|
INDOMETHACIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$962.98
|
|
|
Service Code
|
NDC 63323065909
|
| Hospital Charge Code |
10267
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$423.71 |
| Max. Negotiated Rate |
$866.68 |
| Rate for Payer: Aetna American Axle |
$625.94
|
| Rate for Payer: Aetna Commercial |
$818.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$625.94
|
| Rate for Payer: Cash Price |
$770.38
|
| Rate for Payer: Cofinity Commercial |
$674.09
|
| Rate for Payer: Cofinity Commercial |
$828.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.38
|
| Rate for Payer: Healthscope Commercial |
$866.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.53
|
| Rate for Payer: PHP Commercial |
$818.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.94
|
| Rate for Payer: Priority Health SBD |
$606.68
|
| Rate for Payer: UMR Bronson Commercial |
$423.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.24
|
|
|
INDOMETHACIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$7,707.72
|
|
|
Service Code
|
NDC 69344010101
|
| Hospital Charge Code |
3900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,391.40 |
| Max. Negotiated Rate |
$6,936.95 |
| Rate for Payer: Aetna American Axle |
$5,010.02
|
| Rate for Payer: Aetna Commercial |
$6,551.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,010.02
|
| Rate for Payer: Cash Price |
$6,166.18
|
| Rate for Payer: Cofinity Commercial |
$5,395.40
|
| Rate for Payer: Cofinity Commercial |
$6,628.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,395.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,166.18
|
| Rate for Payer: Healthscope Commercial |
$6,936.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,395.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,780.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,551.56
|
| Rate for Payer: PHP Commercial |
$6,551.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,010.02
|
| Rate for Payer: Priority Health SBD |
$4,855.86
|
| Rate for Payer: UMR Bronson Commercial |
$3,391.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,780.79
|
|
|
INDOMETHACIN 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$7,707.72
|
|
|
Service Code
|
NDC 69344010101
|
| Hospital Charge Code |
3900
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,851.86 |
| Max. Negotiated Rate |
$6,936.95 |
| Rate for Payer: Aetna American Axle |
$5,010.02
|
| Rate for Payer: Aetna Commercial |
$6,551.56
|
| Rate for Payer: Aetna Medicare |
$3,853.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,010.02
|
| Rate for Payer: BCBS Complete |
$3,083.09
|
| Rate for Payer: Cash Price |
$6,166.18
|
| Rate for Payer: Cofinity Commercial |
$5,395.40
|
| Rate for Payer: Cofinity Commercial |
$6,628.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,395.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,166.18
|
| Rate for Payer: Healthscope Commercial |
$6,936.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,395.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,780.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,551.56
|
| Rate for Payer: PHP Commercial |
$6,551.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,010.02
|
| Rate for Payer: Priority Health SBD |
$4,855.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,851.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,780.79
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$120.18
|
|
|
Service Code
|
NDC 50268043015
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.47 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: Aetna American Axle |
$78.12
|
| Rate for Payer: Aetna Commercial |
$102.15
|
| Rate for Payer: Aetna Medicare |
$60.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.12
|
| Rate for Payer: BCBS Complete |
$48.07
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$108.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.15
|
| Rate for Payer: PHP Commercial |
$102.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.12
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: UMR Bronson Commercial |
$44.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.14
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 23155001001
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 23155001001
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.64 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$210.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.42
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$155.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 50268043011
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna American Axle |
$1.57
|
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna Medicare |
$1.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.57
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UMR Bronson Commercial |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.81
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$120.18
|
|
|
Service Code
|
NDC 50268043015
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.88 |
| Max. Negotiated Rate |
$108.16 |
| Rate for Payer: Aetna American Axle |
$78.12
|
| Rate for Payer: Aetna Commercial |
$102.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.12
|
| Rate for Payer: Cash Price |
$96.14
|
| Rate for Payer: Cofinity Commercial |
$103.35
|
| Rate for Payer: Cofinity Commercial |
$84.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$108.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.15
|
| Rate for Payer: PHP Commercial |
$102.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.12
|
| Rate for Payer: Priority Health SBD |
$75.71
|
| Rate for Payer: UMR Bronson Commercial |
$52.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.14
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$113.53
|
|
|
Service Code
|
NDC 50268043115
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna American Axle |
$73.79
|
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: Aetna Medicare |
$56.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.79
|
| Rate for Payer: BCBS Complete |
$45.41
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$79.47
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.79
|
| Rate for Payer: Priority Health SBD |
