|
ABATACEPT INJECTION
|
Professional
|
$40.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$62.31 |
| Rate for Payer: Aetna Commercial |
$57.98
|
| Rate for Payer: Aetna Medicare |
$43.27
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$50.93
|
| Rate for Payer: BCN Medicare Advantage |
$43.27
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$62.31
|
| Rate for Payer: Cofinity Commercial |
$57.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.27
|
| Rate for Payer: Healthscope Commercial |
$51.93
|
| Rate for Payer: Healthscope Whirlpool |
$51.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.43
|
| Rate for Payer: PACE SWMI |
$43.27
|
| Rate for Payer: PHP Medicare Advantage |
$43.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Medicare |
$43.27
|
| Rate for Payer: UHC Medicare Advantage |
$44.57
|
|
|
ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
IP
|
$10,553.81
|
|
|
Service Code
|
MS-DRG 770
|
| Min. Negotiated Rate |
$8,020.90 |
| Max. Negotiated Rate |
$10,553.81 |
| Rate for Payer: Aetna Medicare |
$8,443.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,553.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,553.81
|
| Rate for Payer: BCBS MAPPO |
$8,443.05
|
| Rate for Payer: BCN Medicare Advantage |
$8,443.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,443.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,443.05
|
| Rate for Payer: Mclaren Medicare |
$8,443.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,865.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,709.51
|
| Rate for Payer: PACE Medicare |
$8,020.90
|
| Rate for Payer: PACE SWMI |
$8,443.05
|
| Rate for Payer: PHP Commercial |
$9,287.36
|
| Rate for Payer: PHP Medicare Advantage |
$8,443.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,255.31
|
| Rate for Payer: Priority Health Medicare |
$8,443.05
|
| Rate for Payer: Priority Health Narrow Network |
$8,204.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8,443.05
|
| Rate for Payer: UHC Medicare Advantage |
$8,696.34
|
| Rate for Payer: VA VA |
$8,443.05
|
|
|
ABORTION WITHOUT D&C
|
Facility
IP
|
$12,701.33
|
|
|
Service Code
|
MS-DRG 779
|
| Min. Negotiated Rate |
$9,553.10 |
| Max. Negotiated Rate |
$12,701.33 |
| Rate for Payer: Aetna Medicare |
$10,055.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,569.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,569.88
|
| Rate for Payer: BCBS MAPPO |
$10,055.90
|
| Rate for Payer: BCN Medicare Advantage |
$10,055.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,055.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,055.90
|
| Rate for Payer: Mclaren Medicare |
$10,055.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,558.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,564.28
|
| Rate for Payer: PACE Medicare |
$9,553.10
|
| Rate for Payer: PACE SWMI |
$10,055.90
|
| Rate for Payer: PHP Commercial |
$11,061.49
|
| Rate for Payer: PHP Medicare Advantage |
$10,055.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,701.33
|
| Rate for Payer: Priority Health Medicare |
$10,055.90
|
| Rate for Payer: Priority Health Narrow Network |
$10,161.06
|
| Rate for Payer: Railroad Medicare Medicare |
$10,055.90
|
| Rate for Payer: UHC Medicare Advantage |
$10,357.58
|
| Rate for Payer: VA VA |
$10,055.90
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.55
|
|
|
Service Code
|
NDC 45802-732-00
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: ASR ASR |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.20
|
| Rate for Payer: Cash Price |
$1.24
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.24
|
| Rate for Payer: Healthscope Commercial |
$1.55
|
| Rate for Payer: Healthscope Whirlpool |
$1.50
|
| Rate for Payer: Mclaren Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.36
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$18.56
|
|
|
Service Code
|
NDC 45802-732-30
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$18.56 |
| Rate for Payer: Aetna Commercial |
$16.70
|
| Rate for Payer: ASR ASR |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$17.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Whirlpool |
$18.00
|
| Rate for Payer: Mclaren Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.33
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$14.03
|
|
|
Service Code
|
NDC 51672-2115-2
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.82 |
| Max. Negotiated Rate |
$14.03 |
| Rate for Payer: Aetna Commercial |
$12.63
|
| Rate for Payer: ASR ASR |
$13.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.88
|
| Rate for Payer: BCN Commercial |
$10.88
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$14.03
|
| Rate for Payer: Healthscope Whirlpool |
$13.61
|
| Rate for Payer: Mclaren Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.35
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$2.34
|
|
|
Service Code
|
NDC 51672-2115-0
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: ASR ASR |
