|
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 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: MI Amish Medical Board Commercial |
$1.79
|
| 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: UHC All Payor (Choice/PPO) |
$1.46
|
| Rate for Payer: UHC Core |
$1.17
|
| Rate for Payer: UHC Exchange |
$0.88
|
| 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
|
OP
|
$188.94
|
|
|
Service Code
|
NDC 00045016604
|
| Hospital Charge Code |
93073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.91 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna American Axle |
$122.81
|
| Rate for Payer: Aetna Commercial |
$160.60
|
| Rate for Payer: Aetna Medicare |
$94.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.81
|
| Rate for Payer: BCBS Complete |
$75.58
|
| 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: MI Amish Medical Board Commercial |
$151.15
|
| 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: UHC All Payor (Choice/PPO) |
$122.81
|
| Rate for Payer: UHC Core |
$98.44
|
| Rate for Payer: UHC Exchange |
$74.25
|
| Rate for Payer: UMR Bronson Commercial |
$69.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.71
|
|
|
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 Advantage |
$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 Commercial |
$63.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.16
|
| Rate for Payer: PHP Commercial |
$63.65
|
| 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
|
$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 Advantage |
$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: MI Amish Medical Board Commercial |
$59.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.16
|
| Rate for Payer: PHP Commercial |
$63.65
|
| Rate for Payer: Priority Health SBD |
$47.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.67
|
| Rate for Payer: UHC Core |
$39.01
|
| Rate for Payer: UHC Exchange |
$29.43
|
| 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
|
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
|
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
|
IP
|
$52.69
|
|
|
Service Code
|
NDC 00536132197
|
| 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 Advantage |
$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 Commercial |
$44.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.52
|
| Rate for Payer: PHP Commercial |
$44.79
|
| 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
|
IP
|
$87.36
|
|
|
Service Code
|
NDC 51672211604
|
| 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 Advantage |
$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 Commercial |
$74.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.52
|
| Rate for Payer: PHP Commercial |
$74.26
|
| 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 RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna American Axle |
$1.11
|
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.11
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Advantage |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$1.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.71
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna American Axle |
$1.11
|
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: Aetna Medicare |
$0.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.11
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cofinity Advantage |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$1.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.28
|
| Rate for Payer: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health SBD |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.11
|
| Rate for Payer: UHC Core |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UMR Bronson Commercial |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
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 Advantage |
$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: MI Amish Medical Board Commercial |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.52
|
| Rate for Payer: PHP Commercial |
$74.26
|
| Rate for Payer: Priority Health SBD |
$55.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.78
|
| Rate for Payer: UHC Core |
$45.51
|
| Rate for Payer: UHC Exchange |
$34.33
|
| Rate for Payer: UMR Bronson Commercial |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 00904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$88.20
|
|
|
Service Code
|
NDC 50580045811
|
| 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 Advantage |
$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 Commercial |
$74.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: PHP Commercial |
$74.97
|
| 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
|
OP
|
$88.20
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.63 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: Aetna American Axle |
$57.33
|
| Rate for Payer: Aetna Commercial |
$74.97
|
| Rate for Payer: Aetna Medicare |
$44.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.33
|
| Rate for Payer: BCBS Complete |
$35.28
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$70.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.15
|
| Rate for Payer: PHP Commercial |
$74.97
|
| Rate for Payer: Priority Health SBD |
$55.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.33
|
| Rate for Payer: UHC Core |
$45.95
|
| Rate for Payer: UHC Exchange |
$34.66
|
| Rate for Payer: UMR Bronson Commercial |
$32.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.15
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
NDC 00450049660
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna American Axle |
$169.00
|
| Rate for Payer: Aetna Commercial |
$221.00
|
| Rate for Payer: Aetna Medicare |
$130.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.00
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$208.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health SBD |
$163.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.00
|
| Rate for Payer: UHC Core |
$135.46
|
| Rate for Payer: UHC Exchange |
$102.18
|
| Rate for Payer: UMR Bronson Commercial |
$96.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
NDC 49483034010
|
| Hospital Charge Code |
101
|
|
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 Advantage |
$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 Commercial |
$696.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.25
|
| Rate for Payer: PHP Commercial |
$696.15
|
| 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 325 MG TABLET
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
NDC 00536132710
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.41 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna American Axle |
$450.45
|
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.45
|
| Rate for Payer: UHC Core |
$361.05
|
| Rate for Payer: UHC Exchange |
$272.35
|
| Rate for Payer: UMR Bronson Commercial |
$256.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
NDC 00450049660
|
| 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 Advantage |
$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 Commercial |
$221.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.00
|
| Rate for Payer: PHP Commercial |
$221.00
|
| 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
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 904677361
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
NDC 49483034010
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.03 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna American Axle |
$532.35
|
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.35
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$655.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$696.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$614.25
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: Priority Health SBD |
$515.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$532.35
|
| Rate for Payer: UHC Core |
$426.70
|
| Rate for Payer: UHC Exchange |
$321.87
|
| Rate for Payer: UMR Bronson Commercial |
$303.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
NDC 00536132710
|
| 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 Advantage |
$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 Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| 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 500 MG TABLET
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Advantage |
$86.80
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| 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: MI Amish Medical Board Commercial |
$99.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.60
|
| Rate for Payer: UHC Core |
$64.60
|
| Rate for Payer: UHC Exchange |
$48.73
|
| Rate for Payer: UMR Bronson Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
NDC 87701041772
|
| 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 Medicare |
$378.00
|
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.40
|
| Rate for Payer: UHC Core |
$393.88
|
| Rate for Payer: UHC Exchange |
$297.11
|
| 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
|
$945.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna American Axle |
$614.25
|
| Rate for Payer: Aetna Commercial |
$803.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.25
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cofinity Advantage |
$661.50
|
| Rate for Payer: Cofinity Commercial |
$812.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.00
|
| Rate for Payer: Healthscope Commercial |
$850.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$661.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$708.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$708.75
|
| Rate for Payer: PHP Commercial |
$803.25
|
| Rate for Payer: Priority Health SBD |
$595.35
|
| Rate for Payer: UMR Bronson Commercial |
$415.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$708.75
|
|
