|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$6.34
|
|
|
Service Code
|
NDC 68094050361
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$5.71 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$5.07
|
| Rate for Payer: Cofinity Commercial |
$5.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.07
|
| Rate for Payer: Healthscope Commercial |
$5.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.39
|
| Rate for Payer: Nomi Health Commercial |
$5.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.75
|
| Rate for Payer: PHP Commercial |
$5.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.58
|
| Rate for Payer: UHC Core |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.75
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68094060059
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.07
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Mclaren Medicaid |
$0.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.02
|
| Rate for Payer: PACE SWMI |
$1.07
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.74
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.59
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Medicaid |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$1.07
|
| Rate for Payer: UHCCP Medicaid |
$0.76
|
| Rate for Payer: VA VA |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.30
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.07
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Mclaren Medicaid |
$0.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PACE Senior Care Partners |
$1.02
|
| Rate for Payer: PACE SWMI |
$1.07
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.74
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: Railroad Medicare Medicare |
$1.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.59
|
| Rate for Payer: UHC Exchange |
$1.07
|
| Rate for Payer: UHC Medicaid |
$0.76
|
| Rate for Payer: UHC Medicare Advantage |
$1.07
|
| Rate for Payer: UHCCP Medicaid |
$0.76
|
| Rate for Payer: VA VA |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
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 |
$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
|
$2.74
|
|
|
Service Code
|
NDC 00121102205
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.26
|
| 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: Healthscope Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| 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: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.41
|
| Rate for Payer: UHC Core |
$2.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.30
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.55
|
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.44
|
| Rate for Payer: Healthscope Commercial |
$3.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$3.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.23
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.78
|
| Rate for Payer: UHC Core |
$3.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.23
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Medicare |
$6.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.38
|
| Rate for Payer: BCBS Complete |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$5.90
|
| Rate for Payer: BCBS Trust/PPO |
$19.40
|
| Rate for Payer: BCN Commercial |
$19.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.90
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.90
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.70
|
| Rate for Payer: Mclaren Medicaid |
$4.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.20
|
| Rate for Payer: Meridian Medicaid |
$4.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Nomi Health Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PACE Senior Care Partners |
$5.61
|
| Rate for Payer: PACE SWMI |
$5.90
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.53
|
| Rate for Payer: Priority Health Medicare |
$5.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.43
|
| Rate for Payer: Railroad Medicare Medicare |
$5.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.77
|
| Rate for Payer: UHC Core |
$19.71
|
| Rate for Payer: UHC Exchange |
$5.90
|
| Rate for Payer: UHC Medicaid |
$4.16
|
| Rate for Payer: UHC Medicare Advantage |
$5.90
|
| Rate for Payer: UHCCP Medicaid |
$4.16
|
| Rate for Payer: VA VA |
$5.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.70
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.49
|
| Rate for Payer: BCN Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$18.88
|
| 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: Lakeland Regional Health Systems Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Nomi Health Commercial |
$19.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.77
|
| Rate for Payer: UHC Core |
$19.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.70
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.68 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: BCBS Trust/PPO |
$124.22
|
| Rate for Payer: BCN Commercial |
$124.22
|
| Rate for Payer: Cash Price |
$120.32
|
| 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: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.35
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.00
|
| Rate for Payer: BCBS Complete |
$27.84
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$123.64
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Mclaren Medicaid |
$26.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Meridian Medicaid |
$27.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PACE Senior Care Partners |
$35.72
