|
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 |
$1.03 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.00
|
| Rate for Payer: PHP Commercial |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.53
|
| Rate for Payer: Priority Health SBD |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.04
|
|
|
Service Code
|
NDC 68094060062
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$2.83
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.03
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 00121204400
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
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 |
$1.28 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna American Axle |
$1.89
|
| Rate for Payer: Aetna Commercial |
$2.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.33
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.47
|
| Rate for Payer: PHP Commercial |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.89
|
| Rate for Payer: Priority Health SBD |
$1.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$13.98
|
|
|
Service Code
|
NDC 45802013326
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$12.58 |
| Rate for Payer: Aetna American Axle |
$9.09
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Medicare |
$6.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.09
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$9.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.18
|
| Rate for Payer: Healthscope Commercial |
$12.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.88
|
| Rate for Payer: PHP Commercial |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.09
|
| Rate for Payer: Priority Health SBD |
$8.81
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.48
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
NDC 68094050362
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna American Axle |
$3.84
|
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.84
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cofinity Commercial |
$4.14
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.73
|
| Rate for Payer: Healthscope Commercial |
$5.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.02
|
| Rate for Payer: PHP Commercial |
$5.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health SBD |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.43
|
|
|
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 |
$2.09 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna American Axle |
$3.09
|
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.70
|
|
|
Service Code
|
NDC 00121182810
|
| 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 Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.59
|
| 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: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: PHP Commercial |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.40
|
| Rate for Payer: Priority Health SBD |
$2.33
|
| 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
|
$2.55
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.66
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 00121204410
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
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 Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.60
|
| 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: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| 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
|
$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 Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.60
|
| 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: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| 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
|
$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 Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.20
|
| 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: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| 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
|
$66.15
|
|
|
Service Code
|
NDC 00904791251
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$59.53 |
| Rate for Payer: Aetna American Axle |
$43.00
|
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.00
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$46.30
|
| Rate for Payer: Cofinity Commercial |
$56.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.92
|
| Rate for Payer: Healthscope Commercial |
$59.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.23
|
| Rate for Payer: PHP Commercial |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.00
|
| Rate for Payer: Priority Health SBD |
$41.67
|
| Rate for Payer: UMR Bronson Commercial |
$29.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.61
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
NDC 00904791459
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.56 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$54.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
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 Commercial |
$1,014.30
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.30
|
| 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: PHP Commercial |
$1,231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.85
|
| Rate for Payer: Priority Health SBD |
$912.87
|
| 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
|
$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 Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.20
|
| 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: PHP Commercial |
$107.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| 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
|
$124.00
|
|
|
Service Code
|
NDC 00904791459
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna American Axle |
$80.60
|
| Rate for Payer: Aetna Commercial |
$105.40
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.60
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$106.64
|
| Rate for Payer: Cofinity Commercial |
$86.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$111.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.40
|
| Rate for Payer: PHP Commercial |
$105.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health SBD |
$78.12
|
| Rate for Payer: UMR Bronson Commercial |
$45.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.00
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$66.15
|
|
|
Service Code
|
NDC 00904791251
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$59.53 |
| Rate for Payer: Aetna American Axle |
$43.00
|
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Aetna Medicare |
$33.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.00
|
| Rate for Payer: BCBS Complete |
$26.46
|
| Rate for Payer: Cash Price |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$46.30
|
| Rate for Payer: Cofinity Commercial |
$56.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.92
|
| Rate for Payer: Healthscope Commercial |
$59.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.23
|
| Rate for Payer: PHP Commercial |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.00
|
| Rate for Payer: Priority Health SBD |
$41.67
|
| Rate for Payer: UMR Bronson Commercial |
$24.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.61
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
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 Commercial |
$1,014.30
|
| Rate for Payer: Cofinity Commercial |
$1,246.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,014.30
|
| 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: PHP Commercial |
$1,231.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$941.85
|
| 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
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna American Axle |
$13.00
|
| Rate for Payer: Aetna Commercial |
$17.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: PHP Commercial |
$17.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health SBD |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.00
|
|
|
IBUPROFEN 20 MG/1 ML ORAL SUSP (NICU-ONLY)
|
Facility
|
IP
|
$92.76
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
161540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$83.48 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: Cash Price |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$64.93
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.21
|
| Rate for Payer: Healthscope Commercial |
$83.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.85
|
| Rate for Payer: PHP Commercial |
$78.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.29
|
| Rate for Payer: Priority Health SBD |
$58.44
|
| Rate for Payer: UMR Bronson Commercial |
$40.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.57
|
|
|
IBUPROFEN 20 MG/1 ML ORAL SUSP (NICU-ONLY)
|
Facility
|
OP
|
$92.76
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
161540
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$83.48 |
| Rate for Payer: Aetna American Axle |
$60.29
|
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Medicare |
$46.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.29
|
| Rate for Payer: BCBS Complete |
$37.10
|
| Rate for Payer: Cash Price |
$74.21
|
| Rate for Payer: Cofinity Commercial |
$64.93
|
| Rate for Payer: Cofinity Commercial |
$79.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.21
|
| Rate for Payer: Healthscope Commercial |
$83.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.85
|
| Rate for Payer: PHP Commercial |
$78.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.29
|
| Rate for Payer: Priority Health SBD |
$58.44
|
| Rate for Payer: UMR Bronson Commercial |
$34.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.57
|
|
