|
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 |
$197.18 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: BCBS Trust/PPO |
$247.63
|
| Rate for Payer: BCN Commercial |
$234.44
|
| 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: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO |
$263.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.25
|
| 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
|
$357.20
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$92.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.62
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: BCBS MAPPO |
$89.30
|
| Rate for Payer: BCBS Trust/PPO |
$293.65
|
| Rate for Payer: BCN Commercial |
$277.72
|
| Rate for Payer: BCN Medicare Advantage |
$89.30
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.30
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PACE Senior Care Partners |
$84.84
|
| Rate for Payer: PACE SWMI |
$89.30
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: PHP Medicare Advantage |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Medicare |
$90.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: Railroad Medicare Medicare |
$89.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.30
|
| Rate for Payer: UHC Exchange |
$89.30
|
| Rate for Payer: UHC Medicare Advantage |
$89.30
|
| Rate for Payer: VA VA |
$89.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.18 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: BCBS Trust/PPO |
$291.58
|
| Rate for Payer: BCN Commercial |
$276.04
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
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 |
$72.05 |
| 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 |
$121.34
|
| Rate for Payer: BCBS MAPPO |
$75.84
|
| Rate for Payer: BCBS Trust/PPO |
$249.39
|
| Rate for Payer: BCN Commercial |
$235.86
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Nomi Health Commercial |
$248.76
|
| 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 Cigna Priority Health |
$197.18
|
| Rate for Payer: Priority Health HMO/PPO |
$263.92
|
| Rate for Payer: Priority Health Medicare |
$76.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.25
|
| 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 Dual Complete DSNP |
$75.84
|
| Rate for Payer: UHC Exchange |
$75.84
|
| Rate for Payer: UHC Medicare Advantage |
$75.84
|
| Rate for Payer: VA VA |
$75.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 58555
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$3,671.97
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,496.88 |
| Max. Negotiated Rate |
$3,671.97 |
| Rate for Payer: BCBS Complete |
$3,671.97
|
| Rate for Payer: Mclaren Medicaid |
$3,496.88
|
| Rate for Payer: Meridian Medicaid |
$3,671.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,496.88
|
| Rate for Payer: UHCCP Medicaid |
$3,496.88
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 58562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
|
Facility
|
OP
|
$3,671.97
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,496.88 |
| Max. Negotiated Rate |
$3,671.97 |
| Rate for Payer: BCBS Complete |
$3,671.97
|
| Rate for Payer: Mclaren Medicaid |
$3,496.88
|
| Rate for Payer: Meridian Medicaid |
$3,671.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,496.88
|
| Rate for Payer: UHCCP Medicaid |
$3,496.88
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$2,365.09
|
|
|
Service Code
|
CPT 58558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,252.32 |
| Max. Negotiated Rate |
$2,365.09 |
| Rate for Payer: BCBS Complete |
$2,365.09
|
| Rate for Payer: Mclaren Medicaid |
$2,252.32
|
| Rate for Payer: Meridian Medicaid |
$2,365.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,252.32
|
| Rate for Payer: UHCCP Medicaid |
$2,252.32
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 00121091400
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.84
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.14
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.53
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 68094060059
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.21
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS MAPPO |
$0.97
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.97
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.97
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: PACE Senior Care Partners |
$0.92
|
| Rate for Payer: PACE SWMI |
$0.97
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.37
|
| Rate for Payer: Priority Health Medicare |
$0.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.59
|
| Rate for Payer: Railroad Medicare Medicare |
$0.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.97
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$0.97
|
| Rate for Payer: VA VA |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.87
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$8.19
|
|
|
Service Code
|
NDC 68094003758
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: Aetna Medicare |
$2.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.56
|
| Rate for Payer: BCBS Complete |
$3.28
|
| Rate for Payer: BCBS MAPPO |
$2.05
|
| Rate for Payer: BCBS Trust/PPO |
$6.73
|
| Rate for Payer: BCN Commercial |
$6.37
|
| Rate for Payer: BCN Medicare Advantage |
$2.05
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$7.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.05
|
| Rate for Payer: Healthscope Commercial |
$7.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.96
|
| Rate for Payer: Nomi Health Commercial |
$6.72
|
| Rate for Payer: PACE Senior Care Partners |
$1.95
|
| Rate for Payer: PACE SWMI |
$2.05
|
| Rate for Payer: PHP Commercial |
$6.96
|
| Rate for Payer: PHP Medicare Advantage |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.32
|
| Rate for Payer: Priority Health HMO/PPO |
$7.13
|
| Rate for Payer: Priority Health Medicare |
$2.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.21
|
| Rate for Payer: UHC Core |
$6.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.05
|
| Rate for Payer: UHC Exchange |
$2.05
|
| Rate for Payer: UHC Medicare Advantage |
$2.05
|
| Rate for Payer: VA VA |
$2.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.14
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| 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: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO |
$2.22
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO |
$3.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.41
|
| Rate for Payer: UHC Core |
$3.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
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 |
$1.89 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: BCBS Trust/PPO |
$2.38
|
| Rate for Payer: BCN Commercial |
$2.25
|
| 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: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO |
$2.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.95
|
| 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
|
$2.55
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCN Commercial |
$1.97
|
| 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 |
$2.30
|
| 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: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.71
|
| 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 |
$0.69 |
| 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 |
$1.16
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.26
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| 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 Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health HMO/PPO |
$2.53
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.95
|
| 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 Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Exchange |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.73
|
| 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
|
$5.81
|
|
|
Service Code
|
NDC 68094050359
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$2.32
|
| Rate for Payer: BCBS MAPPO |
$1.45
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.52
|
| Rate for Payer: BCN Medicare Advantage |
$1.45
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.45
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.45
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: PHP Medicare Advantage |
$1.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.45
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UHC Medicare Advantage |
$1.45
|
| Rate for Payer: VA VA |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 00121091700
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.80
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.98
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| 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: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Nomi Health Commercial |
$2.09
|
| Rate for Payer: PACE Senior Care Partners |
$0.61
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health HMO/PPO |
$2.22
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.71
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.64
|
| Rate for Payer: VA VA |
$0.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 00121091400
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.47
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS MAPPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: BCN Medicare Advantage |
$1.18
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: PACE Senior Care Partners |
$1.12
|
| Rate for Payer: PACE SWMI |
$1.18
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO |
$4.10
|
| Rate for Payer: Priority Health Medicare |
$1.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.14
|
| Rate for Payer: UHC Core |
$3.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.18
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: VA VA |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.53
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 09900001941
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.93
|
| Rate for Payer: BCN Commercial |
$1.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| 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: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: Nomi Health Commercial |
$1.93
|
| Rate for Payer: PACE Senior Care Partners |
$0.56
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2.04
|
| Rate for Payer: Priority Health Medicare |
$0.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.57
|
| Rate for Payer: Railroad Medicare Medicare |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
| Rate for Payer: VA VA |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 00121102200
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.12
|
| 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: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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
|
$8.19
|
|
|
Service Code
|
NDC 68094003758
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$7.37 |
| Rate for Payer: Aetna Commercial |
$6.96
|
| Rate for Payer: BCBS Trust/PPO |
$6.69
|
| Rate for Payer: BCN Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$7.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.55
|
| Rate for Payer: Healthscope Commercial |
$7.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.96
|
| Rate for Payer: Nomi Health Commercial |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.32
|
| Rate for Payer: Priority Health HMO/PPO |
$7.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.21
|
| Rate for Payer: UHC Core |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.14
|
|
