|
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
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
NDC 63739008702
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$453.60
|
| Rate for Payer: ASR ASR |
$488.88
|
| Rate for Payer: ASR Commercial |
$488.88
|
| Rate for Payer: BCBS Trust/PPO |
$410.71
|
| 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: UHC All Payor (Choice/PPO) + Core |
$443.52
|
|
|
ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
NDC 00536132701
|
| Hospital Charge Code |
101
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.62 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: Aetna Commercial |
$96.39
|
| Rate for Payer: ASR ASR |
$103.89
|
| Rate for Payer: ASR Commercial |
$103.89
|
| Rate for Payer: BCBS Trust/PPO |
$87.28
|
| 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 Commercial |
$91.04
|
| Rate for Payer: Nomi Health Commercial |
$87.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.25
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$1,386.00
|
|
|
Service Code
|
NDC 51645070610
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$900.90 |
| 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: ASR Commercial |
$1,344.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,129.45
|
| 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 Commercial |
$1,178.10
|
| Rate for Payer: Nomi Health Commercial |
$1,136.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,219.68
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: ASR ASR |
$271.60
|
| Rate for Payer: ASR Commercial |
$271.60
|
| Rate for Payer: BCBS Trust/PPO |
$228.17
|
| Rate for Payer: BCN Commercial |
$217.08
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.00
|
| Rate for Payer: Healthscope Commercial |
$280.00
|
| Rate for Payer: Healthscope Whirlpool |
$271.60
|
| Rate for Payer: Mclaren Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.00
|
| Rate for Payer: Nomi Health Commercial |
$229.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
NDC 50580045711
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Medicare |
$140.00
|
| Rate for Payer: ASR ASR |
$271.60
|
| Rate for Payer: ASR Commercial |
$271.60
|
| Rate for Payer: BCBS Complete |
$112.00
|
| Rate for Payer: BCBS Trust/PPO |
$229.29
|
| Rate for Payer: BCN Commercial |
$217.08
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.00
|
| Rate for Payer: Healthscope Commercial |
$280.00
|
| Rate for Payer: Healthscope Whirlpool |
$271.60
|
| Rate for Payer: Mclaren Commercial |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.00
|
| Rate for Payer: Nomi Health Commercial |
$229.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.34
|
| Rate for Payer: Priority Health Narrow Network |
$196.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.40
|
|
|
ACETAMINOPHEN 500 MG TABLET
|
Facility
|
OP
|
$1,386.00
|
|
|
Service Code
|
NDC 51645070610
|
| Hospital Charge Code |
102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.40 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Aetna Commercial |
$1,247.40
|
| Rate for Payer: Aetna Medicare |
$693.00
|
| Rate for Payer: ASR ASR |
$1,344.42
|
| Rate for Payer: ASR Commercial |
$1,344.42
|
| Rate for Payer: BCBS Complete |
$554.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.00
|
| 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 Commercial |
$1,178.10
|
| Rate for Payer: Nomi Health Commercial |
$1,136.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$900.90
|
| Rate for Payer: 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 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: ASR ASR |
$5.57
|
| Rate for Payer: ASR Commercial |
$5.57
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Healthscope Whirlpool |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.88
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.03
|
| Rate for Payer: Priority Health Narrow Network |
$4.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.05
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: ASR ASR |
$5.57
|
| Rate for Payer: ASR Commercial |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Healthscope Whirlpool |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.88
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.05
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
NDC 66689005699
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: ASR Commercial |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| 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 Commercial |
$4.59
|
| Rate for Payer: Nomi Health Commercial |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
NDC 66689005699
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: ASR Commercial |
$5.24
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$4.42
|
| 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 Commercial |
$4.59
|
| Rate for Payer: Nomi Health Commercial |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 81033000230
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: ASR ASR |
$5.57
|
| Rate for Payer: ASR Commercial |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$4.68
|
| Rate for Payer: BCN Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Healthscope Whirlpool |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.88
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.05
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.40
|
|
|
Service Code
|
NDC 66689005601
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: ASR Commercial |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$4.40
|
| 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 Commercial |
$4.59
|
| Rate for Payer: Nomi Health Commercial |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.40
|
|
|
Service Code
|
NDC 66689005601
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$5.40 |
| Rate for Payer: Aetna Commercial |
$4.86
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: ASR ASR |
$5.24
|
| Rate for Payer: ASR Commercial |
$5.24
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: BCBS Trust/PPO |
$4.42
|
| 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 Commercial |
$4.59
|
| Rate for Payer: Nomi Health Commercial |
$4.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.73
|
| Rate for Payer: Priority Health Narrow Network |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.75
|
|
|
ACETAMINOPHEN 650 MG/20.3 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
NDC 81033000220
|
| Hospital Charge Code |
119323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.17
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: ASR ASR |
$5.57
|
| Rate for Payer: ASR Commercial |
$5.57
|
| Rate for Payer: BCBS Complete |
$2.30
|
| Rate for Payer: BCBS Trust/PPO |
$4.70
|
| Rate for Payer: BCN Commercial |
$4.45
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$5.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$5.74
|
| Rate for Payer: Healthscope Whirlpool |
$5.57
|
| Rate for Payer: Mclaren Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.88
