|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$117.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.73
|
| Rate for Payer: BCBS Complete |
$83.95
|
| Rate for Payer: BCBS MAPPO |
$113.39
|
| Rate for Payer: BCBS Trust/PPO |
$372.86
|
| Rate for Payer: BCN Commercial |
$372.86
|
| Rate for Payer: BCN Medicare Advantage |
$113.39
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.39
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Mclaren Medicaid |
$79.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.06
|
| Rate for Payer: Meridian Medicaid |
$83.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Nomi Health Commercial |
$371.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PACE Senior Care Partners |
$107.72
|
| Rate for Payer: PACE SWMI |
$113.39
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: PHP Medicare Advantage |
$113.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$394.59
|
| Rate for Payer: Priority Health Medicare |
$114.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$315.67
|
| Rate for Payer: Railroad Medicare Medicare |
$113.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.12
|
| Rate for Payer: UHC Core |
$378.71
|
| Rate for Payer: UHC Exchange |
$113.39
|
| Rate for Payer: UHC Medicaid |
$79.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.39
|
| Rate for Payer: UHCCP Medicaid |
$79.96
|
| Rate for Payer: VA VA |
$113.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.02 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.39
|
| Rate for Payer: BCBS Complete |
$39.92
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$177.29
|
| Rate for Payer: BCN Medicare Advantage |
$53.91
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Mclaren Medicaid |
$38.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: Meridian Medicaid |
$39.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PACE Senior Care Partners |
$51.22
|
| Rate for Payer: PACE SWMI |
$53.91
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: PHP Medicare Advantage |
$53.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.09
|
| Rate for Payer: Railroad Medicare Medicare |
$53.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicaid |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| Rate for Payer: UHCCP Medicaid |
$38.02
|
| Rate for Payer: VA VA |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$303.36
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$250.55
|
| Rate for Payer: BCN Commercial |
$250.55
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.52
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.96
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$95.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115.30
|
| Rate for Payer: BCBS Complete |
$68.29
|
| Rate for Payer: BCBS MAPPO |
$92.24
|
| Rate for Payer: BCBS Trust/PPO |
$303.31
|
| Rate for Payer: BCN Commercial |
$303.31
|
| Rate for Payer: BCN Medicare Advantage |
$92.24
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.24
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Mclaren Medicaid |
$65.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.85
|
| Rate for Payer: Meridian Medicaid |
$68.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PACE Senior Care Partners |
$87.63
|
| Rate for Payer: PACE SWMI |
$92.24
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: PHP Medicare Advantage |
$92.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.99
|
| Rate for Payer: Priority Health Medicare |
$93.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.79
|
| Rate for Payer: Railroad Medicare Medicare |
$92.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.68
|
| Rate for Payer: UHC Core |
$308.07
|
| Rate for Payer: UHC Exchange |
$92.24
|
| Rate for Payer: UHC Medicaid |
$65.05
|
| Rate for Payer: UHC Medicare Advantage |
$92.24
|
| Rate for Payer: UHCCP Medicaid |
$65.05
|
| Rate for Payer: VA VA |
$92.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$303.36
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$78.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.80
|
| Rate for Payer: BCBS Complete |
$56.15
|
| Rate for Payer: BCBS MAPPO |
$75.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.39
|
| Rate for Payer: BCN Commercial |
$249.39
|
| Rate for Payer: BCN Medicare Advantage |
$75.84
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.84
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$53.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.63
|
| Rate for Payer: Meridian Medicaid |
$56.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.52
|
| Rate for Payer: PACE Senior Care Partners |
$72.05
|
| Rate for Payer: PACE SWMI |
$75.84
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: PHP Medicare Advantage |
$75.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$263.92
|
| Rate for Payer: Priority Health Medicare |
$76.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.14
|
| Rate for Payer: Railroad Medicare Medicare |
$75.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.96
|
| Rate for Payer: UHC Core |
$253.31
|
| Rate for Payer: UHC Exchange |
$75.84
|
| Rate for Payer: UHC Medicaid |
$53.48
|
| Rate for Payer: UHC Medicare Advantage |
$75.84
|
| Rate for Payer: UHCCP Medicaid |
$53.48
|
| Rate for Payer: VA VA |
$75.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.79 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: BCBS Trust/PPO |
$304.72
|
| Rate for Payer: BCN Commercial |
$304.72
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Nomi Health Commercial |
$302.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$320.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.68
|
| Rate for Payer: UHC Core |
$308.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$5,355.15
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$5,100.15 |
| Max. Negotiated Rate |
$5,355.15 |
| Rate for Payer: BCBS Complete |
$5,355.15
|
| Rate for Payer: Mclaren Medicaid |
$5,100.15
|
| Rate for Payer: Meridian Medicaid |
$5,355.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,100.15
|
| Rate for Payer: UHC Medicaid |
$5,100.15
|
| Rate for Payer: UHCCP Medicaid |
$5,100.15
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,276.13
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$4,072.51 |
| Max. Negotiated Rate |
$4,276.13 |
| Rate for Payer: BCBS Complete |
$4,276.13
|
| Rate for Payer: Mclaren Medicaid |
$4,072.51
|
| Rate for Payer: Meridian Medicaid |
$4,276.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,072.51
|
| Rate for Payer: UHC Medicaid |
$4,072.51
|
| Rate for Payer: UHCCP Medicaid |
$4,072.51
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$3,952.21
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$3,764.01 |
| Max. Negotiated Rate |
$3,952.21 |
| Rate for Payer: BCBS Complete |
$3,952.21
|
| Rate for Payer: Mclaren Medicaid |
$3,764.01
|
| Rate for Payer: Meridian Medicaid |