$2.27
|
| Rate for Payer: BCBS Trust/PPO |
$1.81
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.87
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$2.34
|
| Rate for Payer: Healthscope Whirlpool |
$2.27
|
| Rate for Payer: Mclaren Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.06
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$4.75
|
|
|
Service Code
|
NDC 68094-015-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.04
|
|
|
Service Code
|
NDC 68094-015-62
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: ASR ASR |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$3.91
|
| Rate for Payer: BCN Commercial |
$3.91
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Cofinity Commercial |
$4.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.03
|
| Rate for Payer: Healthscope Commercial |
$5.04
|
| Rate for Payer: Healthscope Whirlpool |
$4.89
|
| Rate for Payer: Mclaren Commercial |
$4.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.44
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.18
|
|
|
Service Code
|
NDC 0121-0966-05
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.66
|
| Rate for Payer: ASR ASR |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Healthscope Whirlpool |
$5.02
|
| Rate for Payer: Mclaren Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.56
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$3.98
|
|
|
Service Code
|
NDC 68094-231-59
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: ASR ASR |
$3.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.09
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: Cash Price |
$3.19
|
| Rate for Payer: Cofinity Commercial |
$3.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.98
|
| Rate for Payer: Healthscope Whirlpool |
$3.86
|
| Rate for Payer: Mclaren Commercial |
$3.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.50
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
IP
|
$5.18
|
|
|
Service Code
|
NDC 0121-0966-00
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$5.18 |
| Rate for Payer: Aetna Commercial |
$4.66
|
| Rate for Payer: ASR ASR |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: Cash Price |
$4.15
|
| Rate for Payer: Cofinity Commercial |
$4.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$5.18
|
| Rate for Payer: Healthscope Whirlpool |
$5.02
|
| Rate for Payer: Mclaren Commercial |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.56
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$10.11
|
|
|
Service Code
|
NDC 51672-2116-2
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.08 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: ASR ASR |
$9.81
|
| Rate for Payer: BCBS Trust/PPO |
$7.84
|
| Rate for Payer: BCN Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$8.09
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.09
|
| Rate for Payer: Healthscope Commercial |
$10.11
|
| Rate for Payer: Healthscope Whirlpool |
$9.81
|
| Rate for Payer: Mclaren Commercial |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.90
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$87.36
|
|
|
Service Code
|
NDC 51672-2116-4
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: ASR ASR |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$67.73
|
| Rate for Payer: BCN Commercial |
$67.73
|
| Rate for Payer: Cash Price |
$69.89
|
| Rate for Payer: Cofinity Commercial |
$82.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.89
|
| Rate for Payer: Healthscope Commercial |
$87.36
|
| Rate for Payer: Healthscope Whirlpool |
$84.74
|
| Rate for Payer: Mclaren Commercial |
$78.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.88
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.69
|
|
|
Service Code
|
NDC 51672-2116-0
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna Commercial |
$1.52
|
| Rate for Payer: ASR ASR |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$1.31
|
| Rate for Payer: BCN Commercial |
$1.31
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.35
|
| Rate for Payer: Healthscope Commercial |
$1.69
|
| Rate for Payer: Healthscope Whirlpool |
$1.64
|
| Rate for Payer: Mclaren Commercial |
$1.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.49
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$992.25
|
|
|
Service Code
|
NDC 63739-440-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$694.58 |
| Max. Negotiated Rate |
$992.25 |
| Rate for Payer: Aetna Commercial |
$893.02
|
| Rate for Payer: ASR ASR |
$962.48
|
| Rate for Payer: BCBS Trust/PPO |
$769.29
|
| Rate for Payer: BCN Commercial |
$769.29
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cofinity Commercial |
$932.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$793.80
|
| Rate for Payer: Healthscope Commercial |
$992.25
|
| Rate for Payer: Healthscope Whirlpool |
$962.48
|
| Rate for Payer: Mclaren Commercial |
