|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: Aetna Medicare |
$9.35
|
| Rate for Payer: ASR ASR |
$18.14
|
| Rate for Payer: ASR Commercial |
$18.14
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$13.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.46
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.98
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: ASR ASR |
$18.41
|
| Rate for Payer: ASR Commercial |
$18.41
|
| Rate for Payer: BCBS Complete |
$7.59
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCN Commercial |
$14.72
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Healthscope Whirlpool |
$18.41
|
| Rate for Payer: Mclaren Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.13
|
| Rate for Payer: Nomi Health Commercial |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.63
|
| Rate for Payer: Priority Health Narrow Network |
$13.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: ASR ASR |
$1.53
|
| Rate for Payer: ASR Commercial |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.29
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Healthscope Whirlpool |
$1.53
|
| Rate for Payer: Mclaren Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.34
|
| Rate for Payer: Nomi Health Commercial |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.39
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 45802073200
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: ASR ASR |
$1.53
|
| Rate for Payer: ASR Commercial |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.29
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cofinity Commercial |
$1.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Healthscope Whirlpool |
$1.53
|
| Rate for Payer: Mclaren Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.34
|
| Rate for Payer: Nomi Health Commercial |
$1.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.39
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: ASR Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.54
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.98
|
|
|
Service Code
|
NDC 45802073230
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.34 |
| Max. Negotiated Rate |
$18.98 |
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: ASR ASR |
$18.41
|
| Rate for Payer: ASR Commercial |
$18.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.47
|
| Rate for Payer: BCN Commercial |
$14.72
|
| Rate for Payer: Cash Price |
$15.19
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.18
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Healthscope Whirlpool |
$18.41
|
| Rate for Payer: Mclaren Commercial |
$17.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.13
|
| Rate for Payer: Nomi Health Commercial |
$15.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.70
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
NDC 51672211502
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna Commercial |
$16.83
|
| Rate for Payer: ASR ASR |
$18.14
|
| Rate for Payer: ASR Commercial |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$15.24
|
| Rate for Payer: BCN Commercial |
$14.50
|
| Rate for Payer: Cash Price |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.96
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Healthscope Whirlpool |
$18.14
|
| Rate for Payer: Mclaren Commercial |
$16.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Nomi Health Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.46
|
|
|
ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 51672211500
|
| Hospital Charge Code |
103
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.12 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: ASR ASR |
$3.03
|
| Rate for Payer: ASR Commercial |
$3.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$2.42
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.12
|
| Rate for Payer: Healthscope Whirlpool |
$3.03
|
| Rate for Payer: Mclaren Commercial |
$2.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: Nomi Health Commercial |
$2.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.73
|
| Rate for Payer: Priority Health Narrow Network |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$5.04
|
|
|
Service Code
|
NDC 68094001562
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: ASR ASR |
$4.89
|
| Rate for Payer: ASR Commercial |
$4.89
|
| Rate for Payer: BCBS Trust/PPO |
$4.11
|
| 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 Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.44
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: ASR ASR |
$4.77
|
| Rate for Payer: ASR Commercial |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Whirlpool |
$4.77
|
| Rate for Payer: Mclaren Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.33
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 00121096600
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: ASR ASR |
$4.77
|
| Rate for Payer: ASR Commercial |
$4.77
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$4.03
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Whirlpool |
$4.77
|
| Rate for Payer: Mclaren Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.31
|
| Rate for Payer: Priority Health Narrow Network |
$3.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.33
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$5.04
|
|
|
Service Code
|
NDC 68094001562
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: ASR ASR |
$4.89
|
| Rate for Payer: ASR Commercial |
$4.89
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$4.13
|
| 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 Commercial |
$4.28
|
| Rate for Payer: Nomi Health Commercial |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.42
|
| Rate for Payer: Priority Health Narrow Network |
$3.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.44
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: ASR ASR |
$4.19
|
| Rate for Payer: ASR Commercial |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$3.52
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Healthscope Whirlpool |
$4.19
|
| Rate for Payer: Mclaren Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.80
