BCBS Trust/PPO |
$101.94
|
| Rate for Payer: BCN Commercial |
$101.94
|
| Rate for Payer: BCN Medicare Advantage |
$31.00
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.00
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Mclaren Medicaid |
$21.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.55
|
| Rate for Payer: Meridian Medicaid |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PACE Senior Care Partners |
$29.45
|
| Rate for Payer: PACE SWMI |
$31.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: PHP Medicare Advantage |
$31.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$107.88
|
| Rate for Payer: Priority Health Medicare |
$31.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.30
|
| Rate for Payer: Railroad Medicare Medicare |
$31.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.12
|
| Rate for Payer: UHC Core |
$103.54
|
| Rate for Payer: UHC Exchange |
$31.00
|
| Rate for Payer: UHC Medicaid |
$21.86
|
| Rate for Payer: UHC Medicare Advantage |
$31.00
|
| Rate for Payer: UHCCP Medicaid |
$21.86
|
| Rate for Payer: VA VA |
$31.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: BCBS Trust/PPO |
$4.79
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.43
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Nomi Health Commercial |
$3.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Mclaren Medicaid |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.09
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Nomi Health Commercial |
$3.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.61
|
| Rate for Payer: Priority Health Medicare |
$1.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicaid |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: UHCCP Medicaid |
$0.73
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: BCBS Trust/PPO |
$4.79
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.43
|
| Rate for Payer: BCN Commercial |
$3.43
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Nomi Health Commercial |
$3.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Mclaren Medicaid |
$0.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.09
|
| Rate for Payer: Meridian Medicaid |
$0.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Nomi Health Commercial |
$3.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.61
|
| Rate for Payer: Priority Health Medicare |
$1.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.65
|
| Rate for Payer: UHC Core |
$3.47
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicaid |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: UHCCP Medicaid |
$0.73
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.81
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.77
|
| Rate for Payer: BCN Commercial |
$4.77
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Mclaren Medicaid |
$1.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.52
|
| Rate for Payer: Meridian Medicaid |
$1.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.10
|
| Rate for Payer: UHC Core |
$4.84
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicaid |
$1.02
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: UHCCP Medicaid |
$1.02
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| 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 |
$0.39
|
| Rate for Payer: BCBS MAPPO |
$0.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| 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: Mclaren Medicaid |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| 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 Choice Medicaid |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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 Exchange |
$0.52
|
| Rate for Payer: UHC Medicaid |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.52
|
| Rate for Payer: UHCCP Medicaid |
$0.37
|
| 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 |
$1.45 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| 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: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.45
|
| 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
|
OP
|
$48.65
|
|
|
Service Code
|
NDC 00904579146
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna Commercial |
$41.35
|
| Rate for Payer: Aetna Medicare |
$12.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.20
|
| Rate for Payer: BCBS Complete |
$9.01
|
| Rate for Payer: BCBS MAPPO |
$12.16
|
| Rate for Payer: BCBS Trust/PPO |
$40.00
|
| Rate for Payer: BCN Commercial |
$40.00
|
| Rate for Payer: BCN Medicare Advantage |
$12.16
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cofinity Commercial |
$41.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$43.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.49
|
| Rate for Payer: Mclaren Medicaid |
$8.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.77
|
| Rate for Payer: Meridian Medicaid |
$9.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.35
|
| Rate for Payer: Nomi Health Commercial |
$39.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.49
|
| Rate for Payer: PACE Senior Care Partners |
$11.55
|
| Rate for Payer: PACE SWMI |
$12.16
|
| Rate for Payer: PHP Commercial |
$41.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.33
|
| Rate for Payer: Priority Health Medicare |
$12.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.86
|
| Rate for Payer: Railroad Medicare Medicare |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.81
|
| Rate for Payer: UHC Core |
$40.62
|
| Rate for Payer: UHC Exchange |
$12.16
|
| Rate for Payer: UHC Medicaid |
$8.58
|
| Rate for Payer: UHC Medicare Advantage |
$12.16
|
| Rate for Payer: UHCCP Medicaid |
$8.58
|
| Rate for Payer: VA VA |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.49
|
|
