|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 00121091405
|
| 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
|
$8.19
|
|
|
Service Code
|
NDC 68094003701
|
| 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
|
$3.87
|
|
|
Service Code
|
NDC 68094060059
|
| 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
|
$5.81
|
|
|
Service Code
|
NDC 68094050359
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.74
|
| Rate for Payer: BCN Commercial |
$4.49
|
| 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: Healthscope Commercial |
$5.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: Nomi Health Commercial |
$4.76
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health HMO/PPO |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.11
|
| Rate for Payer: UHC Core |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
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
|
$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
|
$4.71
|
|
|
Service Code
|
NDC 00121091405
|
| 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
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 00121091805
|
| 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
|
$6.20
|
|
|
Service Code
|
NDC 68094050361
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare |
$1.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.94
|
| Rate for Payer: BCBS Complete |
$2.48
|
| Rate for Payer: BCBS MAPPO |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.10
|
| Rate for Payer: BCN Commercial |
$4.82
|
| Rate for Payer: BCN Medicare Advantage |
$1.55
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$5.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.27
|
| Rate for Payer: Nomi Health Commercial |
$5.08
|
| Rate for Payer: PACE Senior Care Partners |
$1.47
|
| Rate for Payer: PACE SWMI |
$1.55
|
| Rate for Payer: PHP Commercial |
$5.27
|
| Rate for Payer: PHP Medicare Advantage |
$1.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.03
|
| Rate for Payer: Priority Health HMO/PPO |
$5.39
|
| Rate for Payer: Priority Health Medicare |
$1.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.46
|
| Rate for Payer: UHC Core |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.55
|
| Rate for Payer: UHC Exchange |
$1.55
|
| Rate for Payer: UHC Medicare Advantage |
$1.55
|
| Rate for Payer: VA VA |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.65
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.16
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS MAPPO |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: BCN Medicare Advantage |
$0.93
|
| 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: Health Alliance Plan Medicare Advantage |
$0.93
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: PACE Senior Care Partners |
$0.88
|
| Rate for Payer: PACE SWMI |
$0.93
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: PHP Medicare Advantage |
$0.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO |
$3.24
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.49
|
| Rate for Payer: Railroad Medicare Medicare |
$0.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.27
|
| Rate for Payer: UHC Core |
$3.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.93
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UHC Medicare Advantage |
$0.93
|
| Rate for Payer: VA VA |
$0.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
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
|
$2.57
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
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 |
$0.65 |
| 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 |
$1.10
|
| Rate for Payer: BCBS MAPPO |
$0.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.13
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| 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 Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO |
$2.38
|
| Rate for Payer: Priority Health Medicare |
$0.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.84
|
| 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 Dual Complete DSNP |
$0.69
|
| Rate for Payer: UHC Exchange |
$0.69
|
| Rate for Payer: UHC Medicare Advantage |
$0.69
|
| 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
|
$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
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 09900001941
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.92
|
| Rate for Payer: BCN Commercial |
$1.82
|
| 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: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.53
|
| Rate for Payer: Priority Health HMO/PPO |
$2.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.57
|
| 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
|
$6.20
|
|
|
Service Code
|
NDC 68094050361
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: BCBS Trust/PPO |
$5.06
|
| Rate for Payer: BCN Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$4.96
|
| Rate for Payer: Cofinity Commercial |
$5.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.96
|
| Rate for Payer: Healthscope Commercial |
$5.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.27
|
| Rate for Payer: Nomi Health Commercial |
$5.08
|
| Rate for Payer: PHP Commercial |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.03
|
| Rate for Payer: Priority Health HMO/PPO |
$5.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.46
|
| Rate for Payer: UHC Core |
$5.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.65
|
|
|
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
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 00121102205
|
| 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
|
$2.91
|
|
|
Service Code
|
NDC 00121091805
|
| 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
|
$4.75
|
|
|
Service Code
|
NDC 00121183605
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.88
|
| Rate for Payer: BCN Commercial |
$3.67
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO |
$4.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.18
|
| Rate for Payer: UHC Core |
$3.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.33
|
| Rate for Payer: BCN Commercial |
$15.46
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO |
$17.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.25
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.44
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: BCN Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: PACE Senior Care Partners |
$4.75
|
| Rate for Payer: PACE SWMI |
$5.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: PHP Medicare Advantage |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO |
$17.40
|
| Rate for Payer: Priority Health Medicare |
$5.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.40
|
| Rate for Payer: Railroad Medicare Medicare |
$5.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.60
|
| Rate for Payer: UHC Core |
$16.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.00
|
| Rate for Payer: UHC Exchange |
$5.00
|
| Rate for Payer: UHC Medicare Advantage |
$5.00
|
| Rate for Payer: VA VA |
$5.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.76 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: BCBS Trust/PPO |
$122.77
|
| Rate for Payer: BCN Commercial |
$116.23
|
| 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: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.77
|
| 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 |
$35.72 |
| 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 |
$60.16
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$123.64
|
| Rate for Payer: BCN Commercial |
$116.94
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Nomi Health Commercial |
$123.33
|
| 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 Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health HMO/PPO |
$130.85
|
| Rate for Payer: Priority Health Medicare |
$37.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.77
|
| 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 Dual Complete DSNP |
$37.60
|
| Rate for Payer: UHC Exchange |
$37.60
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: VA VA |
$37.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.08 |
| 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 |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$144.34
|
| 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 |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| 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 Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| 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 Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
