|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$2,573.89
|
|
|
Service Code
|
CPT 49083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$2,573.89
|
|
|
Service Code
|
CPT 49082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.11 |
| Max. Negotiated Rate |
$2,573.89 |
| Rate for Payer: Aetna Medicare |
$950.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,142.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,142.97
|
| Rate for Payer: BCBS Complete |
$514.61
|
| Rate for Payer: BCBS MAPPO |
$914.38
|
| Rate for Payer: BCN Medicare Advantage |
$914.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$914.38
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Mclaren Medicare |
$914.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$960.10
|
| Rate for Payer: Meridian Medicaid |
$514.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,051.54
|
| Rate for Payer: PACE Medicare |
$868.66
|
| Rate for Payer: PACE SWMI |
$914.38
|
| Rate for Payer: PHP Medicare Advantage |
$914.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Medicare |
$914.38
|
| Rate for Payer: Railroad Medicare Medicare |
$914.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,573.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$914.38
|
| Rate for Payer: UHC Exchange |
$1,747.47
|
| Rate for Payer: UHC Medicare Advantage |
$914.38
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
| Rate for Payer: VA VA |
$914.38
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$4,066.57
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,066.57 |
| Rate for Payer: Aetna Medicare |
$1,502.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,066.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,760.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$4,066.57
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$774.34 |
| Max. Negotiated Rate |
$4,066.57 |
| Rate for Payer: Aetna Medicare |
$1,502.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,805.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,805.83
|
| Rate for Payer: BCBS Complete |
$813.05
|
| Rate for Payer: BCBS MAPPO |
$1,444.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.66
|
| Rate for Payer: Mclaren Medicaid |
$774.34
|
| Rate for Payer: Mclaren Medicare |
$1,444.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.89
|
| Rate for Payer: Meridian Medicaid |
$813.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,661.36
|
| Rate for Payer: PACE Medicare |
$1,372.43
|
| Rate for Payer: PACE SWMI |
$1,444.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.34
|
| Rate for Payer: Priority Health Medicare |
$1,444.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,066.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,444.66
|
| Rate for Payer: UHC Exchange |
$2,760.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,444.66
|
| Rate for Payer: UHCCP Medicaid |
$774.34
|
| Rate for Payer: VA VA |
$1,444.66
|
|
|
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
|
$26.70
|
|
|
Service Code
|
HCPCS J0136
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.88 |
| 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: 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
|
OP
|
$23.59
|
|
|
Service Code
|
HCPCS J0131
|
| Hospital Charge Code |
151854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna American Axle |
$21.40
|
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$18.80
|
| Rate for Payer: Aetna Commercial |
$27.99
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Commercial |
$24.59
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$14.46
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna Medicare |
$16.46
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Complete |
$13.17
|
| Rate for Payer: BCBS Complete |
$11.57
|
| Rate for Payer: BCBS Complete |
$9.44
|
| 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 |
$20.29
|
| Rate for Payer: Cofinity Commercial |
$28.32
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$24.88
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| 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: 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 |
$23.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| 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 |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.99
|
| 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 |
$20.05
|
| Rate for Payer: PHP Commercial |
$27.99
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| 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 |
$15.04
|
| Rate for Payer: Priority Health SBD |
$18.23
|
| Rate for Payer: Priority Health SBD |
$20.75
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.70
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.18
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
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 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 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 |
$9.49
|
| 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
|
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
|
$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 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 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 SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$2.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
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
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
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
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna American Axle |
$3.22
|
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| 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 |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.71
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68094001562
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health SBD |
$3.10
|
| Rate for Payer: UMR Bronson Commercial |
$1.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
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
|
|