$71.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 50268043111
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$113.53
|
|
|
Service Code
|
NDC 50268043115
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.95 |
| Max. Negotiated Rate |
$102.18 |
| Rate for Payer: Aetna American Axle |
$73.79
|
| Rate for Payer: Aetna Commercial |
$96.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.79
|
| Rate for Payer: Cash Price |
$90.82
|
| Rate for Payer: Cofinity Commercial |
$79.47
|
| Rate for Payer: Cofinity Commercial |
$97.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.82
|
| Rate for Payer: Healthscope Commercial |
$102.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.50
|
| Rate for Payer: PHP Commercial |
$96.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.79
|
| Rate for Payer: Priority Health SBD |
$71.52
|
| Rate for Payer: UMR Bronson Commercial |
$49.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.15
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 68462030201
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$146.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$108.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 68462030201
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$205.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.94
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 50268043111
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
OP
|
$1,186.75
|
|
|
Service Code
|
NDC 68462030205
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$439.10 |
| Max. Negotiated Rate |
$1,068.08 |
| Rate for Payer: Aetna American Axle |
$771.39
|
| Rate for Payer: Aetna Commercial |
$1,008.74
|
| Rate for Payer: Aetna Medicare |
$593.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.39
|
| Rate for Payer: BCBS Complete |
$474.70
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cofinity Commercial |
$1,020.60
|
| Rate for Payer: Cofinity Commercial |
$830.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$830.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.40
|
| Rate for Payer: Healthscope Commercial |
$1,068.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.74
|
| Rate for Payer: PHP Commercial |
$1,008.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$771.39
|
| Rate for Payer: Priority Health SBD |
$747.65
|
| Rate for Payer: UMR Bronson Commercial |
$439.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.06
|
|
|
INDOMETHACIN 50 MG CAPSULE
|
Facility
|
IP
|
$1,186.75
|
|
|
Service Code
|
NDC 68462030205
|
| Hospital Charge Code |
3898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$522.17 |
| Max. Negotiated Rate |
$1,068.08 |
| Rate for Payer: Aetna American Axle |
$771.39
|
| Rate for Payer: Aetna Commercial |
$1,008.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.39
|
| Rate for Payer: Cash Price |
$949.40
|
| Rate for Payer: Cofinity Commercial |
$1,020.60
|
| Rate for Payer: Cofinity Commercial |
$830.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$830.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$949.40
|
| Rate for Payer: Healthscope Commercial |
$1,068.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$830.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$890.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,008.74
|
| Rate for Payer: PHP Commercial |
$1,008.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$771.39
|
| Rate for Payer: Priority Health SBD |
$747.65
|
| Rate for Payer: UMR Bronson Commercial |
$522.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$890.06
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$18,935.61
|
|
|
Service Code
|
NDC 00054195030
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,006.18 |
| Max. Negotiated Rate |
$17,042.05 |
| Rate for Payer: Aetna American Axle |
$12,308.15
|
| Rate for Payer: Aetna Commercial |
$16,095.27
|
| Rate for Payer: Aetna Medicare |
$9,467.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,308.15
|
| Rate for Payer: BCBS Complete |
$7,574.24
|
| Rate for Payer: Cash Price |
$15,148.49
|
| Rate for Payer: Cofinity Commercial |
$13,254.93
|
| Rate for Payer: Cofinity Commercial |
$16,284.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,254.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,148.49
|
| Rate for Payer: Healthscope Commercial |
$17,042.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,254.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,201.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,095.27
|
| Rate for Payer: PHP Commercial |
$16,095.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,308.15
|
| Rate for Payer: Priority Health SBD |
$11,929.43
|
| Rate for Payer: UMR Bronson Commercial |
$7,006.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,201.71
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$21,919.17
|
|
|
Service Code
|
NDC 70710185207
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,644.43 |
| Max. Negotiated Rate |
$19,727.25 |
| Rate for Payer: Aetna American Axle |
$14,247.46
|
| Rate for Payer: Aetna Commercial |
$18,631.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,247.46
|
| Rate for Payer: Cash Price |
$17,535.34
|
| Rate for Payer: Cofinity Commercial |
$15,343.42
|
| Rate for Payer: Cofinity Commercial |
$18,850.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,535.34
|
| Rate for Payer: Healthscope Commercial |
$19,727.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,343.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,631.29
|
| Rate for Payer: PHP Commercial |
$18,631.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,247.46
|
| Rate for Payer: Priority Health SBD |
$13,809.08
|
| Rate for Payer: UMR Bronson Commercial |
$9,644.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,439.38
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$730.64
|
|
|
Service Code
|
NDC 70710185206
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.48 |
| Max. Negotiated Rate |
$657.58 |
| Rate for Payer: Aetna American Axle |
$474.92
|
| Rate for Payer: Aetna Commercial |
$621.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.92
|
| Rate for Payer: Cash Price |
$584.51
|
| Rate for Payer: Cofinity Commercial |
$511.45
|
| Rate for Payer: Cofinity Commercial |
