|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
NDC 57896020110
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$471.24 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Aetna American Axle |
$696.15
|
| Rate for Payer: Aetna Commercial |
$910.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.15
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Advantage |
$749.70
|
| Rate for Payer: Cofinity Commercial |
$921.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$856.80
|
| Rate for Payer: Healthscope Commercial |
$963.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$749.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$803.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$910.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PHP Commercial |
$910.35
|
| Rate for Payer: Priority Health SBD |
$674.73
|
| Rate for Payer: UMR Bronson Commercial |
$471.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$803.25
|
|
|
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
|
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
|
|
|
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 Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.28
|
| Rate for Payer: UHC Core |
$78.78
|
| Rate for Payer: UHC Exchange |
$59.42
|
| 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
|
$124.00
|
|
|
Service Code
|
NDC 00904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity 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: 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: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 00904673061
|
| 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
|
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 Advantage |
$105.84
|
| Rate for Payer: Cofinity Commercial |
$130.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$136.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.40
|
| Rate for Payer: PHP Commercial |
$128.52
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$66.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
NDC 00904672080
|
| 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 Advantage |
$617.40
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| 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: Opus (Opus Packaging Group) HMA |
$661.50
|
| Rate for Payer: PHP Commercial |
$749.70
|
| 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
|
$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 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Advantage |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.77
|
| Rate for Payer: UHC Core |
$3.02
|
| Rate for Payer: UHC Exchange |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 00904732176
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Advantage |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.69
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$1.87
|
| Rate for Payer: UHC Exchange |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.80
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$2.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Advantage |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.77
|
| Rate for Payer: UHC Core |
$3.02
|
| Rate for Payer: UHC Exchange |
$2.28
|
| Rate for Payer: UMR Bronson Commercial |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
NDC 00904732103
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.44
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Advantage |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.69
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.33
|
| Rate for Payer: UHC Core |
$1.87
|
| Rate for Payer: UHC Exchange |
$1.41
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Advantage |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 00904732176
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Advantage |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.69
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.15
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$3.59
|
|
|
Service Code
|
NDC 00904732103
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna American Axle |
$2.33
|
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.33
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Cofinity Advantage |
$2.51
|
| Rate for Payer: Cofinity Commercial |
$3.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.87
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.69
|
| Rate for Payer: PHP Commercial |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.26
|
| Rate for Payer: UMR Bronson Commercial |
$1.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.69
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.80
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna American Axle |
$3.77
|
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.77
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Advantage |
$4.06
|
| Rate for Payer: Cofinity Commercial |
$4.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: PHP Commercial |
$4.93
|
| Rate for Payer: Priority Health SBD |
$3.65
|
| Rate for Payer: UMR Bronson Commercial |
$2.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.35
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 00121197121
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
NDC 00121197100
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna American Axle |
$2.70
|
| Rate for Payer: Aetna Commercial |
$3.53
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.70
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.32
|
| Rate for Payer: Cofinity Advantage |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.32
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.11
|
| Rate for Payer: PHP Commercial |
$3.53
|
| Rate for Payer: Priority Health SBD |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.16
|
| Rate for Payer: UHC Exchange |
$1.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.11
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$210.10
|
|
|
Service Code
|
NDC 45802073033
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$189.09 |
| Rate for Payer: Aetna American Axle |
$136.56
|
| Rate for Payer: Aetna Commercial |
$178.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.56
|
| Rate for Payer: Cash Price |
$168.08
|
| Rate for Payer: Cofinity Advantage |
$147.07
|
| Rate for Payer: Cofinity Commercial |
$180.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.08
|
| Rate for Payer: Healthscope Commercial |
$189.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.57
|
| Rate for Payer: PHP Commercial |
$178.59
|
| Rate for Payer: Priority Health SBD |
$132.36
|
| Rate for Payer: UMR Bronson Commercial |
$92.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.57
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$103.95
|
|
|
Service Code
|
NDC 45802073032
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.46 |
| Max. Negotiated Rate |
$93.56 |
| Rate for Payer: Aetna American Axle |
$67.57
|
| Rate for Payer: Aetna Commercial |
$88.36
|
| Rate for Payer: Aetna Medicare |
$51.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.57
|
| Rate for Payer: BCBS Complete |
$41.58
|
| Rate for Payer: Cash Price |
$83.16
|
| Rate for Payer: Cofinity Advantage |
$72.77
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.16
|
| Rate for Payer: Healthscope Commercial |
$93.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.96
|
| Rate for Payer: PHP Commercial |
$88.36
|
| Rate for Payer: Priority Health SBD |
$65.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.57
|
| Rate for Payer: UHC Core |
$54.16
|
| Rate for Payer: UHC Exchange |
$40.85
|
| Rate for Payer: UMR Bronson Commercial |
$38.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.96
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna American Axle |
$1.35
|
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Advantage |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: PHP Commercial |
$1.77
|
| Rate for Payer: Priority Health SBD |
$1.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.35
|
| Rate for Payer: UHC Core |
$1.08
|
| Rate for Payer: UHC Exchange |
$0.82
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.56
|
|