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Medicare |
$37.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.68
|
| Rate for Payer: Railroad Medicare Medicare |
$37.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.35
|
| Rate for Payer: UHC Core |
$125.58
|
| Rate for Payer: UHC Exchange |
$37.60
|
| Rate for Payer: UHC Medicaid |
$26.52
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: UHCCP Medicaid |
$26.52
|
| Rate for Payer: VA VA |
$37.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$2.75
|
|
|
Service Code
|
NDC 60687044611
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: BCBS Trust/PPO |
$2.27
|
| Rate for Payer: BCN Commercial |
$2.27
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.06
|
| Rate for Payer: PHP Commercial |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$274.95
|
|
|
Service Code
|
NDC 60687044601
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: Aetna Medicare |
$71.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.92
|
| Rate for Payer: BCBS Complete |
$50.89
|
| Rate for Payer: BCBS MAPPO |
$68.74
|
| Rate for Payer: BCBS Trust/PPO |
$226.04
|
| Rate for Payer: BCN Commercial |
$226.04
|
| Rate for Payer: BCN Medicare Advantage |
$68.74
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.74
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Mclaren Medicaid |
$48.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.17
|
| Rate for Payer: Meridian Medicaid |
$50.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PACE Senior Care Partners |
$65.30
|
| Rate for Payer: PACE SWMI |
$68.74
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: PHP Medicare Advantage |
$68.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Medicare |
$69.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.37
|
| Rate for Payer: Railroad Medicare Medicare |
$68.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: UHC Exchange |
$68.74
|
| Rate for Payer: UHC Medicaid |
$48.47
|
| Rate for Payer: UHC Medicare Advantage |
$68.74
|
| Rate for Payer: UHCCP Medicaid |
$48.47
|
| Rate for Payer: VA VA |
$68.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$274.95
|
|
|
Service Code
|
NDC 60687044601
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.37 |
| Max. Negotiated Rate |
$247.46 |
| Rate for Payer: Aetna Commercial |
$233.71
|
| Rate for Payer: BCBS Trust/PPO |
$227.08
|
| Rate for Payer: BCN Commercial |
$227.08
|
| Rate for Payer: Cash Price |
$219.96
|
| Rate for Payer: Cofinity Commercial |
$236.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.96
|
| Rate for Payer: Healthscope Commercial |
$247.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.71
|
| Rate for Payer: Nomi Health Commercial |
$225.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.21
|
| Rate for Payer: PHP Commercial |
$233.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$239.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.96
|
| Rate for Payer: UHC Core |
$229.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.21
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$2.75
|
|
|
Service Code
|
NDC 60687044611
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.34
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| 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 |
$2.26
|
| Rate for Payer: BCN Commercial |
$2.26
|
| Rate for Payer: BCN Medicare Advantage |
$0.69
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| 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 |
$0.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| 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 |
$2.34
|
| 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 |
$2.39
|
| 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) |
$2.42
|
| Rate for Payer: UHC Core |
$2.30
|
| 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 600 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.96 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: BCBS Trust/PPO |
$335.77
|
| Rate for Payer: BCN Commercial |
$335.77
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Nomi Health Commercial |
$333.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.76
|
| Rate for Payer: UHC Core |
$339.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$406.55
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.67 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna Medicare |
$105.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.05
|
| Rate for Payer: BCBS Complete |
$75.25
|
| Rate for Payer: BCBS MAPPO |
$101.64
|
| Rate for Payer: BCBS Trust/PPO |
$334.22
|
| Rate for Payer: BCN Commercial |
$334.22
|
| Rate for Payer: BCN Medicare Advantage |
$101.64
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.64
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Mclaren Medicaid |
$71.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.72
|
| Rate for Payer: Meridian Medicaid |
$75.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Nomi Health Commercial |
$333.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PACE Senior Care Partners |
$96.56
|
| Rate for Payer: PACE SWMI |
$101.64
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$353.70
|
| Rate for Payer: Priority Health Medicare |
$102.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$282.96
|
| Rate for Payer: Railroad Medicare Medicare |
$101.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.76
|
| Rate for Payer: UHC Core |
$339.47
|
| Rate for Payer: UHC Exchange |
$101.64
|
| Rate for Payer: UHC Medicaid |
$71.67
|
| Rate for Payer: UHC Medicare Advantage |
$101.64
|
| Rate for Payer: UHCCP Medicaid |