$628.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$511.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.51
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.04
|
| Rate for Payer: PHP Commercial |
$621.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.92
|
| Rate for Payer: Priority Health SBD |
$460.30
|
| Rate for Payer: UMR Bronson Commercial |
$321.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.98
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$18,935.61
|
|
|
Service Code
|
NDC 00054195030
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,331.67 |
| Max. Negotiated Rate |
$17,042.05 |
| Rate for Payer: Aetna American Axle |
$12,308.15
|
| Rate for Payer: Aetna Commercial |
$16,095.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,308.15
|
| Rate for Payer: Cash Price |
$15,148.49
|
| Rate for Payer: Cofinity Commercial |
$13,254.93
|
| Rate for Payer: Cofinity Commercial |
$16,284.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,254.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,148.49
|
| Rate for Payer: Healthscope Commercial |
$17,042.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,254.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,201.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,095.27
|
| Rate for Payer: PHP Commercial |
$16,095.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,308.15
|
| Rate for Payer: Priority Health SBD |
$11,929.43
|
| Rate for Payer: UMR Bronson Commercial |
$8,331.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,201.71
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$22,366.50
|
|
|
Service Code
|
NDC 69344010233
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,275.60 |
| Max. Negotiated Rate |
$20,129.85 |
| Rate for Payer: Aetna American Axle |
$14,538.22
|
| Rate for Payer: Aetna Commercial |
$19,011.52
|
| Rate for Payer: Aetna Medicare |
$11,183.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,538.22
|
| Rate for Payer: BCBS Complete |
$8,946.60
|
| Rate for Payer: Cash Price |
$17,893.20
|
| Rate for Payer: Cofinity Commercial |
$15,656.55
|
| Rate for Payer: Cofinity Commercial |
$19,235.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,656.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,893.20
|
| Rate for Payer: Healthscope Commercial |
$20,129.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,656.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,011.52
|
| Rate for Payer: PHP Commercial |
$19,011.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,538.22
|
| Rate for Payer: Priority Health SBD |
$14,090.90
|
| Rate for Payer: UMR Bronson Commercial |
$8,275.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,774.88
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$21,919.17
|
|
|
Service Code
|
NDC 70710185207
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,110.09 |
| Max. Negotiated Rate |
$19,727.25 |
| Rate for Payer: Aetna American Axle |
$14,247.46
|
| Rate for Payer: Aetna Commercial |
$18,631.29
|
| Rate for Payer: Aetna Medicare |
$10,959.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,247.46
|
| Rate for Payer: BCBS Complete |
$8,767.67
|
| Rate for Payer: Cash Price |
$17,535.34
|
| Rate for Payer: Cofinity Commercial |
$15,343.42
|
| Rate for Payer: Cofinity Commercial |
$18,850.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,343.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,535.34
|
| Rate for Payer: Healthscope Commercial |
$19,727.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,343.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,439.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,631.29
|
| Rate for Payer: PHP Commercial |
$18,631.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,247.46
|
| Rate for Payer: Priority Health SBD |
$13,809.08
|
| Rate for Payer: UMR Bronson Commercial |
$8,110.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,439.38
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$22,366.50
|
|
|
Service Code
|
NDC 69344010233
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9,841.26 |
| Max. Negotiated Rate |
$20,129.85 |
| Rate for Payer: Aetna American Axle |
$14,538.22
|
| Rate for Payer: Aetna Commercial |
$19,011.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,538.22
|
| Rate for Payer: Cash Price |
$17,893.20
|
| Rate for Payer: Cofinity Commercial |
$15,656.55
|
| Rate for Payer: Cofinity Commercial |
$19,235.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,656.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,893.20
|
| Rate for Payer: Healthscope Commercial |
$20,129.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,656.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,774.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,011.52
|
| Rate for Payer: PHP Commercial |
$19,011.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,538.22
|
| Rate for Payer: Priority Health SBD |
$14,090.90
|
| Rate for Payer: UMR Bronson Commercial |
$9,841.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,774.88
|
|
|
INDOMETHACIN 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$730.64
|
|
|
Service Code
|
NDC 70710185206
|
| Hospital Charge Code |
3901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.34 |
| Max. Negotiated Rate |
$657.58 |
| Rate for Payer: Aetna American Axle |
$474.92
|
| Rate for Payer: Aetna Commercial |
$621.04
|
| Rate for Payer: Aetna Medicare |
$365.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.92
|
| Rate for Payer: BCBS Complete |
$292.26
|
| Rate for Payer: Cash Price |
$584.51
|
| Rate for Payer: Cofinity Commercial |
$511.45
|
| Rate for Payer: Cofinity Commercial |
$628.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$511.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$584.51
|
| Rate for Payer: Healthscope Commercial |
$657.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$511.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$547.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.04
|
| Rate for Payer: PHP Commercial |
$621.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.92
|
| Rate for Payer: Priority Health SBD |
$460.30
|
| Rate for Payer: UMR Bronson Commercial |
$270.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$547.98
|
|
