|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
NDC 0904-6730-61
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
OP
|
$756.00
|
|
|
Service Code
|
NDC 8770141772
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.72 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna American Axle |
$491.40
|
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.40
|
| Rate for Payer: BCBS Complete |
$302.40
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$642.60
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$529.20
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UMR Bronson Commercial |
$279.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$151.20
|
|
|
Service Code
|
NDC 0904-6730-60
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.84
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$819.00
|
|
|
Service Code
|
NDC 0904-6720-80
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna American Axle |
$532.35
|
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.35
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$573.30
|
| Rate for Payer: Cofinity Commercial |
$704.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Healthscope Commercial |
$737.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health SBD |
$515.97
|
| Rate for Payer: UMR Bronson Commercial |
$360.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$819.00
|
|
|
Service Code
|
NDC 0904-6730-80
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$360.36 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna American Axle |
$532.35
|
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.35
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$573.30
|
| Rate for Payer: Cofinity Commercial |
$704.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Healthscope Commercial |
$737.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$573.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health SBD |
$515.97
|
| Rate for Payer: UMR Bronson Commercial |
$360.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 57896-221-01
|
| Hospital Charge Code |
102
|
|
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 650 MG/20.3 ML ORAL SOLUTION
|
Facility
OP
|
$5.01
|
|
|
Service Code
|
NDC 66689-056-99
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna American Axle |
$3.26
|
| Rate for Payer: Aetna Commercial |
$4.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.26
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: Priority Health SBD |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
OP
|
$5.01
|
|
|
Service Code
|
NDC 66689-056-01
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna American Axle |
$3.26
|
| Rate for Payer: Aetna Commercial |
$4.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.26
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: Priority Health SBD |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.06
|
|
|
Service Code
|
NDC 0121-1971-21
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna American Axle |
$3.29
|
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.29
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.30
|
| Rate for Payer: PHP Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.54
|
| Rate for Payer: Priority Health SBD |
$3.19
|
| Rate for Payer: UMR Bronson Commercial |
$2.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.80
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
OP
|
$5.69
|
|
|
Service Code
|
NDC 81033-002-20
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.69
|
|
|
Service Code
|
NDC 81033-002-30
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
OP
|
$3.36
|
|
|
Service Code
|
NDC 0904-6820-76
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: BCBS Complete |
$1.34
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.69
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health SBD |
$2.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.52
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.06
|
|
|
Service Code
|
NDC 0121-1971-00
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna American Axle |
$3.29
|
| Rate for Payer: Aetna Commercial |
$4.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.29
|
| Rate for Payer: Cash Price |
$4.05
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.05
|
| Rate for Payer: Healthscope Commercial |
$4.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.30
|
| Rate for Payer: PHP Commercial |
$4.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.54
|
| Rate for Payer: Priority Health SBD |
$3.19
|
| Rate for Payer: UMR Bronson Commercial |
$2.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.80
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
OP
|
$5.69
|
|
|
Service Code
|
NDC 81033-002-30
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: BCBS Complete |
$2.28
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.69
|
|
|
Service Code
|
NDC 81033-002-20
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: Aetna American Axle |
$3.70
|
| Rate for Payer: Aetna Commercial |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.70
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Cofinity Commercial |
$3.98
|
| Rate for Payer: Cofinity Commercial |
$4.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.84
|
| Rate for Payer: PHP Commercial |
$4.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.98
|
| Rate for Payer: Priority Health SBD |
$3.58
|
| Rate for Payer: UMR Bronson Commercial |
$2.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.27
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.82
|
|
|
Service Code
|
NDC 45802-730-00
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.64 |
| Rate for Payer: Aetna American Axle |
$1.18
|
| Rate for Payer: Aetna Commercial |
$1.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.18
|
| Rate for Payer: Cash Price |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$1.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| Rate for Payer: Priority Health SBD |
$1.15
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.36
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$209.00
|
|
|
Service Code
|
NDC 45802-730-33
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna American Axle |
$135.85
|
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.85
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$146.30
