|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna American Axle |
$71.79
|
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| 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: 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: UMR Bronson Commercial |
$48.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.84
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| 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
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 67877029401
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| 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: 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: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$150.40
|
|
|
Service Code
|
NDC 59651036001
|
| 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
|
IP
|
$470.00
|
|
|
Service Code
|
NDC 67877031905
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| 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: 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: UMR Bronson Commercial |
$206.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$150.40
|
|
|
Service Code
|
NDC 00904585361
|
| 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
|
OP
|
$265.55
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna Medicare |
$132.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: BCBS Complete |
$106.22
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.61
|
| Rate for Payer: UHC Core |
$138.35
|
| Rate for Payer: UHC Exchange |
$104.36
|
| Rate for Payer: UMR Bronson Commercial |
$98.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 68084065811
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: BCBS Complete |
$1.06
|
| 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: MI Amish Medical Board Commercial |
$2.13
|
| 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: UHC All Payor (Choice/PPO) |
$1.73
|
| Rate for Payer: UHC Core |
$1.39
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UMR Bronson Commercial |
$0.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$265.55
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$239.00 |
| Rate for Payer: Aetna American Axle |
$172.61
|
| Rate for Payer: Aetna Commercial |
$225.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.61
|
| Rate for Payer: Cash Price |
$212.44
|
| Rate for Payer: Cofinity Advantage |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.44
|
| Rate for Payer: Healthscope Commercial |
$239.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.16
|
| Rate for Payer: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.41 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Advantage |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UMR Bronson Commercial |
$73.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 59651036101
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$975.25
|
|
|
Service Code
|
NDC 59651036105
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$429.11 |
| Max. Negotiated Rate |
$877.73 |
| Rate for Payer: Aetna American Axle |
$633.91
|
| Rate for Payer: Aetna Commercial |
$828.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.91
|
| Rate for Payer: Cash Price |
$780.20
|
| Rate for Payer: Cofinity Advantage |
$682.67
|
| Rate for Payer: Cofinity Commercial |
$838.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.20
|
| Rate for Payer: Healthscope Commercial |
$877.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$682.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$731.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.44
|
| Rate for Payer: PHP Commercial |
$828.96
|
| Rate for Payer: Priority Health SBD |
$614.41
|
| Rate for Payer: UMR Bronson Commercial |
$429.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$731.44
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 55111068301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.86
|
| Rate for Payer: UHC Core |
$127.33
|
| Rate for Payer: UHC Exchange |
$96.05
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$237.35
|
|
|
Service Code
|
NDC 69367039501
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.82 |
| Max. Negotiated Rate |
$213.62 |
| Rate for Payer: Aetna American Axle |
$154.28
|
| Rate for Payer: Aetna Commercial |
$201.75
|
| Rate for Payer: Aetna Medicare |
$118.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.28
|
| Rate for Payer: BCBS Complete |
$94.94
|
| Rate for Payer: Cash Price |
$189.88
|
| Rate for Payer: Cofinity Advantage |
$166.15
|
| Rate for Payer: Cofinity Commercial |
$204.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.88
|
| Rate for Payer: Healthscope Commercial |
$213.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.01
|
| Rate for Payer: PHP Commercial |
$201.75
|
| Rate for Payer: Priority Health SBD |
$149.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.28
|
| Rate for Payer: UHC Core |
$123.66
|
| Rate for Payer: UHC Exchange |
$93.28
|
| Rate for Payer: UMR Bronson Commercial |
$87.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.01
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 55111068301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$219.96 |
| Rate for Payer: Aetna American Axle |
$158.86
|
| Rate for Payer: Aetna Commercial |
$207.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.86
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Advantage |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$219.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$107.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$166.85
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Aetna American Axle |
$108.45
|
| Rate for Payer: Aetna Commercial |
$141.82
|
| Rate for Payer: Aetna Medicare |
$83.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.45
|
| Rate for Payer: BCBS Complete |
$66.74
|
| Rate for Payer: Cash Price |
$133.48
|
| Rate for Payer: Cofinity Advantage |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$143.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.48
|
| Rate for Payer: Healthscope Commercial |
$150.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$125.14
|
| Rate for Payer: PHP Commercial |
$141.82
|
| Rate for Payer: Priority Health SBD |
$105.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.45
|
| Rate for Payer: UHC Core |
$86.93
|
| Rate for Payer: UHC Exchange |
$65.57
|
| Rate for Payer: UMR Bronson Commercial |
$61.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.14
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 00904585460
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$195.05
|
|
|
Service Code
|
NDC 00904585460
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna Medicare |
$97.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: BCBS Complete |
$78.02
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.78
|
| Rate for Payer: UHC Core |
$101.62
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UMR Bronson Commercial |
$72.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$406.55
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.88 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna American Axle |
$264.26
|
| Rate for Payer: Aetna Commercial |
$345.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.26
|
| Rate for Payer: Cash Price |
$325.24
|
| Rate for Payer: Cofinity Advantage |
$284.58
|
| Rate for Payer: Cofinity Commercial |
$349.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.24
|
| Rate for Payer: Healthscope Commercial |
$365.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.91
|
| Rate for Payer: PHP Commercial |
$345.57
|
| Rate for Payer: Priority Health SBD |
$256.13
|
| Rate for Payer: UMR Bronson Commercial |
$178.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.91
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$634.50
|
|
|
Service Code
|
NDC 67877032005
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.18 |
| Max. Negotiated Rate |
$571.05 |
| Rate for Payer: Aetna American Axle |
$412.43
|
| Rate for Payer: Aetna Commercial |
$539.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.43
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cofinity Advantage |
$444.15
|
| Rate for Payer: Cofinity Commercial |
$545.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.60
|
| Rate for Payer: Healthscope Commercial |
$571.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$444.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$475.88
|
| Rate for Payer: PHP Commercial |
$539.33
|
| Rate for Payer: Priority Health SBD |
$399.74
|
| Rate for Payer: UMR Bronson Commercial |
$279.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.88
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.67
|
| Rate for Payer: UHC Core |
$96.72
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 59651036101
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$237.35
|
|
|
Service Code
|
NDC 69367039501
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.43 |
| Max. Negotiated Rate |
$213.62 |
| Rate for Payer: Aetna American Axle |
$154.28
|
| Rate for Payer: Aetna Commercial |
$201.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.28
|
| Rate for Payer: Cash Price |
$189.88
|
| Rate for Payer: Cofinity Advantage |
$166.15
|
| Rate for Payer: Cofinity Commercial |
$204.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.88
|
| Rate for Payer: Healthscope Commercial |
$213.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$166.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$178.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.01
|
| Rate for Payer: PHP Commercial |
$201.75
|
| Rate for Payer: Priority Health SBD |
$149.53
|
| Rate for Payer: UMR Bronson Commercial |
$104.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$178.01
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna American Axle |
$2.65
|
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.65
|
| Rate for Payer: Cash Price |
$3.26
|
| Rate for Payer: Cofinity Advantage |
$2.85
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.26
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.05
|
| Rate for Payer: PHP Commercial |
$3.46
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.05
|
|