$893.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$694.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$873.18
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$107.10
|
|
|
Service Code
|
NDC 0536-1327-01
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$83.03
|
| Rate for Payer: BCN Commercial |
$83.03
|
| Rate for Payer: Cash Price |
$85.68
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.68
|
| Rate for Payer: Healthscope Commercial |
$107.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.89
|
| Rate for Payer: Mclaren Commercial |
$96.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
IP
|
$492.00
|
|
|
Service Code
|
NDC 63739-087-02
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$442.80
|
| Rate for Payer: ASR ASR |
$477.24
|
| Rate for Payer: BCBS Trust/PPO |
$381.45
|
| Rate for Payer: BCN Commercial |
$381.45
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$462.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.60
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: Healthscope Whirlpool |
$477.24
|
| Rate for Payer: Mclaren Commercial |
$442.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.96
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$1,386.00
|
|
|
Service Code
|
NDC 51645-706-10
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$970.20 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: ASR ASR |
$1,344.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,074.57
|
| Rate for Payer: BCN Commercial |
$1,074.57
|
| Rate for Payer: Cash Price |
$1,108.80
|
| Rate for Payer: Cofinity Commercial |
$1,302.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,108.80
|
| Rate for Payer: Healthscope Commercial |
$1,386.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,344.42
|
| Rate for Payer: Mclaren Commercial |
$1,247.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,178.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$970.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.68
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
IP
|
$88.20
|
|
|
Service Code
|
NDC 57896-221-01
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna Commercial |
$79.38
|
| Rate for Payer: ASR ASR |
$85.55
|
| Rate for Payer: BCBS Trust/PPO |
$68.38
|
| Rate for Payer: BCN Commercial |
$68.38
|
| Rate for Payer: Cash Price |
$70.56
|
| Rate for Payer: Cofinity Commercial |
$82.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.56
|
| Rate for Payer: Healthscope Commercial |
$88.20
|
| Rate for Payer: Healthscope Whirlpool |
$85.55
|
| Rate for Payer: Mclaren Commercial |
$79.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.62
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
NDC 66689-056-01
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.19
|
| Rate for Payer: BCN Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Whirlpool |
$5.24
|
| Rate for Payer: Mclaren Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
IP
|
$5.40
|
|
|
Service Code
|
NDC 66689-056-99
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.19
|
| Rate for Payer: BCN Commercial |
$4.19
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.32
|
| Rate for Payer: Healthscope Commercial |
$5.40
|
| Rate for Payer: Healthscope Whirlpool |
$5.24
|
| Rate for Payer: Mclaren Commercial |
$4.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$1.81
|
|
|
Service Code
|
NDC 45802-730-00
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: ASR ASR |
$1.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| Rate for Payer: Cash Price |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$1.81
|
| Rate for Payer: Healthscope Whirlpool |
$1.76
|
| Rate for Payer: Mclaren Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.59
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$17.89
|
|
|
Service Code
|
NDC 45802-730-30
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$17.89 |
| Rate for Payer: Aetna Commercial |
$16.10
|
| Rate for Payer: ASR ASR |
$17.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.87
|
| Rate for Payer: BCN Commercial |
$13.87
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$17.89
|
| Rate for Payer: Healthscope Whirlpool |
$17.35
|
| Rate for Payer: Mclaren Commercial |
$16.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.74
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
IP
|
$90.65
|
|
|
Service Code
|
NDC 45802-730-32
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.46 |
| Max. Negotiated Rate |
$90.65 |
| Rate for Payer: Aetna Commercial |
$81.58
|
| Rate for Payer: ASR ASR |
$87.93
|
| Rate for Payer: BCBS Trust/PPO |
$70.28
|
| Rate for Payer: BCN Commercial |
$70.28
|
| Rate for Payer: Cash Price |
$72.52
|
| Rate for Payer: Cofinity Commercial |
$85.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.52
|
| Rate for Payer: Healthscope Commercial |
$90.65
|
| Rate for Payer: Healthscope Whirlpool |
$87.93
|
| Rate for Payer: Mclaren Commercial |
$81.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.77
|
|
