|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$11.88
|
|
|
Service Code
|
NDC 00121065700
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$10.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$10.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.91
|
| Rate for Payer: PHP Commercial |
$10.10
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: UMR Bronson Commercial |
$5.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.91
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$11.88
|
|
|
Service Code
|
NDC 00121065700
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$10.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$10.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.91
|
| Rate for Payer: PHP Commercial |
$10.10
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.72
|
| Rate for Payer: UHC Core |
$6.19
|
| Rate for Payer: UHC Exchange |
$4.67
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.91
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
OP
|
$11.88
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: BCBS Complete |
$4.75
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$10.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$10.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.91
|
| Rate for Payer: PHP Commercial |
$10.10
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.72
|
| Rate for Payer: UHC Core |
$6.19
|
| Rate for Payer: UHC Exchange |
$4.67
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.91
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SOLUTION
|
Facility
|
IP
|
$11.88
|
|
|
Service Code
|
NDC 00121065705
|
| Hospital Charge Code |
119321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$10.69 |
| Rate for Payer: Aetna American Axle |
$7.72
|
| Rate for Payer: Aetna Commercial |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.72
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$10.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$10.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.91
|
| Rate for Payer: PHP Commercial |
$10.10
|
| Rate for Payer: Priority Health SBD |
$7.48
|
| Rate for Payer: UMR Bronson Commercial |
$5.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.91
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
NDC 68094006161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
NDC 68094006159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
NDC 68094006159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.13
|
| Rate for Payer: UHC Core |
$3.31
|
| Rate for Payer: UHC Exchange |
$2.50
|
| Rate for Payer: UMR Bronson Commercial |
$2.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.00
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$1.81
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 00121178100
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Exchange |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
NDC 68094006161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna American Axle |
$4.13
|
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.13
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Advantage |
$4.45
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 00904727870
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Advantage |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.46
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 00121178105
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Advantage |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.02
|
| Rate for Payer: UHC Core |
$2.42
|
| Rate for Payer: UHC Exchange |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$188.94
|
|
|
Service Code
|
NDC 00045016604
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.13 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna American Axle |
$122.81
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.81
|
| Rate for Payer: Cash Price |
$151.15
|
| Rate for Payer: Cofinity Advantage |
$132.26
|
| Rate for Payer: Cofinity Commercial |
$162.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.15
|
| Rate for Payer: Healthscope Commercial |
$170.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.71
|
| Rate for Payer: PHP Commercial |
$160.60
|
| Rate for Payer: Priority Health SBD |
$119.03
|
| Rate for Payer: UMR Bronson Commercial |
$83.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.71
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$38.83
|
|
|
Service Code
|
NDC 00904676620
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: Aetna American Axle |
$25.24
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Medicare |
$19.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.24
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$31.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.12
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health SBD |
$24.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.24
|
| Rate for Payer: UHC Core |
$20.23
|
| Rate for Payer: UHC Exchange |
$15.26
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.12
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$49.92
|
|
|
Service Code
|
NDC 45802020126
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna American Axle |
$32.45
|
| Rate for Payer: Aetna Commercial |
$42.43
|
| Rate for Payer: Aetna Medicare |
$24.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.45
|
| Rate for Payer: BCBS Complete |
$19.97
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$34.94
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.94
|
| Rate for Payer: Healthscope Commercial |
$44.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.44
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: Priority Health SBD |
$31.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.45
|
| Rate for Payer: UHC Core |
$26.01
|
| Rate for Payer: UHC Exchange |
$19.62
|
| Rate for Payer: UMR Bronson Commercial |
$18.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.44
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$49.92
|
|
|
Service Code
|
NDC 45802020126
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$44.93 |
| Rate for Payer: Aetna American Axle |
$32.45
|
| Rate for Payer: Aetna Commercial |
$42.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.45
|
| Rate for Payer: Cash Price |
$39.94
|
| Rate for Payer: Cofinity Advantage |
$34.94
|
| Rate for Payer: Cofinity Commercial |
$42.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.94
|
| Rate for Payer: Healthscope Commercial |
$44.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.44
|
| Rate for Payer: PHP Commercial |
$42.43
|
| Rate for Payer: Priority Health SBD |
$31.45
|
| Rate for Payer: UMR Bronson Commercial |
$21.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.44
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.24
|
|
|
Service Code
|
NDC 09900000628
|
| 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 Advantage |
$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 Commercial |
$1.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.90
|
| 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
|
|