|
| Rate for Payer: Cofinity Commercial |
$179.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.20
|
| Rate for Payer: Healthscope Commercial |
$188.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$177.65
|
| Rate for Payer: PHP Commercial |
$177.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health SBD |
$131.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.75
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$90.65
|
|
|
Service Code
|
NDC 45802-730-32
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.89 |
| Max. Negotiated Rate |
$81.58 |
| Rate for Payer: Aetna American Axle |
$58.92
|
| Rate for Payer: Aetna Commercial |
$77.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.92
|
| Rate for Payer: Cash Price |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$63.46
|
| Rate for Payer: Cofinity Commercial |
$77.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.52
|
| Rate for Payer: Healthscope Commercial |
$81.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.05
|
| Rate for Payer: PHP Commercial |
$77.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.46
|
| Rate for Payer: Priority Health SBD |
$57.11
|
| Rate for Payer: UMR Bronson Commercial |
$39.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.99
|
|
|
ACETAMINOPHEN 80 MG CHEWABLE TABLET
|
Facility
IP
|
$43.01
|
|
|
Service Code
|
NDC 0904-5791-46
|
| Hospital Charge Code |
99
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$38.71 |
| Rate for Payer: Aetna American Axle |
$27.96
|
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.96
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Commercial |
$36.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$38.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.56
|
| Rate for Payer: PHP Commercial |
$36.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health SBD |
$27.10
|
| Rate for Payer: UMR Bronson Commercial |
$18.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.26
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 51672-2114-0
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: Aetna American Axle |
$1.52
|
| Rate for Payer: Aetna Commercial |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.52
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$2.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.99
|
| Rate for Payer: PHP Commercial |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
ACETAMINOPHEN 80 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$107.10
|
|
|
Service Code
|
NDC 51672-2114-4
|
| Hospital Charge Code |
8946
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.39 |
| Rate for Payer: Aetna American Axle |
$69.62
|
| Rate for Payer: Aetna Commercial |
$91.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.62
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Cofinity Commercial |
$92.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$96.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: PHP Commercial |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: Priority Health SBD |
$67.47
|
| Rate for Payer: UMR Bronson Commercial |
$47.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.32
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$254.60
|
|
|
Service Code
|
NDC 23155-288-01
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: Aetna American Axle |
$165.49
|
| Rate for Payer: Aetna Commercial |
$216.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.49
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$178.22
|
| Rate for Payer: Cofinity Commercial |
$218.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$229.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$178.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: PHP Commercial |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: Priority Health SBD |
$160.40
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.95
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$9.12
|
|
|
Service Code
|
NDC 50268-054-11
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$8.21 |
| Rate for Payer: Aetna American Axle |
$5.93
|
| Rate for Payer: Aetna Commercial |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.93
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$6.38
|
| Rate for Payer: Cofinity Commercial |
$7.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$8.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.75
|
| Rate for Payer: PHP Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.38
|
| Rate for Payer: Priority Health SBD |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.84
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$810.67
|
|
|
Service Code
|
NDC 51672-4023-1
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.69 |
| Max. Negotiated Rate |
$729.60 |
| Rate for Payer: Aetna American Axle |
$526.94
|
| Rate for Payer: Aetna Commercial |
$689.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.94
|
| Rate for Payer: Cash Price |
$648.54
|
| Rate for Payer: Cofinity Commercial |
$567.47
|
| Rate for Payer: Cofinity Commercial |
$697.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.54
|
| Rate for Payer: Healthscope Commercial |
$729.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$567.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$608.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$689.07
|
| Rate for Payer: PHP Commercial |
$689.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.47
|
| Rate for Payer: Priority Health SBD |
$510.72
|
| Rate for Payer: UMR Bronson Commercial |
$356.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$608.00
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
NDC 50268-054-15
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna American Axle |
$296.40
|
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.40
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$319.20
|
| Rate for Payer: Cofinity Commercial |
$392.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.80
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$319.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$342.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: PHP Commercial |
$387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health SBD |
$287.28
|
| Rate for Payer: UMR Bronson Commercial |
$200.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$342.00
|
|
