|
ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL, PERIPANCREATIC, WITH OR WITHOUT PARA-AORTIC AND VENA CAVAL NODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT 38747
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$1,879.00 |
| Rate for Payer: BCBS Trust/PPO |
$979.19
|
| Rate for Payer: BCN Commercial |
$979.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.75
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$260.68
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$2,887.15
|
|
|
Service Code
|
CPT 49083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.61 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$748.47
|
| Rate for Payer: BCN Commercial |
$748.47
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.67
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$100.61
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,887.15
|
|
|
Service Code
|
CPT 49082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$775.62
|
| Rate for Payer: BCN Commercial |
$775.62
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.30
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$70.27
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.19 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.48
|
| Rate for Payer: BCN Commercial |
$1,165.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.31
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$191.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$874.11
|
| Rate for Payer: BCN Commercial |
$874.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.20
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$142.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.70
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.75 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna American Axle |
$17.36
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: UMR Bronson Commercial |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.70
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$24.03 |
| Rate for Payer: Aetna American Axle |
$17.36
|
| Rate for Payer: Aetna Commercial |
$22.70
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.36
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cash Price |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$22.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.36
|
| Rate for Payer: Healthscope Commercial |
$24.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.70
|
| Rate for Payer: PHP Commercial |
$22.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.36
|
| Rate for Payer: Priority Health SBD |
$16.82
|
| Rate for Payer: UMR Bronson Commercial |
$9.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.02
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.93
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$21.40
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.59
|
| Rate for Payer: PHP Commercial |
$24.59
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: UMR Bronson Commercial |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$14.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
|
|
ACETAMINOPHEN 1,000 MG/100 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$32.93
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna American Axle |
$21.40
|
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Medicare |
$14.46
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$11.57
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.80
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: UMR Bronson Commercial |
$10.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna American Axle |
$1.03
|
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.03
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$1.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.35
|
| Rate for Payer: PHP Commercial |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health SBD |
$1.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.19
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Aetna American Axle |
$1.03
|
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.03
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.11
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.27
|
| Rate for Payer: Healthscope Commercial |
$1.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.35
|
| Rate for Payer: PHP Commercial |
$1.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health SBD |
$1.00
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.19
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.99
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$17.09 |
| Rate for Payer: Aetna American Axle |
$12.34
|
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.34
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$13.29
|
| Rate for Payer: Cofinity Commercial |
$16.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$17.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.14
|
| Rate for Payer: PHP Commercial |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health SBD |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.24
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.64
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna American Axle |
$8.22
|
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.22
|
| Rate for Payer: BCBS Complete |
$5.06
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$10.87
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.11
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.74
|
| Rate for Payer: PHP Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.64
|
|
|
Service Code
|
NDC 00121065700
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna American Axle |
$8.22
|
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.22
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$10.87
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.11
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.74
|
| Rate for Payer: PHP Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$12.64
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna American Axle |
$8.22
|
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.22
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$10.87
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.11
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.74
|
| Rate for Payer: PHP Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$12.64
|
|
|
Service Code
|
NDC 00121065700
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna American Axle |
$8.22
|
| Rate for Payer: Aetna Commercial |
$10.74
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.22
|
| Rate for Payer: BCBS Complete |
$5.06
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$10.87
|
| Rate for Payer: Cofinity Commercial |
$8.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.11
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.74
|
| Rate for Payer: PHP Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.22
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UMR Bronson Commercial |
$2.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 68094006159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.95
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$6.08
|
|
|
Service Code
|
NDC 68094006159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$3.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$2.43
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.95
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 68094006161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.95
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