$71.67
|
| Rate for Payer: VA VA |
$101.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.42 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$43.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.14
|
| Rate for Payer: BCBS Complete |
$30.88
|
| Rate for Payer: BCBS MAPPO |
$41.71
|
| Rate for Payer: BCBS Trust/PPO |
$137.17
|
| Rate for Payer: BCN Commercial |
$137.17
|
| Rate for Payer: BCN Medicare Advantage |
$41.71
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.71
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Mclaren Medicaid |
$29.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.80
|
| Rate for Payer: Meridian Medicaid |
$30.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PACE Senior Care Partners |
$39.63
|
| Rate for Payer: PACE SWMI |
$41.71
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: PHP Medicare Advantage |
$41.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.16
|
| Rate for Payer: Priority Health Medicare |
$42.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.13
|
| Rate for Payer: Railroad Medicare Medicare |
$41.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.83
|
| Rate for Payer: UHC Core |
$139.32
|
| Rate for Payer: UHC Exchange |
$41.71
|
| Rate for Payer: UHC Medicaid |
$29.42
|
| Rate for Payer: UHC Medicare Advantage |
$41.71
|
| Rate for Payer: UHCCP Medicaid |
$29.42
|
| Rate for Payer: VA VA |
$41.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.75
|
| Rate for Payer: BCBS MAPPO |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.35
|
| Rate for Payer: BCN Commercial |
$3.35
|
| Rate for Payer: BCN Medicare Advantage |
$1.02
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.02
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Mclaren Medicaid |
$0.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.07
|
| Rate for Payer: Meridian Medicaid |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.97
|
| Rate for Payer: PACE SWMI |
$1.02
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: PHP Medicare Advantage |
$1.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.54
|
| Rate for Payer: Priority Health Medicare |
$1.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.40
|
| Rate for Payer: UHC Exchange |
$1.02
|
| Rate for Payer: UHC Medicaid |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$1.02
|
| Rate for Payer: UHCCP Medicaid |
$0.72
|
| Rate for Payer: VA VA |
$1.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 55111068301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.10 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: BCBS Trust/PPO |
$201.85
|
| Rate for Payer: BCN Commercial |
$201.85
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: BCBS Trust/PPO |
$137.80
|
| Rate for Payer: BCN Commercial |
$137.80
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Nomi Health Commercial |
$136.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$145.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.83
|
| Rate for Payer: UHC Core |
$139.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$3.36
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Nomi Health Commercial |
$3.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.58
|
| Rate for Payer: UHC Core |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 55111068301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$63.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.38
|
| Rate for Payer: BCBS Complete |
$45.24
|
| Rate for Payer: BCBS MAPPO |
$61.10
|
| Rate for Payer: BCBS Trust/PPO |
$200.92
|
| Rate for Payer: BCN Commercial |
$200.92
|
| Rate for Payer: BCN Medicare Advantage |
$61.10
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.10
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Mclaren Medicaid |
$43.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.16
|
| Rate for Payer: Meridian Medicaid |
$45.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$67.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PACE Senior Care Partners |
$58.05
|
| Rate for Payer: PACE SWMI |
$61.10
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: PHP Medicare Advantage |
$61.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.63
|
| Rate for Payer: Priority Health Medicare |
$61.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.10
|
| Rate for Payer: Railroad Medicare Medicare |
$61.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.07
|
| Rate for Payer: UHC Core |
$204.07
|
| Rate for Payer: UHC Exchange |
$61.10
|
| Rate for Payer: UHC Medicaid |
$43.09
|
| Rate for Payer: UHC Medicare Advantage |
$61.10
|
| Rate for Payer: UHCCP Medicaid |
$43.09
|
| Rate for Payer: VA VA |
$61.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$152.62
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.33
|
| Rate for Payer: BCN Commercial |
$153.33
|
| Rate for Payer: Cash Price |
$148.52
|
| 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: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$18.80
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$16.92 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$15.53
|
| Rate for Payer: BCN Commercial |
$15.53
|
| Rate for Payer: Cash Price |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.04
|
| Rate for Payer: Healthscope Commercial |
$16.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.98
|
| Rate for Payer: Nomi Health Commercial |
$15.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.10
|
| Rate for Payer: PHP Commercial |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC Core |
$15.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.10
|
|