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| 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 Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: ASR ASR |
$4.77
|
| Rate for Payer: ASR Commercial |
$4.77
|
| Rate for Payer: BCBS Trust/PPO |
$4.01
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Whirlpool |
$4.77
|
| Rate for Payer: Mclaren Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.33
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 68094023159
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Aetna Commercial |
$3.89
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: ASR ASR |
$4.19
|
| Rate for Payer: ASR Commercial |
$4.19
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$4.32
|
| Rate for Payer: Healthscope Whirlpool |
$4.19
|
| Rate for Payer: Mclaren Commercial |
$3.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.79
|
| Rate for Payer: Priority Health Narrow Network |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.80
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 68094001559
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| 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 Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
ACETAMINOPHEN 160 MG/5 ML (5 ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 00121096605
|
| Hospital Charge Code |
8943
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$4.43
|
| Rate for Payer: Aetna Medicare |
$2.46
|
| Rate for Payer: ASR ASR |
$4.77
|
| Rate for Payer: ASR Commercial |
$4.77
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS Trust/PPO |
$4.03
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Whirlpool |
$4.77
|
| Rate for Payer: Mclaren Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.31
|
| Rate for Payer: Priority Health Narrow Network |
$3.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.33
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$87.36
|
|
|
Service Code
|
NDC 51672211604
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.78 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: ASR ASR |
$84.74
|
| Rate for Payer: ASR Commercial |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$71.19
|
| 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 Commercial |
$74.26
|
| Rate for Payer: Nomi Health Commercial |
$71.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.88
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1.70
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: Aetna Medicare |
$0.85
|
| Rate for Payer: ASR ASR |
$1.65
|
| Rate for Payer: ASR Commercial |
$1.65
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS Trust/PPO |
$1.39
|
| Rate for Payer: BCN Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Healthscope Whirlpool |
$1.65
|
| Rate for Payer: Mclaren Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.44
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.49
|
| Rate for Payer: Priority Health Narrow Network |
$1.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.50
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: ASR ASR |
$1.65
|
| Rate for Payer: ASR Commercial |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.39
|
| Rate for Payer: BCN Commercial |
$1.32
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.36
|
| Rate for Payer: Healthscope Commercial |
$1.70
|
| Rate for Payer: Healthscope Whirlpool |
$1.65
|
| Rate for Payer: Mclaren Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.44
|
| Rate for Payer: Nomi Health Commercial |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.50
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$87.36
|
|
|
Service Code
|
NDC 51672211604
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: ASR ASR |
$84.74
|
| Rate for Payer: ASR Commercial |
$84.74
|
| Rate for Payer: BCBS Complete |
$34.94
|
| Rate for Payer: BCBS Trust/PPO |
$71.54
|
| 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 Commercial |
$74.26
|
| Rate for Payer: Nomi Health Commercial |
$71.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.54
|
| Rate for Payer: Priority Health Narrow Network |
$61.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.88
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$10.21
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Aetna Medicare |
$5.10
|
| Rate for Payer: ASR ASR |
$9.90
|
| Rate for Payer: ASR Commercial |
$9.90
|
| Rate for Payer: BCBS Complete |
$4.08
|
| Rate for Payer: BCBS Trust/PPO |
$8.36
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$9.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.68
|
| Rate for Payer: Nomi Health Commercial |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.95
|
| Rate for Payer: Priority Health Narrow Network |
$7.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$10.21
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: ASR ASR |
$9.90
|
| Rate for Payer: ASR Commercial |
$9.90
|
| Rate for Payer: BCBS Trust/PPO |
$8.32
|
| Rate for Payer: BCN Commercial |
$7.92
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.17
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Healthscope Whirlpool |
$9.90
|
| Rate for Payer: Mclaren Commercial |
$9.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.68
|
| Rate for Payer: Nomi Health Commercial |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.98
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
NDC 63739008702
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Aetna Medicare |
$252.00
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: ASR Commercial |
$488.88
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS Trust/PPO |
$412.73
|
| Rate for Payer: BCN Commercial |
$390.75
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$473.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.20
|
| Rate for Payer: Healthscope Commercial |
$504.00
|
| Rate for Payer: Healthscope Whirlpool |
$488.88
|
| Rate for Payer: Mclaren Commercial |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$441.60
|
| Rate for Payer: Priority Health Narrow Network |
$353.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.52
|
|
