|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.56
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Advantage |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: Priority Health SBD |
$2.48
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 09900001942
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 00121204410
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 00121204410
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$1.64
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
NDC 00121091405
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Aetna Commercial |
$2.23
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.70
|
| Rate for Payer: BCBS Complete |
$1.05
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cofinity Advantage |
$1.83
|
| Rate for Payer: Cofinity Commercial |
$2.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.10
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.97
|
| Rate for Payer: PHP Commercial |
$2.23
|
| Rate for Payer: Priority Health SBD |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.03
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 00121102200
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Advantage |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: UHC Exchange |
$1.08
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 00121102205
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Advantage |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.78
|
| Rate for Payer: UHC Core |
$1.43
|
| Rate for Payer: UHC Exchange |
$1.08
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Advantage |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health SBD |
$1.62
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.34
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.87
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$119.70
|
|
|
Service Code
|
NDC 00904791259
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna Medicare |
$59.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: BCBS Complete |
$47.88
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: Priority Health SBD |
$75.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.81
|
| Rate for Payer: UHC Core |
$62.36
|
| Rate for Payer: UHC Exchange |
$47.04
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$37.44
|
|
|
Service Code
|
NDC 00904674724
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$18.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: BCBS Complete |
$14.98
|
| Rate for Payer: Cash Price |
$29.95
|
| Rate for Payer: Cofinity Advantage |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.95
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.08
|
| Rate for Payer: PHP Commercial |
$31.82
|
| Rate for Payer: Priority Health SBD |
$23.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.34
|
| Rate for Payer: UHC Core |
$19.51
|
| Rate for Payer: UHC Exchange |
$14.71
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$119.70
|
|
|
Service Code
|
NDC 00904791259
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.41 |
| Max. Negotiated Rate |
$107.73 |
| Rate for Payer: Aetna Commercial |
$101.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.81
|
| Rate for Payer: Cash Price |
$95.76
|
| Rate for Payer: Cofinity Advantage |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$102.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$107.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.78
|
| Rate for Payer: PHP Commercial |
$101.75
|
| Rate for Payer: Priority Health SBD |
$75.41
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$37.44
|
|
|
Service Code
|
NDC 00904674724
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.34
|
| Rate for Payer: Cash Price |
$29.95
|
| Rate for Payer: Cofinity Advantage |
$26.21
|
| Rate for Payer: Cofinity Commercial |
$32.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.95
|
| Rate for Payer: Healthscope Commercial |
$33.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.08
|
| Rate for Payer: PHP Commercial |
$31.82
|
| Rate for Payer: Priority Health SBD |
$23.59
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.34
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.34
|
| Rate for Payer: UHC Core |
$12.30
|
| Rate for Payer: UHC Exchange |
$9.27
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$75.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Advantage |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.76
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: UHC Exchange |
$59.11
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084065811
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 68084065811
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.36 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.61
|
| Rate for Payer: UHC Core |
$138.35
|
| Rate for Payer: UHC Exchange |
$104.36
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
NDC 67877031905
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.71 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Advantage |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.50
|
| Rate for Payer: UHC Core |
$244.87
|
| Rate for Payer: UHC Exchange |
$184.71
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
NDC 67877031905
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.10 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Advantage |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.75 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Advantage |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health SBD |
$94.75
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.67
|
| Rate for Payer: UHC Core |
$96.72
|
| Rate for Payer: UHC Exchange |
$72.96
|
|
