|
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD)
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 58559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.96 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,798.22
|
| Rate for Payer: BCN Commercial |
$2,798.22
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.56
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$275.96
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 58562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.26 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,701.44
|
| Rate for Payer: BCN Commercial |
$2,701.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.79
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$215.26
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.11 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,298.17
|
| Rate for Payer: BCN Commercial |
$4,298.17
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.92
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$348.11
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 58558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$224.67 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,228.30
|
| Rate for Payer: BCN Commercial |
$3,228.30
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.14
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$224.67
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$429.20
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
70544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$188.85 |
| Max. Negotiated Rate |
$386.28 |
| Rate for Payer: Aetna American Axle |
$278.98
|
| Rate for Payer: Aetna Commercial |
$364.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.98
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$300.44
|
| Rate for Payer: Cofinity Commercial |
$369.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.36
|
| Rate for Payer: Healthscope Commercial |
$386.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.82
|
| Rate for Payer: PHP Commercial |
$364.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.98
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: UMR Bronson Commercial |
$188.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.90
|
|
|
IBANDRONATE 3 MG/3 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$429.20
|
|
|
Service Code
|
HCPCS J1740
|
| Hospital Charge Code |
70544
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$386.28 |
| Rate for Payer: Aetna American Axle |
$278.98
|
| Rate for Payer: Aetna American Axle |
$166.54
|
| Rate for Payer: Aetna Commercial |
$217.78
|
| Rate for Payer: Aetna Commercial |
$364.82
|
| Rate for Payer: Aetna Medicare |
$214.60
|
| Rate for Payer: Aetna Medicare |
$128.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.98
|
| Rate for Payer: BCBS Complete |
$171.68
|
| Rate for Payer: BCBS Complete |
$102.48
|
| Rate for Payer: BCBS Trust/PPO |
$73.15
|
| Rate for Payer: BCBS Trust/PPO |
$73.15
|
| Rate for Payer: BCN Commercial |
$73.15
|
| Rate for Payer: BCN Commercial |
$73.15
|
| Rate for Payer: Cash Price |
$204.97
|
| Rate for Payer: Cash Price |
$204.97
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cash Price |
$343.36
|
| Rate for Payer: Cofinity Commercial |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$220.34
|
| Rate for Payer: Cofinity Commercial |
$369.11
|
| Rate for Payer: Cofinity Commercial |
$300.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.97
|
| Rate for Payer: Healthscope Commercial |
$230.59
|
| Rate for Payer: Healthscope Commercial |
$386.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.78
|
| Rate for Payer: PHP Commercial |
$364.82
|
| Rate for Payer: PHP Commercial |
$217.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.98
|
| Rate for Payer: Priority Health SBD |
$270.40
|
| Rate for Payer: Priority Health SBD |
$161.41
|
| Rate for Payer: UMR Bronson Commercial |
$94.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.90
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.04
|
|
|
Service Code
|
NDC 68094060062
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: BCBS Complete |
$1.62
|
| 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 |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.03
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 00121102205
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Aetna American Axle |
$1.78
|
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.78
|
| Rate for Payer: Cash Price |
$2.19
|
| Rate for Payer: Cofinity Commercial |
$1.92
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$2.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: PHP Commercial |
$2.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.06
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.57
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna American Axle |
$1.67
|
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.67
|
| Rate for Payer: BCBS Complete |
$1.03
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.62
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna American Axle |
$2.42
|
| Rate for Payer: Aetna Commercial |
$3.16
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.42
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health SBD |
$2.34
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.79
|
|
|
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 |
$3.14
|
| 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 |
$2.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: PHP Commercial |
$3.14
|
| 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 |
$2.78
|
|
|
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 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.91
|
|
|
Service Code
|
NDC 00121091840
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| 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
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 66689033950
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 09900001941
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.00
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.64
|
| 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 |
$1.64
|
| 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 |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.76
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 00121091700
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| 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 |
$2.30
|
| 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
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
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
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 09900001942
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna American Axle |
$3.06
|
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health SBD |
$2.96
|
| Rate for Payer: UMR Bronson Commercial |
$2.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.52
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$20.43
|
|
|
Service Code
|
NDC 00904530909
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$18.39 |
| Rate for Payer: Aetna American Axle |
$13.28
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.28
|
| Rate for Payer: BCBS Complete |
$8.17
|
| Rate for Payer: Cash Price |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$14.30
|
| Rate for Payer: Cofinity Commercial |
$17.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$18.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.28
|
| Rate for Payer: Priority Health SBD |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.32
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$5.81
|
|
|
Service Code
|
NDC 68094050359
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$5.23 |
| Rate for Payer: Aetna American Axle |
$3.78
|
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.78
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$5.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.94
|
| Rate for Payer: PHP Commercial |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.78
|
| Rate for Payer: Priority Health SBD |
$3.66
|
| Rate for Payer: UMR Bronson Commercial |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.36
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$89.26
|
|
|
Service Code
|
NDC 51672138509
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.03 |
| Max. Negotiated Rate |
$80.33 |
| Rate for Payer: Aetna American Axle |
$58.02
|
| Rate for Payer: Aetna Commercial |
$75.87
|
| Rate for Payer: Aetna Medicare |
$44.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.02
|
| Rate for Payer: BCBS Complete |
$35.70
|
| Rate for Payer: Cash Price |
$71.41
|
| Rate for Payer: Cofinity Commercial |
$62.48
|
| Rate for Payer: Cofinity Commercial |
$76.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.41
|
| Rate for Payer: Healthscope Commercial |
$80.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.87
|
| Rate for Payer: PHP Commercial |
$75.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.02
|
| Rate for Payer: Priority Health SBD |
$56.23
|
| Rate for Payer: UMR Bronson Commercial |
$33.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.94
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 66689033901
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: Aetna American Axle |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.00
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: PHP Commercial |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health SBD |
$2.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.46
|
|
|
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
|
OP
|
$92.76
|
|
|
Service Code
|
NDC 45802095243
|
| Hospital Charge Code |
10246
|
|
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
|
|
