|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$10.22
|
|
|
Service Code
|
NDC 51672211602
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna Commercial |
$9.19
|
| Rate for Payer: Aetna Medicare |
$3.78
|
| Rate for Payer: ASR ASR |
$9.91
|
| Rate for Payer: BCBS Complete |
$4.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.42
|
| Rate for Payer: BCN Commercial |
$8.42
|
| 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 |
$9.91
|
| Rate for Payer: Healthscope Whirlpool |
$10.21
|
| Rate for Payer: Mclaren Commercial |
$9.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.68
|
| Rate for Payer: Nomi Health Commercial |
$8.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.66
|
| Rate for Payer: Priority Health Cigna 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 |
$8.99
|
|
|
ACETAMINOPHEN 325 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1.70
|
|
|
Service Code
|
NDC 51672211600
|
| Hospital Charge Code |
104
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna Commercial |
$1.53
|
| Rate for Payer: ASR ASR |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$1.40
|
| Rate for Payer: BCN Commercial |
$1.40
|
| 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 |
$1.65
|
| Rate for Payer: Healthscope Whirlpool |
$1.70
|
| Rate for Payer: Mclaren Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.45
|
| Rate for Payer: Nomi Health Commercial |
$1.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.50
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
NDC 63739008702
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: Aetna Medicare |
$186.48
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS Trust/PPO |
$415.55
|
| Rate for Payer: BCN Commercial |
$415.55
|
| 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 |
$488.88
|
| Rate for Payer: Healthscope Whirlpool |
$504.00
|
| Rate for Payer: Mclaren Commercial |
$453.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$403.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$428.40
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: Priority Health Cigna 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
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$113.40
|
|
|
Service Code
|
NDC 536132701
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$102.06
|
| Rate for Payer: Aetna Medicare |
$41.96
|
| Rate for Payer: ASR ASR |
$110.00
|
| Rate for Payer: BCBS Complete |
$45.36
|
| Rate for Payer: BCBS Trust/PPO |
$93.50
|
| Rate for Payer: BCN Commercial |
$93.50
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$113.40
|
| Rate for Payer: Mclaren Commercial |
$102.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.36
|
| Rate for Payer: Priority Health Narrow Network |
$79.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.79
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$113.40
|
|
|
Service Code
|
NDC 536132701
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$102.06
|
| Rate for Payer: ASR ASR |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$93.12
|
| Rate for Payer: BCN Commercial |
$93.12
|
| Rate for Payer: Cash Price |
$90.72
|
| Rate for Payer: Cofinity Commercial |
$106.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$110.00
|
| Rate for Payer: Healthscope Whirlpool |
$113.40
|
| Rate for Payer: Mclaren Commercial |
$102.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$92.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.79
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
NDC 63739008702
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: BCBS Trust/PPO |
$413.88
|
| Rate for Payer: BCN Commercial |
$413.88
|
| 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 |
$488.88
|
| Rate for Payer: Healthscope Whirlpool |
$504.00
|
| 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: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$443.52
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$130.41
|
| Rate for Payer: ASR ASR |
$140.55
|
| Rate for Payer: BCBS Trust/PPO |
$118.99
|
| Rate for Payer: BCN Commercial |
$118.99
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$136.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$140.55
|
| Rate for Payer: Healthscope Whirlpool |
$144.90
|
| Rate for Payer: Mclaren Commercial |
$130.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.51
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 904673061
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.00 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: ASR ASR |
$120.28
|
| Rate for Payer: BCBS Trust/PPO |
$101.83
|
| Rate for Payer: BCN Commercial |
$101.83
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$116.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$120.28
|
| Rate for Payer: Healthscope Whirlpool |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$111.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.12
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
NDC 51645070610
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$512.82 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Aetna Medicare |
$512.82
|
| Rate for Payer: ASR ASR |
$1,344.42
|
| Rate for Payer: BCBS Complete |
$554.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,142.76
|
| Rate for Payer: BCN Commercial |
$1,142.76
|
| 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 |
$1,344.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.00
|
| Rate for Payer: Mclaren Commercial |
$1,247.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,178.10
|
| Rate for Payer: Nomi Health Commercial |
$1,136.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,039.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,214.41
|
| Rate for Payer: Priority Health Narrow Network |
$971.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.68
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
NDC 51645070610
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,039.50 |
| 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 |
$1,138.18
|
| Rate for Payer: BCN Commercial |
$1,138.18
|
| 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 |
$1,344.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.00
|
| Rate for Payer: Mclaren Commercial |
$1,247.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,178.10
|
| Rate for Payer: Nomi Health Commercial |
$1,136.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,039.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.68
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna Commercial |
$130.41
|
| Rate for Payer: Aetna Medicare |
$53.61
|
| Rate for Payer: ASR ASR |
$140.55
|
| Rate for Payer: BCBS Complete |
$57.96
|
| Rate for Payer: BCBS Trust/PPO |
$119.47
|
| Rate for Payer: BCN Commercial |
$119.47
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$136.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$140.55
|
| Rate for Payer: Healthscope Whirlpool |
$144.90
|
| Rate for Payer: Mclaren Commercial |
$130.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: Nomi Health Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$126.96
|
| Rate for Payer: Priority Health Narrow Network |
$101.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.51
|
|
|
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 |
$124.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Medicare |
$45.88
|
| Rate for Payer: ASR ASR |
