|
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
|
|
|
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 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 |
$38.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.52
|
|
|
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 Commercial |
$1.20
|
| Rate for Payer: Cofinity Commercial |
$1.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.20
|
| 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: PHP Commercial |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.11
|
| Rate for Payer: Priority Health SBD |
$1.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.28
|
|
|
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 Commercial |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.00
|
| 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: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| 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
|
$630.00
|
|
|
Service Code
|
NDC 00536132710
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$233.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna American Axle |
$150.80
|
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: Aetna Medicare |
$116.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.80
|
| Rate for Payer: BCBS Complete |
$92.80
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health SBD |
$146.16
|
| Rate for Payer: UMR Bronson Commercial |
$85.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.00
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
NDC 00536132710
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna American Axle |
$409.50
|
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.50
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$441.00
|
| Rate for Payer: Cofinity Commercial |
$541.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$441.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$504.00
|
| Rate for Payer: Healthscope Commercial |
$567.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$441.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$472.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.50
|
| Rate for Payer: PHP Commercial |
$535.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health SBD |
$396.90
|
| Rate for Payer: UMR Bronson Commercial |
$277.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$472.50
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$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 Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| 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: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| 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
|
$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 Commercial |
$182.00
|
| Rate for Payer: Cofinity Commercial |
$223.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$182.00
|
| 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: PHP Commercial |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health SBD |
$163.80
|
| 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
|
$693.00
|
|
|
Service Code
|
NDC 49483034010
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.92 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna American Axle |
$450.45
|
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$485.10
|
| 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: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UMR Bronson Commercial |
$304.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
NDC 50580045811
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Aetna American Axle |
$150.80
|
| Rate for Payer: Aetna Commercial |
$197.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.80
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$199.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$162.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.60
|
| Rate for Payer: Healthscope Commercial |
$208.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.20
|
| Rate for Payer: PHP Commercial |
$197.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.80
|
| Rate for Payer: Priority Health SBD |
$146.16
|
| Rate for Payer: UMR Bronson Commercial |
$102.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.00
|
|
|
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 Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| 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: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| 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
|
$693.00
|
|
|
Service Code
|
NDC 49483034010
|
| 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 Commercial |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$485.10
|
| 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: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: UMR Bronson Commercial |
$256.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$519.75
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.34 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna American Axle |
$573.30
|
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Medicare |
$441.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.30
|
| Rate for Payer: BCBS Complete |
$352.80
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$617.40
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health SBD |
$555.66
|
| Rate for Payer: UMR Bronson Commercial |
$326.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
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 Commercial |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$529.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UMR Bronson Commercial |
$279.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna American Axle |
$83.20
|
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| Rate for Payer: UMR Bronson Commercial |
$56.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Aetna American Axle |
$83.20
|
| Rate for Payer: Aetna Commercial |
$108.80
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.20
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$110.08
|
| Rate for Payer: Cofinity Commercial |
$89.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.40
|
| Rate for Payer: Healthscope Commercial |
$115.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.80
|
| Rate for Payer: PHP Commercial |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health SBD |
$80.64
|
| Rate for Payer: UMR Bronson Commercial |
$47.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
NDC 00904673080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna American Axle |
$573.30
|
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.30
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$617.40
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$617.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$617.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$749.70
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health SBD |
$555.66
|
| Rate for Payer: UMR Bronson Commercial |
$388.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$151.20
|
|
|
Service Code
|
NDC 00904673060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.94 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna Medicare |
$75.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: BCBS Complete |
$60.48
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$55.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
NDC 00904672080
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.64 |
| Max. Negotiated Rate |
$680.40 |
| Rate for Payer: Aetna American Axle |
$491.40
|
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.40
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$529.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UMR Bronson Commercial |
$332.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$151.20
|
|
|
Service Code
|
NDC 00904673060
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.53 |
| Max. Negotiated Rate |
$136.08 |
| Rate for Payer: Aetna American Axle |
$98.28
|
| Rate for Payer: Aetna Commercial |
$128.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.28
|
| Rate for Payer: Cash Price |
$120.96
|
| Rate for Payer: Cofinity Commercial |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
NDC 00904672080
|
| 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 Commercial |
$529.20
|
| Rate for Payer: Cofinity Commercial |
$650.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$529.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$604.80
|
| Rate for Payer: Healthscope Commercial |
$680.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$529.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$567.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$642.60
|
| Rate for Payer: PHP Commercial |
$642.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health SBD |
$476.28
|
| Rate for Payer: UMR Bronson Commercial |
$279.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$567.00
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 66689005601
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna American Axle |
$3.26
|
| Rate for Payer: Aetna Commercial |
$4.26
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.26
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health SBD |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.01
|
|
|
Service Code
|
NDC 66689005699
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.51 |
| Rate for Payer: Aetna American Axle |
$3.26
|
| Rate for Payer: Aetna Commercial |
$4.26
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.26
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.01
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Cofinity Commercial |
$4.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$4.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.26
|
| Rate for Payer: PHP Commercial |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health SBD |
$3.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.75
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna American Axle |
$3.74
|
| Rate for Payer: Aetna Commercial |
$4.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.74
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.60
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.89
|
| Rate for Payer: PHP Commercial |
$4.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.74
|
| Rate for Payer: Priority Health SBD |
$3.62
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.31
|
|
