|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
IP
|
$14.30
|
|
|
Service Code
|
NDC 0121-0657-00
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Aetna American Axle |
$9.30
|
| Rate for Payer: Aetna Commercial |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.30
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cofinity Commercial |
$10.01
|
| Rate for Payer: Cofinity Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.44
|
| Rate for Payer: Healthscope Commercial |
$12.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.16
|
| Rate for Payer: PHP Commercial |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.01
|
| Rate for Payer: Priority Health SBD |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.04
|
|
|
Service Code
|
NDC 68094-015-62
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$4.54 |
| Rate for Payer: Aetna American Axle |
$3.28
|
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| 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 Multiplan/Beech St/PHCS |
$4.28
|
| Rate for Payer: PHP Commercial |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: Priority Health SBD |
$3.18
|
| Rate for Payer: UMR Bronson Commercial |
$2.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.78
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$6.03
|
|
|
Service Code
|
NDC 68094-061-61
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna American Axle |
$3.92
|
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.92
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.22
|
| Rate for Payer: Priority Health SBD |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.52
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094-015-59
|
| 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: 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 Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| 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
|
$6.03
|
|
|
Service Code
|
NDC 68094-061-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna American Axle |
$3.92
|
| Rate for Payer: Aetna Commercial |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.92
|
| Rate for Payer: Cash Price |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$4.22
|
| Rate for Payer: Cofinity Commercial |
$5.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.82
|
| Rate for Payer: Healthscope Commercial |
$5.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.13
|
| Rate for Payer: PHP Commercial |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.22
|
| Rate for Payer: Priority Health SBD |
$3.80
|
| Rate for Payer: UMR Bronson Commercial |
$2.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.52
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-1781-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094-015-61
|
| 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: 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 Multiplan/Beech St/PHCS |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.33
|
| 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
|
$5.19
|
|
|
Service Code
|
NDC 0121-0966-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.19
|
|
|
Service Code
|
NDC 0121-0966-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.28 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna American Axle |
$3.37
|
| Rate for Payer: Aetna Commercial |
$4.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.37
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.15
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.41
|
| Rate for Payer: PHP Commercial |
$4.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: Priority Health SBD |
$3.27
|
| Rate for Payer: UMR Bronson Commercial |
$2.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.89
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$52.69
|
|
|
Service Code
|
NDC 45802-201-26
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna American Axle |
$34.25
|
| Rate for Payer: Aetna Commercial |
$44.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.25
|
| Rate for Payer: Cash Price |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$45.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.15
|
| Rate for Payer: Healthscope Commercial |
$47.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.79
|
| Rate for Payer: PHP Commercial |
$44.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.88
|
| Rate for Payer: Priority Health SBD |
$33.19
|
| Rate for Payer: UMR Bronson Commercial |
$23.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.52
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$2.24
|
|
|
Service Code
|
NDC 9900-0006-28
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.90
|
| Rate for Payer: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.68
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$74.88
|
|
|
Service Code
|
NDC 96295-13681
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$67.39 |
| Rate for Payer: Aetna American Axle |
$48.67
|
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.67
|
| Rate for Payer: Cash Price |
$59.90
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.90
|
| Rate for Payer: Healthscope Commercial |
$67.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.65
|
| Rate for Payer: PHP Commercial |
$63.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.42
|
| Rate for Payer: Priority Health SBD |
$47.17
|
| Rate for Payer: UMR Bronson Commercial |
$32.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.16
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$38.83
|
|
|
Service Code
|
NDC 0904-6766-20
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna American Axle |
$25.24
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.24
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$33.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Healthscope Commercial |
$34.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.18
|
| Rate for Payer: Priority Health SBD |
$24.46
|
| Rate for Payer: UMR Bronson Commercial |
$17.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.12
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
IP
|
$47.15
|
|
|
Service Code
|
NDC 0536-1321-97
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.75 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Aetna American Axle |
$30.65
|
| Rate for Payer: Aetna Commercial |
$40.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.65
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cofinity Commercial |
$33.00
|
| Rate for Payer: Cofinity Commercial |
$40.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.72
|
| Rate for Payer: Healthscope Commercial |
$42.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.08
|
| Rate for Payer: PHP Commercial |
$40.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.00
|
| Rate for Payer: Priority Health SBD |
$29.70
|
| Rate for Payer: UMR Bronson Commercial |
$20.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.36
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 51672-2116-0
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna American Axle |
$1.10
|
| Rate for Payer: Aetna Commercial |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.10
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: PHP Commercial |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: Priority Health SBD |
$1.06
|
| Rate for Payer: UMR Bronson Commercial |
$0.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.27
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$87.36
|
|
|
Service Code
|
NDC 51672-2116-4
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Healthscope Commercial |
$78.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.26
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.15
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: UMR Bronson Commercial |
$38.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$693.00
|
|
|
Service Code
|
NDC 49483-340-10
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna American Axle |
$450.45
|
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$485.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$519.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$589.05
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.10
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UMR Bronson Commercial |
$304.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 50580-458-11
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.81 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna American Axle |
$57.33
|
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.33
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$61.74
|
| Rate for Payer: Cofinity Commercial |
$75.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$79.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: Priority Health SBD |
$55.57
|
| Rate for Payer: UMR Bronson Commercial |
$38.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
NDC 0904-6773-61
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
OP
|
$992.25
|
|
|
Service Code
|
NDC 63739-440-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.13 |
| Max. Negotiated Rate |
$893.02 |
| Rate for Payer: Aetna American Axle |
$644.96
|
| Rate for Payer: Aetna Commercial |
$843.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.96
|
| Rate for Payer: BCBS Complete |
$396.90
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$694.58
|
| Rate for Payer: Cofinity Commercial |
$853.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.80
|
| Rate for Payer: Healthscope Commercial |
$893.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$694.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$744.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.41
|
| Rate for Payer: PHP Commercial |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.58
|
| Rate for Payer: Priority Health SBD |
$625.12
|
| Rate for Payer: UMR Bronson Commercial |
$367.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$744.19
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
NDC 5789610110
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna American Axle |
$286.65
|
| Rate for Payer: Aetna Commercial |
$374.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.65
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$308.70
|
| Rate for Payer: Cofinity Commercial |
$379.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.80
|
| Rate for Payer: Healthscope Commercial |
$396.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.85
|
| Rate for Payer: PHP Commercial |
$374.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.70
|
| Rate for Payer: Priority Health SBD |
$277.83
|
| Rate for Payer: UMR Bronson Commercial |
$194.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$630.00
|
|
|
Service Code
|
NDC 0536-1327-10
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.00
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
NDC 0904-6773-61
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna American Axle |
$119.60
|
| Rate for Payer: Aetna Commercial |
$156.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$158.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.20
|
| Rate for Payer: Healthscope Commercial |
$165.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$156.40
|
| Rate for Payer: PHP Commercial |
$156.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health SBD |
$115.92
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
NDC 45049660
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna American Axle |
$169.00
|
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.00
|
| Rate for Payer: Healthscope Commercial |
$234.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
| Rate for Payer: Priority Health SBD |
$163.80
|
| Rate for Payer: UMR Bronson Commercial |
$114.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.00
|
|