$120.28
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS Trust/PPO |
$102.24
|
| Rate for Payer: BCN Commercial |
$102.24
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$116.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$120.28
|
| Rate for Payer: Healthscope Whirlpool |
$124.00
|
| Rate for Payer: Mclaren Commercial |
$111.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$108.65
|
| Rate for Payer: Priority Health Narrow Network |
$86.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.12
|
|
|
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 |
$4.35 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: ASR ASR |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$4.76
|
| Rate for Payer: BCN Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
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 |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: ASR ASR |
$5.62
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.08
|
| Rate for Payer: Priority Health Narrow Network |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
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 |
$4.35 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: ASR ASR |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$4.76
|
| Rate for Payer: BCN Commercial |
$4.76
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
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 |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.22
|
| Rate for Payer: Aetna Medicare |
$2.15
|
| Rate for Payer: ASR ASR |
$5.62
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.64
|
| Rate for Payer: Healthscope Commercial |
$5.62
|
| Rate for Payer: Healthscope Whirlpool |
$5.80
|
| Rate for Payer: Mclaren Commercial |
$5.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.93
|
| Rate for Payer: Nomi Health Commercial |
$4.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.08
|
| Rate for Payer: Priority Health Narrow Network |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.10
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$103.95
|
|
|
Service Code
|
NDC 45802073032
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: ASR ASR |
$100.83
|
| Rate for Payer: BCBS Trust/PPO |
$85.36
|
| Rate for Payer: BCN Commercial |
$85.36
|
| Rate for Payer: Cash Price |
$83.16
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.16
|
| Rate for Payer: Healthscope Commercial |
$100.83
|
| Rate for Payer: Healthscope Whirlpool |
$103.95
|
| Rate for Payer: Mclaren Commercial |
$93.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.36
|
| Rate for Payer: Nomi Health Commercial |
$85.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.48
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.65
|
|
|
Service Code
|
NDC 45802073030
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna Commercial |
$16.78
|
| Rate for Payer: ASR ASR |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$17.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Whirlpool |
$18.65
|
| Rate for Payer: Mclaren Commercial |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.41
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
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 |
$103.95 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Aetna Medicare |
$38.46
|
| Rate for Payer: ASR ASR |
$100.83
|
| Rate for Payer: BCBS Complete |
$41.58
|
| Rate for Payer: BCBS Trust/PPO |
$85.71
|
| Rate for Payer: BCN Commercial |
$85.71
|
| Rate for Payer: Cash Price |
$83.16
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.16
|
| Rate for Payer: Healthscope Commercial |
$100.83
|
| Rate for Payer: Healthscope Whirlpool |
$103.95
|
| Rate for Payer: Mclaren Commercial |
$93.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.36
|
| Rate for Payer: Nomi Health Commercial |
$85.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.08
|
| Rate for Payer: Priority Health Narrow Network |
$72.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.48
|
|
|
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 |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$0.77
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Healthscope Whirlpool |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.65
|
|
|
Service Code
|
NDC 45802073030
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$18.65 |
| Rate for Payer: Aetna Commercial |
$16.78
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: ASR ASR |
$18.09
|
| Rate for Payer: BCBS Complete |
$7.46
|
| Rate for Payer: BCBS Trust/PPO |
$15.38
|
| Rate for Payer: BCN Commercial |
$15.38
|
| Rate for Payer: Cash Price |
$14.92
|
| Rate for Payer: Cofinity Commercial |
$17.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$18.09
|
| Rate for Payer: Healthscope Whirlpool |
$18.65
|
| Rate for Payer: Mclaren Commercial |
$16.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.85
|
| Rate for Payer: Nomi Health Commercial |
$15.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.34
|
| Rate for Payer: Priority Health Narrow Network |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.41
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$389.98
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.49 |
| Max. Negotiated Rate |
$389.98 |
| Rate for Payer: Aetna Commercial |
$350.98
|
| Rate for Payer: ASR ASR |
$378.28
|
| Rate for Payer: BCBS Trust/PPO |
$320.25
|
| Rate for Payer: BCN Commercial |
$320.25
|
| Rate for Payer: Cash Price |
$311.98
|
| Rate for Payer: Cofinity Commercial |
$366.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.98
|
| Rate for Payer: Healthscope Commercial |
$378.28
|
| Rate for Payer: Healthscope Whirlpool |
$389.98
|
| Rate for Payer: Mclaren Commercial |
$350.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.48
|
| Rate for Payer: Nomi Health Commercial |
$319.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.18
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$7.80
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$7.02
|
| Rate for Payer: Aetna Medicare |
$2.89
|
| Rate for Payer: ASR ASR |
$7.57
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$6.43
|
| Rate for Payer: BCN Commercial |
$6.43
|
| Rate for Payer: Cash Price |
$6.24
|
| Rate for Payer: Cofinity Commercial |
$7.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.24
|
| Rate for Payer: Healthscope Commercial |
$7.57
|
| Rate for Payer: Healthscope Whirlpool |
$7.80
|
| Rate for Payer: Mclaren Commercial |
$7.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.63
|
| Rate for Payer: Nomi Health Commercial |
$6.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.83
|
| Rate for Payer: Priority Health Narrow Network |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.86
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.28 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Aetna Commercial |
$278.73
|
| Rate for Payer: ASR ASR |
$300.41
|
| Rate for Payer: BCBS Trust/PPO |
$254.33
|
| Rate for Payer: BCN Commercial |
$254.33
|
| Rate for Payer: Cash Price |
$247.76
|
| Rate for Payer: Cofinity Commercial |
$291.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$247.76
|
| Rate for Payer: Healthscope Commercial |
$300.41
|
| Rate for Payer: Healthscope Whirlpool |
$309.70
|
| Rate for Payer: Mclaren Commercial |
$278.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.54
|
|
