|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| 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
|
$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
|
IP
|
$3.92
|
|
|
Service Code
|
NDC 00904727841
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.33
|
| Rate for Payer: PHP Commercial |
$3.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health SBD |
$2.47
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.94
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$6.08
|
|
|
Service Code
|
NDC 68094006161
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna American Axle |
$3.95
|
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$5.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.86
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.17
|
| Rate for Payer: PHP Commercial |
$5.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.95
|
| Rate for Payer: Priority Health SBD |
$3.83
|
| Rate for Payer: UMR Bronson Commercial |
$2.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.56
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 00121178105
|
| 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
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 00121178105
|
| 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
|
$4.76
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
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
|
OP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
NDC 68094001561
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
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
|
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
|
$4.76
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.81
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.05
|
| Rate for Payer: PHP Commercial |
$4.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.57
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$74.88
|
|
|
Service Code
|
NDC 09629513681
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$67.39 |
| Rate for Payer: Aetna American Axle |
$48.67
|
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Medicare |
$37.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.67
|
| Rate for Payer: BCBS Complete |
$29.95
|
| Rate for Payer: Cash Price |
$59.90
|
| Rate for Payer: Cofinity Commercial |
$52.42
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.42
|
| 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 Commercial |
$63.65
|
| Rate for Payer: PHP Commercial |
$63.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.67
|
| Rate for Payer: Priority Health SBD |
$47.17
|
| Rate for Payer: UMR Bronson Commercial |
$27.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.16
|
|
|
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 |
$19.42
|
| 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 Commercial |
$27.18
|
| Rate for Payer: Cofinity Commercial |
$33.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.18
|
| 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 Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.24
|
| Rate for Payer: Priority Health SBD |
$24.46
|
| 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
|
$55.46
|
|
|
Service Code
|
NDC 00536132197
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.52 |
| Max. Negotiated Rate |
$49.91 |
| Rate for Payer: Aetna American Axle |
$36.05
|
| Rate for Payer: Aetna Commercial |
$47.14
|
| Rate for Payer: Aetna Medicare |
$27.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.05
|
| Rate for Payer: BCBS Complete |
$22.18
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cofinity Commercial |
$38.82
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Healthscope Commercial |
$49.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.14
|
| Rate for Payer: PHP Commercial |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.05
|
| Rate for Payer: Priority Health SBD |
$34.94
|
| Rate for Payer: UMR Bronson Commercial |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$74.88
|
|
|
Service Code
|
NDC 09629513681
|
| 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: Cofinity Medicare Advantage |
$52.42
|
| 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 Commercial |
$63.65
|
| Rate for Payer: PHP Commercial |
$63.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.67
|
| 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
|
OP
|
$2.24
|
|
|
Service Code
|
NDC 09900000628
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: Cash Price |
$1.79
|
| Rate for Payer: Cofinity Commercial |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.57
|
| 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: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: Priority Health SBD |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.68
|
|
|
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 Commercial |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.57
|
| 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: PHP Commercial |
$1.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| 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
|
$38.83
|
|
|
Service Code
|
NDC 00904676620
|
| 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: Cofinity Medicare Advantage |
$27.18
|
| 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 Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.24
|
| 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
|
OP
|
$52.69
|
|
|
Service Code
|
NDC 45802020126
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna American Axle |
$34.25
|
| Rate for Payer: Aetna Commercial |
$44.79
|
| Rate for Payer: Aetna Medicare |
$26.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.25
|
| Rate for Payer: BCBS Complete |
$21.08
|
| Rate for Payer: Cash Price |
$42.15
|
| Rate for Payer: Cofinity Commercial |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$45.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.88
|
| 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 Commercial |
$44.79
|
| Rate for Payer: PHP Commercial |
$44.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.25
|
| Rate for Payer: Priority Health SBD |
$33.19
|
| Rate for Payer: UMR Bronson Commercial |
$19.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.52
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$55.46
|
|
|
Service Code
|
NDC 00536132197
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$49.91 |
| Rate for Payer: Aetna American Axle |
$36.05
|
| Rate for Payer: Aetna Commercial |
$47.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.05
|
| Rate for Payer: Cash Price |
$44.37
|
| Rate for Payer: Cofinity Commercial |
$38.82
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.37
|
| Rate for Payer: Healthscope Commercial |
$49.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.14
|
| Rate for Payer: PHP Commercial |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.05
|
| Rate for Payer: Priority Health SBD |
$34.94
|
| Rate for Payer: UMR Bronson Commercial |
$24.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.60
|
|
|
ACETAMINOPHEN 160 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$52.69
|
|
|
Service Code
|
NDC 45802020126
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Cash Price |
$42.15
|
| 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: Cofinity Commercial |
$36.88
|
| Rate for Payer: Cofinity Commercial |
$45.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.88
|
| 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 Commercial |
$44.79
|
| Rate for Payer: PHP Commercial |
$44.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.25
|
| 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 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$87.36
|
|
|
Service Code
|
NDC 51672211604
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: Aetna American Axle |
$56.78
|
| Rate for Payer: Aetna Commercial |
$74.26
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.78
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Commercial |
$61.15
|
| Rate for Payer: Cofinity Commercial |
$75.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.15
|
| 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 Commercial |
$74.26
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: UMR Bronson Commercial |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
|
