|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.98
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna American Axle |
$1.94
|
| Rate for Payer: Aetna Commercial |
$2.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.94
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Advantage |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.53
|
| Rate for Payer: Priority Health SBD |
$1.88
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 00121182800
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna American Axle |
$2.40
|
| Rate for Payer: Aetna Commercial |
$3.15
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Advantage |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.96
|
| Rate for Payer: Healthscope Commercial |
$3.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health SBD |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.93
|
| Rate for Payer: UHC Exchange |
$1.45
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.77
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.22
|
|
|
Service Code
|
NDC 00121083300
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Aetna American Axle |
$2.09
|
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.09
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Advantage |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$2.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.42
|
| Rate for Payer: PHP Commercial |
$2.74
|
| Rate for Payer: Priority Health SBD |
$2.03
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.42
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$87.51
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$78.76 |
| Rate for Payer: Aetna American Axle |
$56.88
|
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$43.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.88
|
| Rate for Payer: BCBS Complete |
$35.00
|
| Rate for Payer: Cash Price |
$70.01
|
| Rate for Payer: Cofinity Advantage |
$61.26
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.01
|
| Rate for Payer: Healthscope Commercial |
$78.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.63
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health SBD |
$55.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.88
|
| Rate for Payer: UHC Core |
$45.59
|
| Rate for Payer: UHC Exchange |
$34.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.63
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
NDC 904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna American Axle |
$15.34
|
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.34
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.34
|
| Rate for Payer: UHC Core |
$12.30
|
| Rate for Payer: UHC Exchange |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.70
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$1,449.00
|
|
|
Service Code
|
NDC 10135018310
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$536.13 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Aetna American Axle |
$941.85
|
| Rate for Payer: Aetna Commercial |
$1,231.65
|
| Rate for Payer: Aetna Medicare |
$724.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.85
|
| Rate for Payer: BCBS Complete |
$579.60
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Advantage |
$1,014.30
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.20
|
| Rate for Payer: Healthscope Commercial |
$1,304.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,159.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PHP Commercial |
$1,231.65
|
| Rate for Payer: Priority Health SBD |
$912.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.85
|
| Rate for Payer: UHC Core |
$754.93
|
| Rate for Payer: UHC Exchange |
$569.46
|
| Rate for Payer: UMR Bronson Commercial |
$536.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.75
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$1,449.00
|
|
|
Service Code
|
NDC 10135018310
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$637.56 |
| Max. Negotiated Rate |
$1,304.10 |
| Rate for Payer: Aetna American Axle |
$941.85
|
| Rate for Payer: Aetna Commercial |
$1,231.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.85
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Advantage |
$1,014.30
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,159.20
|
| Rate for Payer: Healthscope Commercial |
$1,304.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,014.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,086.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,231.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PHP Commercial |
$1,231.65
|
| Rate for Payer: Priority Health SBD |
$912.87
|
| Rate for Payer: UMR Bronson Commercial |
$637.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,086.75
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna American Axle |
$15.34
|
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Medicare |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.34
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.34
|
| Rate for Payer: UHC Core |
$12.30
|
| Rate for Payer: UHC Exchange |
$9.27
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.70
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
NDC 96295013030
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$118.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.20
|
| Rate for Payer: UHC Core |
$77.11
|
| Rate for Payer: UHC Exchange |
$58.16
|
| Rate for Payer: UMR Bronson Commercial |
$54.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$23.60
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna American Axle |
$15.34
|
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.34
|
| Rate for Payer: Cash Price |
$18.88
|
| Rate for Payer: Cofinity Advantage |
$16.52
|
| Rate for Payer: Cofinity Commercial |
$20.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.88
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.70
|
| Rate for Payer: PHP Commercial |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.87
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.70
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
NDC 57896094101
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.62 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.90
|
| Rate for Payer: UHC Core |
$65.65
|
| Rate for Payer: UHC Exchange |
$49.52
|
| Rate for Payer: UMR Bronson Commercial |
$46.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
NDC 96295013030
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Advantage |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.00
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$81.90
|
|
|
Service Code
|
NDC 00904791251
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna American Axle |
$53.23
|
| Rate for Payer: Aetna Commercial |
$69.61
|
| Rate for Payer: Aetna Medicare |
$40.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.23
|
| Rate for Payer: BCBS Complete |
$32.76
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cofinity Advantage |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.42
|