$3,952.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,764.01
|
| Rate for Payer: UHC Medicaid |
$3,764.01
|
| Rate for Payer: UHCCP Medicaid |
$3,764.01
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$10,146.08
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$9,662.94 |
| Max. Negotiated Rate |
$10,146.08 |
| Rate for Payer: BCBS Complete |
$10,146.08
|
| Rate for Payer: Mclaren Medicaid |
$9,662.94
|
| Rate for Payer: Meridian Medicaid |
$10,146.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,662.94
|
| Rate for Payer: UHC Medicaid |
$9,662.94
|
| Rate for Payer: UHCCP Medicaid |
$9,662.94
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$2,797.99
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$2,664.76 |
| Max. Negotiated Rate |
$2,797.99 |
| Rate for Payer: BCBS Complete |
$2,797.99
|
| Rate for Payer: Mclaren Medicaid |
$2,664.76
|
| Rate for Payer: Meridian Medicaid |
$2,797.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,664.76
|
| Rate for Payer: UHC Medicaid |
$2,664.76
|
| Rate for Payer: UHCCP Medicaid |
$2,664.76
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$3,909.62
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$3,723.45 |
| Max. Negotiated Rate |
$3,909.62 |
| Rate for Payer: BCBS Complete |
$3,909.62
|
| Rate for Payer: Mclaren Medicaid |
$3,723.45
|
| Rate for Payer: Meridian Medicaid |
$3,909.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,723.45
|
| Rate for Payer: UHC Medicaid |
$3,723.45
|
| Rate for Payer: UHCCP Medicaid |
$3,723.45
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$2,083.38
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$1,984.17 |
| Max. Negotiated Rate |
$2,083.38 |
| Rate for Payer: BCBS Complete |
$2,083.38
|
| Rate for Payer: Mclaren Medicaid |
$1,984.17
|
| Rate for Payer: Meridian Medicaid |
$2,083.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,984.17
|
| Rate for Payer: UHC Medicaid |
$1,984.17
|
| Rate for Payer: UHCCP Medicaid |
$1,984.17
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$7,737.21
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$7,368.77 |
| Max. Negotiated Rate |
$7,737.21 |
| Rate for Payer: BCBS Complete |
$7,737.21
|
| Rate for Payer: Mclaren Medicaid |
$7,368.77
|
| Rate for Payer: Meridian Medicaid |
$7,737.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,368.77
|
| Rate for Payer: UHC Medicaid |
$7,368.77
|
| Rate for Payer: UHCCP Medicaid |
$7,368.77
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 00121091840
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$8.50
|
|
|
Service Code
|
NDC 68094003701
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: BCBS Trust/PPO |
$7.02
|
| Rate for Payer: BCN Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.48
|
| Rate for Payer: UHC Core |
$7.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 00121091700
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 09900001941
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Nomi Health Commercial |
$1.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.76
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
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 |
$2.74 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$3.15
|
| 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: Lakeland Regional Health Systems Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.47
|
| Rate for Payer: UHC Core |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.96
|
|
|
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 |
$0.48 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.86
|
| Rate for Payer: BCBS Complete |
$0.51
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Mclaren Medicaid |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: Meridian Medicaid |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PACE Senior Care Partners |
$0.65
|
| Rate for Payer: PACE SWMI |
$0.69
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: PHP Medicare Advantage |
$0.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: Railroad Medicare Medicare |
$0.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicaid |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.69
|
| Rate for Payer: UHCCP Medicaid |
$0.48
|
| Rate for Payer: VA VA |
$0.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.46
|
| Rate for Payer: BCN Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.62
|
| Rate for Payer: UHC Core |
$2.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 00121091805
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Mclaren Medicaid |
$0.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: Meridian Medicaid |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.53
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicaid |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.51
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.50
|
|
|
Service Code
|
NDC 68094003758
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$2.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.66
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: BCBS MAPPO |
$2.12
|
| Rate for Payer: BCBS Trust/PPO |
$6.99
|
| Rate for Payer: BCN Commercial |
$6.99
|
| Rate for Payer: BCN Medicare Advantage |
$2.12
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$7.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.38
|
| Rate for Payer: Mclaren Medicaid |
$1.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.23
|
| Rate for Payer: Meridian Medicaid |
$1.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.22
|
| Rate for Payer: Nomi Health Commercial |
$6.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.38
|
| Rate for Payer: PACE Senior Care Partners |
$2.02
|
| Rate for Payer: PACE SWMI |
$2.12
|
| Rate for Payer: PHP Commercial |
$7.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$7.39
|
| Rate for Payer: Priority Health Medicare |
$2.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.48
|
| Rate for Payer: UHC Core |
$7.10
|
| Rate for Payer: UHC Exchange |
$2.12
|
| Rate for Payer: UHC Medicaid |
$1.50
|
| Rate for Payer: UHC Medicare Advantage |
$2.12
|
| Rate for Payer: UHCCP Medicaid |
$1.50
|
| Rate for Payer: VA VA |
$2.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.38
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 00121091840
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.91
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Mclaren Medicaid |
$0.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: Meridian Medicaid |
$0.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.18
|
| Rate for Payer: PACE Senior Care Partners |
$0.69
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.53
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.43
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicaid |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| Rate for Payer: UHCCP Medicaid |
$0.51
|
| Rate for Payer: VA VA |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