|
| Rate for Payer: Nomi Health Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.03
|
| Rate for Payer: Priority Health Narrow Network |
$4.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.05
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18.40
|
|
|
Service Code
|
NDC 45802073030
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: ASR ASR |
$17.85
|
| Rate for Payer: ASR Commercial |
$17.85
|
| Rate for Payer: BCBS Complete |
$7.36
|
| Rate for Payer: BCBS Trust/PPO |
$15.07
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Whirlpool |
$17.85
|
| Rate for Payer: Mclaren Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.64
|
| Rate for Payer: Nomi Health Commercial |
$15.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.12
|
| Rate for Payer: Priority Health Narrow Network |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.19
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$2.08
|
|
|
Service Code
|
NDC 45802073000
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: ASR Commercial |
$2.02
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.02
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.83
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18.40
|
|
|
Service Code
|
NDC 45802073030
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: Aetna Commercial |
$16.56
|
| Rate for Payer: ASR ASR |
$17.85
|
| Rate for Payer: ASR Commercial |
$17.85
|
| Rate for Payer: BCBS Trust/PPO |
$14.99
|
| Rate for Payer: BCN Commercial |
$14.27
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.72
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Whirlpool |
$17.85
|
| Rate for Payer: Mclaren Commercial |
$16.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.64
|
| Rate for Payer: Nomi Health Commercial |
$15.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.19
|
|
|
ACETAMINOPHEN 650 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$103.95
|
|
|
Service Code
|
NDC 45802073032
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.58 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: Aetna Medicare |
$51.98
|
| Rate for Payer: ASR ASR |
$100.83
|
| Rate for Payer: ASR Commercial |
$100.83
|
| Rate for Payer: BCBS Complete |
$41.58
|
| Rate for Payer: BCBS Trust/PPO |
$85.12
|
| Rate for Payer: BCN Commercial |
$80.59
|
| 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 |
$103.95
|
| Rate for Payer: Healthscope Whirlpool |
$100.83
|
| 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: Priority Health Cigna Priority Health |
$67.57
|
| Rate for Payer: 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
|
IP
|
$103.95
|
|
|
Service Code
|
NDC 45802073032
|
| Hospital Charge Code |
105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.57 |
| Max. Negotiated Rate |
$103.95 |
| Rate for Payer: Aetna Commercial |
$93.56
|
| Rate for Payer: ASR ASR |
$100.83
|
| Rate for Payer: ASR Commercial |
$100.83
|
| Rate for Payer: BCBS Trust/PPO |
$84.71
|
| Rate for Payer: BCN Commercial |
$80.59
|
| 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 |
$103.95
|
| Rate for Payer: Healthscope Whirlpool |
$100.83
|
| 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: Priority Health Cigna Priority Health |
$67.57
|
| 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 |
$0.83 |
| Max. Negotiated Rate |
$2.08 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.02
|
| Rate for Payer: ASR Commercial |
$2.02
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.08
|
| Rate for Payer: Healthscope Whirlpool |
$2.02
|
| Rate for Payer: Mclaren Commercial |
$1.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.77
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: 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
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.58 |
| Max. Negotiated Rate |
$467.04 |
| Rate for Payer: Aetna Commercial |
$420.34
|
| Rate for Payer: ASR ASR |
$453.03
|
| Rate for Payer: ASR Commercial |
$453.03
|
| Rate for Payer: BCBS Trust/PPO |
$380.59
|
| Rate for Payer: BCN Commercial |
$362.10
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$439.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$467.04
|
| Rate for Payer: Healthscope Whirlpool |
$453.03
|
| Rate for Payer: Mclaren Commercial |
$420.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Nomi Health Commercial |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.00
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$9.34
|
|
|
Service Code
|
NDC 50268005411
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$9.34 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: ASR ASR |
$9.06
|
| Rate for Payer: ASR Commercial |
$9.06
|
| Rate for Payer: BCBS Trust/PPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$7.24
|
| Rate for Payer: Cash Price |
$7.47
|
| Rate for Payer: Cofinity Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.47
|
| Rate for Payer: Healthscope Commercial |
$9.34
|
| Rate for Payer: Healthscope Whirlpool |
$9.06
|
| Rate for Payer: Mclaren Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.94
|
| Rate for Payer: Nomi Health Commercial |
$7.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.22
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
OP
|
$467.04
|
|
|
Service Code
|
NDC 50268005415
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.82 |
| Max. Negotiated Rate |
$467.04 |
| Rate for Payer: Aetna Commercial |
$420.34
|
| Rate for Payer: Aetna Medicare |
$233.52
|
| Rate for Payer: ASR ASR |
$453.03
|
| Rate for Payer: ASR Commercial |
$453.03
|
| Rate for Payer: BCBS Complete |
$186.82
|
| Rate for Payer: BCBS Trust/PPO |
$382.46
|
| Rate for Payer: BCN Commercial |
$362.10
|
| Rate for Payer: Cash Price |
$373.63
|
| Rate for Payer: Cofinity Commercial |
$439.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$373.63
|
| Rate for Payer: Healthscope Commercial |
$467.04
|
| Rate for Payer: Healthscope Whirlpool |
$453.03
|
| Rate for Payer: Mclaren Commercial |
$420.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.98
|
| Rate for Payer: Nomi Health Commercial |
$382.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.22
|
| Rate for Payer: Priority Health Narrow Network |
$327.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.00
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
|
IP
|
$309.70
|
|
|
Service Code
|
NDC 23155028801
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.30 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Aetna Commercial |
$278.73
|
| Rate for Payer: ASR ASR |
$300.41
|
| Rate for Payer: ASR Commercial |
$300.41
|
| Rate for Payer: BCBS Trust/PPO |
$252.37
|
| Rate for Payer: BCN Commercial |
$240.11
|
| 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 |
$309.70
|
| Rate for Payer: Healthscope Whirlpool |
$300.41
|
| Rate for Payer: Mclaren Commercial |
$278.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.24
|
| Rate for Payer: Nomi Health Commercial |
$253.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$272.54
|
|
