|
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 |
$59.54 |
| 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 |
$59.54
|
| 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
|
$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
|
$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
|
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
|
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 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
|
|
|
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 Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| 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: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| Rate for Payer: Priority Health SBD |
$167.30
|
| Rate for Payer: UMR Bronson Commercial |
$98.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.16
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
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 Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.28
|
| 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: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$55.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
OP
|
$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 Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| 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 Commercial |
$185.88
|
| Rate for Payer: Cofinity Commercial |
$228.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.88
|
| 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: PHP Commercial |
$225.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.61
|
| 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 400 MG TABLET
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 67877029401
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| 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 |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$42.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
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 Commercial |
$105.28
|
| Rate for Payer: Cofinity Commercial |
$129.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$105.28
|
| 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: PHP Commercial |
$127.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.76
|
| Rate for Payer: Priority Health SBD |
$94.75
|
| Rate for Payer: UMR Bronson Commercial |
$66.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.80
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 68084065811
|
| Hospital Charge Code |
3843
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.39 |
| Rate for Payer: Aetna American Axle |
$1.73
|
| Rate for Payer: Aetna Commercial |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.73
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: PHP Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: Priority Health SBD |
$1.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.00
|
|
|
IBUPROFEN 400 MG TABLET
|
Facility
|
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 Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| 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 |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| 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 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 Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.08
|
| 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: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UMR Bronson Commercial |
$90.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.30
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
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 |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| 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 |
$3.04
|
|
|
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 Commercial |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$210.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$171.08
|
| 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: PHP Commercial |
$207.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.86
|
| 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
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$363.78 |
| Rate for Payer: Aetna American Axle |
$262.73
|
| Rate for Payer: Aetna Commercial |
$343.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.73
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$347.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$282.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$363.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$282.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: PHP Commercial |
$343.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health SBD |
$254.65
|
| Rate for Payer: UMR Bronson Commercial |
$177.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.15
|
|
|
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 |
$167.08 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| 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 Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| 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: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| 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
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.08 |
| 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 Commercial |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| 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: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| 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
|
$164.50
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$148.05 |
| Rate for Payer: Aetna American Axle |
$106.92
|
| Rate for Payer: Aetna Commercial |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.92
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$115.15
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$115.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$148.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: PHP Commercial |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health SBD |
$103.64
|
| Rate for Payer: UMR Bronson Commercial |
$72.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.38
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.05
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna American Axle |
$2.63
|
| Rate for Payer: Aetna Commercial |
$3.44
|
| 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 |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.24
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health SBD |
$2.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