| Rate for Payer: PHP Commercial |
$69.61
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.23
|
| Rate for Payer: UHC Core |
$42.67
|
| Rate for Payer: UHC Exchange |
$32.19
|
| Rate for Payer: UMR Bronson Commercial |
$30.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.42
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$182.70
|
|
|
Service Code
|
NDC 00904791459
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.39 |
| Max. Negotiated Rate |
$164.43 |
| Rate for Payer: Aetna American Axle |
$118.75
|
| Rate for Payer: Aetna Commercial |
$155.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.75
|
| Rate for Payer: Cash Price |
$146.16
|
| Rate for Payer: Cofinity Advantage |
$127.89
|
| Rate for Payer: Cofinity Commercial |
$157.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.16
|
| Rate for Payer: Healthscope Commercial |
$164.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.03
|
| Rate for Payer: PHP Commercial |
$155.29
|
| Rate for Payer: Priority Health SBD |
$115.10
|
| Rate for Payer: UMR Bronson Commercial |
$80.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.03
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
NDC 57896094101
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Advantage |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$182.70
|
|
|
Service Code
|
NDC 00904791459
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$164.43 |
| Rate for Payer: Aetna American Axle |
$118.75
|
| Rate for Payer: Aetna Commercial |
$155.29
|
| Rate for Payer: Aetna Medicare |
$91.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.75
|
| Rate for Payer: BCBS Complete |
$73.08
|
| Rate for Payer: Cash Price |
$146.16
|
| Rate for Payer: Cofinity Advantage |
$127.89
|
| Rate for Payer: Cofinity Commercial |
$157.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.16
|
| Rate for Payer: Healthscope Commercial |
$164.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$146.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$137.03
|
| Rate for Payer: PHP Commercial |
$155.29
|
| Rate for Payer: Priority Health SBD |
$115.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.75
|
| Rate for Payer: UHC Core |
$95.19
|
| Rate for Payer: UHC Exchange |
$71.80
|
| Rate for Payer: UMR Bronson Commercial |
$67.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.03
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$81.90
|
|
|
Service Code
|
NDC 00904791251
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.04 |
| Max. Negotiated Rate |
$73.71 |
| Rate for Payer: Aetna American Axle |
$53.23
|
| Rate for Payer: Aetna Commercial |
$69.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.23
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cofinity Advantage |
$57.33
|
| Rate for Payer: Cofinity Commercial |
$70.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.52
|
| Rate for Payer: Healthscope Commercial |
$73.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.42
|
| Rate for Payer: PHP Commercial |
$69.61
|
| Rate for Payer: Priority Health SBD |
$51.60
|
| Rate for Payer: UMR Bronson Commercial |
$36.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.42
|
|
|
IBUPROFEN 20 MG/1 ML ORAL SUSP (NICU-ONLY)
|
Facility
|
IP
|
$87.51
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
161540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$78.76 |
| Rate for Payer: Aetna American Axle |
$56.88
|
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.88
|
| Rate for Payer: Cash Price |
$70.01
|
| Rate for Payer: Cofinity Advantage |
$61.26
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.01
|
| Rate for Payer: Healthscope Commercial |
$78.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.63
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health SBD |
$55.13
|
| Rate for Payer: UMR Bronson Commercial |
$38.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.63
|
|
|
IBUPROFEN 20 MG/1 ML ORAL SUSP (NICU-ONLY)
|
Facility
|
OP
|
$87.51
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
161540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$78.76 |
| Rate for Payer: Aetna American Axle |
$56.88
|
| Rate for Payer: Aetna Commercial |
$74.38
|
| Rate for Payer: Aetna Medicare |
$43.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.88
|
| Rate for Payer: BCBS Complete |
$35.00
|
| Rate for Payer: Cash Price |
$70.01
|
| Rate for Payer: Cofinity Advantage |
$61.26
|
| Rate for Payer: Cofinity Commercial |
$75.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.01
|
| Rate for Payer: Healthscope Commercial |
$78.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.63
|
| Rate for Payer: PHP Commercial |
$74.38
|
| Rate for Payer: Priority Health SBD |
$55.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.88
|
| Rate for Payer: UHC Core |
$45.59
|
| Rate for Payer: UHC Exchange |
$34.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.63
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 59651036001
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.18 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Advantage |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084065811
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Advantage |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 904585361
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.65 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna American Axle |
$97.76
|
| Rate for Payer: Aetna Commercial |
$127.84
|
| Rate for Payer: Aetna Medicare |
$75.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.76
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: Cash Price |
$120.32
|
| Rate for Payer: Cofinity Advantage |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.32
|
| Rate for Payer: Healthscope Commercial |
$135.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$105.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.80
|
| Rate for Payer: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.76
|
| Rate for Payer: UHC Core |
$78.36
|
| Rate for Payer: UHC Exchange |
$59.11
|
| Rate for Payer: UMR Bronson Commercial |
$55.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 67877029401
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Advantage |
$80.61
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.36
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.85
|
| Rate for Payer: UHC Core |
$59.99
|
| Rate for Payer: UHC Exchange |
$45.25
|
| Rate for Payer: UMR Bronson Commercial |
$42.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.87 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
| Rate for Payer: UMR Bronson Commercial |
$40.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
NDC 67877031905
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$235.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Advantage |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.50
|
| Rate for Payer: UHC Core |
$244.87
|
| Rate for Payer: UHC Exchange |
$184.71
|
| Rate for Payer: UMR Bronson Commercial |
$173.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
